Thoracolumbar tuberculosis complicated with severe kyphosis: spinal stability after orthopedic fixation and bone grafting fusion

doi:10.3969/j.issn.2095-4344.2015.53.007

Abstract

Abstract:

BACKGROUND: At present, there was lack of reports on the efficacy of thoracolumbar tuberculosis complicated with severe kyphosis (> 90°). Choice of surgical treatment is necessary for patients with severe spinal tuberculosis kyphosis, affected heart and lung function and neurological disorders.

OBJECTIVE: To retrospectively analyze the repair effect of I-stage posterior osteotomy orthopedic fixation and II-stage anterior debridement interbody bone grafting fusion in repair of patients with thoracolumbar tuberculosis complicated with severe kyphosis.

METHODS: Totally 53 patients with spinal tuberculosis complicated with severe kyphosis were enrolled. Patients underwent posterior osteotomy orthopedic fixation in the first stage, and underwent anterior debridement interbody bone grafting fusion in the second stage. X-ray, CT, MRI and other imaging examinations were conducted before and after the treatment. Erythrocyte sedimentation rate, C-reactive protein, pain visual analog scale scores, kyphosis and ASIA spinal cord injury classification before and after the treatment were compared and analyzed for clinical evaluation of efficacy.

RESULTS AND CONCLUSION: All patients had a successful surgery. The operative time was 290 (195-420) minutes, and the intra-operative amount of blood loss was 1800 (1 100-3 300) mL, the average number of fixed segments were 11.8 (9-16). All these 53 patients were followed up for 26-28 months. The erythrocyte sedimentation rate and C-reactive protein of patients after treatment gradually recovered to normal, and recovered to normal levels at the final follow-up. The mean correction of sagittal Cobb angle was 77.92°, the correction rate reached to 74.6% at the final follow-up. Till the final follow-up, the average loss of corrective angle was 1.35°. The lower back pain and limitation of function obtained varying degrees of alleviating after treatment. The visual analog scale scores in the final follow-up were significantly lower than those before treatment (t=19.219, P < 0.001). ASIA spinal cord injury scores gradually increased. Patients recovered the ability to live and work in varying degrees. These results suggest that I-stage posterior osteotomy orthopedic fixation combined with II-stage anterior debridement interbody bone graft fusion is an effective methods for repair of thoracolumbar tuberculosis complicated with severe kyphosis. The lesions of patients with thoracolumbar tuberculosis complicated with severe kyphosis who were enrolled in this study involve multiple vertebral body, long bone defect, and often need long segmental allograft bone grafting, with long-time of bone grafting fusion, therefore, zygapophyseal bone grafting fusion should be conducted to increase the stability of posterior bone grafting.

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

CLC Number:

R318

Deng Qiang, Paerhati•Rexiti, Zhang Ya-lou, Sheng Wei-bin. Thoracolumbar tuberculosis complicated with severe kyphosis: spinal stability after orthopedic fixation and bone grafting fusion[J]. Chinese Journal of Tissue Engineering Research, 2015, 19(53): 8567-8572.

Figures/Tables 2

References

[1] Rivas-Garcia A, Sarria-Estrada S, Torrents-Odin C, et al. Imaging findings of Pott's disease. Eur Spine J. 2013;22 Suppl 4:567-578.

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

[3] Pola E, Rossi B, Nasto LA, et al. Surgical treatment of tuberculous spondylodiscitis. Eur Rev Med Pharmacol Sci. 2012;16 Suppl 2:79-85.

[4] Bakhsh A. Medical management of spinal tuberculosis: an experience from Pakistan. Spine. 2010;35:E787-791.

[5] Wang X, Pang X, Wu P, et al. One-stage anterior debridement, bone grafting and posterior instrumentation vs. single posterior debridement, bone grafting, and instrumentation for the treatment of thoracic and lumbar spinal tuberculosis. Eur Spine J. 2014;23:830-837.

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

[7] Qureshi MA, Khalique AB, Afzal W, et al. Surgical management of contiguous multilevel thoracolumbar tuberculous spondylitis. Eur Spine J. 2013;22 Suppl 4: 618-623.

[8] He M, Xu H, Zhao J, et al. Anterior debridement, decompression, bone grafting, and instrumentation for lower cervical spine tuberculosis. Spine J. 2014;14:619-627.

[9] O’Shea MK, Fletcher TE, Beeching NJ, et al. Tuberculin skin testing and treatment modulates interferon-gamma release assay results for latent tuberculosis in migrants. PLoS One. 2014;9: e97366.

[10] Alawneh KM, Ayesh MH, Khassawneh BY, et al. Anti-TNF therapy in Jordan: a focus on severe infections and tuberculosis. Biologics. 2014; 8: 193-198.

[11] Ibrahim L, Salah M, Abd El Rahman A, et al. Crucial role of CD4+CD 25+ FOXP3+ T regulatory cell, interferon-gamma and interleukin16 in malignant and tuberculous pleural effusions. Immunol Invest. 2013; 42: 122-136.

[12] Lu G, Wang B, Li J, et al. Anterior debridement and reconstruction via thoracoscopy-assisted mini-open approach for the treatment of thoracic spinal tuberculosis: minimum 5-year follow-up. Eur Spine J. 2012;21:463-469.

[13] Rajasekaran S, Vijay K, Shetty AP. Single-stage closing-opening wedge osteotomy of spine to correct severe post-tubercular kyphotic deformities of the spine: a 3-year follow-up of 17 patients. Eur Spine J. 2010;19:583-592.

[14] Hirakawa A, Miyamoto K, Masuda T, et al. Surgical outcome of 2-stage (posterior and anterior) surgical treatment using spinal instrumentation for tuberculous spondylitis. J Spinal Dis Tech. 2010;23:133-138.

[15] Fukuta S, Miyamoto K, Masuda T, et al. Two-stage (posterior and anterior) surgical treatment using posterior spinal instrumentation for pyogenic and tuberculotic spondylitis. Spine. 2003;28:E302-308.

[16] Wang XB, Li J, Lu GH, et al. Single-stage posterior instrumentation and anterior debridement for active tuberculosis of the thoracic and lumbar spine with kyphotic deformity. Int Orthop. 2012;36:373-380.

[17] Sundararaj GD, Behera S, Ravi V, et al. Role of posterior stabilisation in the management of tuberculosis of the dorsal and lumbar spine. J Bone Joint Surg. 2003;85:100-106.

[18] Reichmann MT, Marshall BG, Cummings F, et al. Tuberculosis and TNF-inhibitors: history of exposure should outweigh investigations. BMJ. 2014.

[19] Spiro AS, Rupprecht M, Stenger P, et al. Surgical treatment of severe congenital thoracolumbar kyphosis through a single posterior approach. Bone Joint J. 2013;95-B:1527-1532.

[20] Kozakiewicz L, Chen Y, Xu J, et al. B cells regulate neutrophilia during Mycobacterium tuberculosis infection and BCG vaccination by modulating the interleukin-17 response. PLoS Pathog. 2013; 9: e1003472.