Screw and rod system fixation combined with debridement treats tuberculosis of the thoracic, lumbar and sacral spine in the elderly

doi:10.3969/j.issn.2095-4344.2013.13.025

Abstract

Abstract:

BACKGROUND: Screw and rod system is a priority choice fixation material for the reconstruction and spine stabilization of elderly spinal tuberculosis patients. There are controversies on the debridment, internal fixation, interbody fusion and the selection of anterior approach operation for the treatment of tuberculosis of thoracic, lumbar and sacral spine in elderly patients.
OBJECTIVE: To observe the effect of screw and rod system fixation combined with debridement in treating tuberculosis of thoracic, lumbar and sacral spine in elderly patients, and to compare the difference of treatment effect of anterior and posterior surgery.
METHODS: Forty-seven elderly patients with tuberculosis of thoracic, lumbar and sacral spine were selected, and divided into two groups according to the surgery program. There were 27 patients in posterior operation group, and the patients in the posterior group were treated with debridment, bone graft fusion and screw and rod system internal fixation. There were 20 patients in anterior operation group, and the patients were treated with debridment, bone graft fusion and posterior screw and rod system internal fixation. Frankel neurological grade was used to evaluate spinal cord injury and recovery situations before and after treatment. The clinical efficacy was evaluated with X-ray films before and after treatment, and the changes of erythrocyte sedimentation rate and Cobb angle were observed before and after treatment.
RESULTS AND CONCLUSION: All the 47 patients were followed-up for 10-36 months, and all the patients were cured. No severe complications occurred during and after operation. Spinal fusion occurred in all the patients at 10-18 months after operation. Frankel neurological grades were improved significantly. There were no significant differences of the improvement of Frankel neurological grades, Cobb angle and erythrocyte sedimentation rate between two groups (P > 0.05). Both of anterior and posterior screw and rod system fixation combined with debridement for the treatment of tuberculosis of thoracic, lumbar and sacral spine in elderly patients can obtain the satisfactory effect, reconstruct the spinal stability and restore normal spine sequence. Reasonable surgical approach should be chosen based on the type of spinal tuberculosis, the extent of the damage and surgery caused spine stability changes.

Key words: bone and joint implants, clinical practice, tuberculosis, spinal, screw and rod system, internal fixation, debridement, bone graft fusion, elderly, lumbar, thoracic, sacral, other grants-supported paper

CLC Number:

R318

Deng Qiang, Guo Hai-long, Sheng Wei-bin, Li Shi-hao, Sheng Jun, Mai Er-dan, Pu La-ti, Zhang Jian. Screw and rod system fixation combined with debridement treats tuberculosis of the thoracic, lumbar and sacral spine in the elderly[J]. Chinese Journal of Tissue Engineering Research, 2013, 17(13): 2463-2470.

Figures/Tables 4

References

1] Pappou IP, Papadopoulos EC, Swanson AN, et al. Pott disease in the thoracolumbar spine with marked kyphosis and progressive paraplegia necessitating posterior vertebral column resection and anterior reconstruction with a cage. Spine. 2006;31:123-127.

[2] Maeda Y, Izawa K, Nabeshima T, et al. Tuberculous spondylitis in elderly Japanese patients. J Orthop Sci.2008;13:16-20.

[3] Park DW, Sohn JW, Kim EH, et al.Outcome and management of spinal tuberculosis according to the severity of disease: a retrospective study of 137 adult patients at Korean teaching hospitals. Spine. 2007;32:E130-135.

[4] Bezer M, Kucukdurmaz F, Aydin N, et al. Tuberculous spondylitis of the lumbosacral region: long-term follow-up of patients treated by chemotherapy, transpedicular drainage, posterior instrumentation, and fusion. J Spinal Disord Tech. 2005;18:425-429.

[5] Lee SH, Sung JK, Park YM. Single-stage transpedicular decompression and posterior instrumentation in treatment of thoracic and thoracolumbar spinal. J Spinal Disord Tech. 2006;19(8):595-602.

[6] Moon MS, Kim SS, Lee BJ, et al. Surgical management of severe rigid tuberculous kyphosis of dorsolumbar spine. Int Orthop. 2011;35(1):75-81.

[7] Jain AK. Simultaneous anterior decompression and posterior instrumentation of the tuberculous spine using an anterolateral extrapleural approach. J Bone Joint Surg [Br]. 2008; 90-B: 1477-1481.

[8] Rajasekaran S. Buckling collapse of the spine in childhood spinal tuberculosis. Clin Orthop Relat Res. 2007;460:86-92.

[9] Christodoulou AG, Givissis P, Karataglis D, et al. Treatment of tuberculous spondylitis with anterior stabilization and titanium cage. Clin Orthop Relat Res. 2006;444:60-65.

