Posterior pedicle screws with iliac bone grafts to repair multi-segmental lumbosacral tuberculosis: to reconstruct lumbosacral stability

doi:10.3969/j.issn.2095-4344.2015.09.011

Abstract

Abstract:

BACKGROUND: The treatment of lumbosacral tuberculosis with multi-segmental vertebral destruction is complex. Besides, debridement and relief of spinal cord compression, it is necessary to restore spine vertebral body height and stability of the spine.
OBJECTIVE: To investigate the surgical treatment effect of multi-segmental lumbosacral tuberculosis by posterior vertebral pedicle fixation and anterior debridement with autologous iliac bone graft.
METHODS: A total of 25 cases of L₂-S₂ vertebral tuberculosis with various degrees of damage, who were treated from March 2005 to December 2012, were selected in this study. After regular anti-tuberculosis treatment for 2-4 weeks, first-phase posterior pedicle screw fixation with anterior debridement and autologous iliac bone graft was performed. Postoperative X-ray and CT scan were conducted to assess bone fusion and deformity correction. Adverse events and material host reaction were recorded.
RESULTS AND CONCLUSION: After repair, average 16-month follow-up was performed. 23 cases of postoperative wound were totally healed, with 2 cases of incisions delaying healing, no sinus formation. After surgery, the lumbago and leg pain disappeared in all patients. During follow-up, graft displacement had no slippage, broken nails or broken rods. Within 6 months, bony fusion occurred. At 1 year after operation, there was no recurrence of tuberculosis with normal erythrocyte sedimentation. X-ray films showed lesion vertebra turned out to be bony union. Postoperative lumbosacral angle was 16°-36°, averagely 26°, and 15°-30° during final follow-up, averagely 20°. These results confirmed that one-stage debridement for multi-segmental lumbosacral tuberculosis and concomitant posterior pedicle fixation system for kyphosis correction therapy, which could reconstruct lumbosacral stability, and restore sagittal plane balance. Autologous iliac bone graft improved fusion rate and obtained satisfactory outcomes.

中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程

全文链接：

Key words: tuberculosis, spinal, bone transplantation, orthopedic fixation devices, blood sedimentation

CLC Number:

R318

Yu Ming, Qiu Nan-hai . Posterior pedicle screws with iliac bone grafts to repair multi-segmental lumbosacral tuberculosis: to reconstruct lumbosacral stability [J]. Chinese Journal of Tissue Engineering Research, 2015, 19(9): 1377-1381.

Figures/Tables 1

References

[1] 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.
[2] 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 lumbar spine.Spine (Phila Pa 1976). 2004;29(13):E275-279.
[3] Mouhsine E, Wettstein M, Schizas C, et al.Modified triangular posterior osteosynthesis of unstable sacrum fracture.Eur Spine J. 2006;15(6):857-863.
[4] Sagi HC. Technical aspects and recommended treatment algorithms in triangular osteosynthesis and spinopelvic fixation for vertical shear transforaminal sacral fractures. J Orthop Trauma. 2009; 23(5):354-360.
[5] 张伟,郭兴峰,张竞,等.应用椎弓根系统经腰-髂间固定治疗骶骨骨折[J].中国修复重建外科杂志,2010,5(24):521-524.
[6] Crocker M, James G, Ibrahim A, et al.Posterior approach vertebrectomy in the thoracolumbar spine with expandable cage reconstruction: indications and techniques based on eight cases.Br J Neurosurg. 2008;22(2):235-240.
[7] Moghtaderi A, Alavi-Naini R, Rahimi-Movaghar V.Tuberculous myelopathy: current aspects of neurologic sequels in the southeast of Iran.Acta Neurol Scand. 2006;113(4):267-272.
[8] 肖联平,江毅,田永刚,等.前路经腹腔一期病灶清除植骨融合内固定术治疗腰骶段脊柱结核[J].中国修复重建外科杂志, 2009, 23(8):913-916.
[9] 崔虎山,李勋,郑炳周,等.后路病灶清除、椎体间融合及器械内固定术治疗结核性脊柱炎的安全性和有效性[J].临床骨科杂志, 2011, 14(1):6-8.
[10] 曾小军,杨述华,禹志宏,等.一期后路病灶清除植骨椎弓根钉系统内固定治疗胸腰椎结核[J].临床骨科杂志,2009,12(6):510-513.
[11] 马君,宋滇文,邵将,等.一期前后路联合手术治疗下腰椎结核[J].中国矫形外科杂志,2010,18(1):13-16.
[12] Tsutsumimoto T, Shimogata M, Ohta H, et al.Mini-open versus conventional open posterior lumbar interbody fusion for the treatment of lumbar degenerative spondylolisthesis: comparison of paraspinal muscle damage and slip reduction. Spine (Phila Pa 1976). 2009 15;34(18):1923-1928.
[13] 梁柱德,宁金沛,庞彤.一期前路病灶清除、自体髂骨植骨联合后路椎弓根内固定治疗腰骶椎结核——附52例报告[J].新医学, 2012,43(1):48-50
[14] 欧云生,权正学,蒋电明,等.一期后路椎弓根内固定前路病灶清除植骨治疗腰骶段脊柱结核并后凸畸形[J].重庆医科大学学报, 2008, 33(1):119-121.
[15] Bridwell KH,Baldus C,Berven S,et al.Changes in radiographic and clinical outcomes with primary treatment adult spinal deformity surgeries from two years to threeto five years follow up Spine(Phila Pa 1976),2010,35(20):1849-1854.
[16] Chen WJ, Chen CH, Shih CH.Surgical treatment of tuberculous spondylitis. 50 patients followed for 2-8 years. Acta Orthop Scand. 1995;66(2):137-142.
[17] 瞿东滨,金大地.正确认识脊柱结核病灶清除术[J].中国脊柱脊髓杂志,2006,16(8): 565-567.
[18] Jin D, Qu D, Chen J, et al.One-stage anterior interbody autografting and instrumentation in primary surgical management of thoracolumbar spinal tuberculosis.Eur Spine J. 2004;13(2):114-121.
[19] 张前法,庞清江,葛志斌,等.骨盆后环损伤内固定重建方法的选择[J].中国修复重建外科杂志,2006, 20(12):1214-1216.
[20] Xu L, Zhi-Ming Y, Xue-Mei L.An experimental study of bioderived bone to repair bone defects as a scaffold of tissue engineering.Int Surg. 2008;93(6):377-380.
[21] Jain AK, Dhammi IK, Prashad B, et al.Simultaneous anterior decompression and posterior instrumentation of the tuberculous spine using an anterolateral extrapleural approach.J Bone Joint Surg Br. 2008;90(11):1477-1481.
[22] Jain AK, Dhammi IK, Jain S, et al. Simultaneously anterior decompression and posterior instrumentation by extrapleural retroperitoneal approach in thoracolumbar lesions. Indian J Orthop. 2010;44(4):409-416.
[23] Lan X, Yang ZM, Ge BF, et al. Culture of osteoblasts on bio-derived bones. Chin J Traumatol, 2005, 8(2): 86-90.
[24] Sandhu HS.Bone morphogenetic proteins and spinal surgery.Spine (Phila Pa 1976). 2003; 28(15 Suppl):S64-73.