[10] Sharif HS, Morgan JL, Shahed MS, et al. Role of CT and MR imaging in the management of tuberculous spondylitis.Radiol Clin North Am. 1995;33:787-804.

[11] Kim DJ, Yun YH, Moon SH, et al. Posterior instrumentation using compressive laminar hooks and anterior interbody arthrodesis for the treatment of tuberculosis of the lower lumber spine. Spine.2004;29:E275-279.

[12] Ye M, Li JQ, Zou Y, et al. One stage anterior and posterior fusion and posterior fixation for the treatment of thoracic and lumbar spinal tuberculosis. Zhongguo Gu Shang. 2009; 22(1): 23-25.

[13] Jain AK. Tuberculosis of the spine: a fresh look at an old disease. J Bone Joint Surg Br.2010;92:905-913.

[14] Arora S, Sabat D, Maini L,et al. The results of nonoperative treatment of craniovertebral junction tuberculosis: a review of twenty-six cases. J Bone Joint Surg Am. 2011;93(6):540-547.

[15] Erturer E, Tezer M, Aydogan M, et al. The results of simultaneous posterior-anterior-posterior surgery in multilevel tuberculosis spondylitis associated with severe kyphosis. Eur Spine J. 2010;19(12):2209-2215.

[16] Huang QS, Zheng C, Hu Y, et al. One-stage surgical management for children with spinal tuberculosis by anterior decompression and posterior instrumentation. Int Orthop. 2009;33(5):1385-1390.

[17] Rajasekaran S, Vijay K, Shetty AP. Single-stage closingopening wedge osteotomy of spine to correct severe posttubercular kyphotic deformities of the spine: a 3-year follow-up of 17 patients. Eur Spine J. 2010;19(4):583-592.

[18] Ito Z, Matsuyama Y, Sakai Y, et al. Bone Union Rate With Autologous Iliac Bone Versus Local Bone Graft in Posterior Lumbar Interbody Fusion.Spine. 2010;35(21):1101-1105.

[19] Karaeminogullari O, Aydinli U, Ozerdemoglu R, et al. Tuberculosis of the lumbar spine: outcomes after combined treatment of two-drug therapy and surgery. Orthopedics. 2007; 30:55-59.

[20] Mihir B, Vinod L, Umesh M, et al. Anterior Instrumentation of the Cervicothoracic Vertebrae. Approach Based on Clinical and Radiologic Criteria. Spine. 2006;31:E244-249.

[21] Ma YZ, Cui X, Li HW, et al. Outcomes of anterior and posterior instrumentation under different surgical procedures for treating thoracic and lumbar spinal tuberculosis in adults. Int Orthop. 2012;36(2):299-305.

[22] Issack PS, Boachie-Adjei O. Surgical correction of kyphotic deformity in spinal tuberculosis. Int Orthop. 2012;36(2):353- 357.

[23] Cormican L, Hammal R, Messenger J, et al. Current difficulties in the diagnosis and management of spinal tuberculosis. Postgrad Med J. 2006;82(963):46-51.

[24] Godlwana L, Gounden P, Ngubo P, et al. Incidence and profile of spinal tuberculosis in patients at the only public hospital admitting such patients in KwaZulu-Natal. Spinal Cord. 2008; 46(5):372-374.

[25] Talu U, Gogus A, Ozturk C, et al. The role of posterior instrumentation and fusion after anterior radical debridement and fusion in the surgical treatment of spinal tuberculosis: experience of 127 cases. J Spinal Disord Tech. 2006;19(8): 554-559.

[26] Jain AK, Jain S. Instrumented stabilization in spinal tuberculosis. Int Orthop. 2012;36(2):285-292.

[27] He Q, Xu J. Comparison between the antero-posterior and anterior approaches for treating L5-S1 vertebral tuberculosis. Int Orthop. 2012;36(2):345-351.

[28] Sheng WB, Hua Q, Cao L, et al. Zhonghua Waike Zazhi. 2005; 43(2):205-209. 盛伟斌,华强,曹力,等.一期后路病灶清除、楔形截骨矫形治疗胸腰椎结核并后凸或侧后凸畸形[J].中华外科杂志,2005,43(2): 205-209.

[29] Pawar UM, Kundnani V, Agashe V, et al. Multidrug-resistant tuberculosis of the spine-is it the beginning of the end? A study of twenty-five culture proven multidrug-resistant tuberculosis spine patients. Spine. 2009;34:E806-810.

[30] Liu P, Zhu Q, Jiang J. Distribution of three antituberculous drugs and their metabolites in different parts of pathological vertebrae with spinal tuberculosis. Spine (Phila Pa 1976). 2011;36:E1290-1295.

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