Transpedicular instrumentation as an adjunct in the treatment of thoracolumbar and lumbar spine tuberculosis with early stage bone destruction
Transpedicular instrumentation as an adjunct in the treatment of thoracolumbar and lumbar spine tuberculosis with early stage bone destruction
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DOI：
10.3171/spi.1999.91.2.0163
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发表时间：
1999-10-01
影响因子：
4.1
通讯作者：
Liang, CL
中科院分区：
文献类型：
--
作者：
Lee, TC;Lu, K;Liang, CL
目的。由于现代成像技术现在可以早期诊断脊柱结核，因此可以选择更保守的治疗方案。作者评估了经椎弓根器械治疗胸腰椎和腰椎结核的有效性，这些患者具有轻度骨质破坏和“不稳定卡住”（当一个人从向前弯曲到直立位置时发生的突然疼痛的“突然”症状）的主要症状。方法。 18 名脊柱结核患者（9 名男性和 9 名女性，年龄范围 49-71 岁）接受了经椎弓根器械治疗，并辅以后外侧融合和化疗。所有患者均因严重不稳定而依赖轮椅或卧床不起，平均症状持续时间为 2.5 个月（ran，ae 1-6 个月）。 17 名患者累及两块相邻的椎骨，一名患者累及单块椎骨。 5 名患者存在轻度神经功能缺损（弗兰克尔 D 级）。在手术过程中，将螺钉植入最靠近病变的两个未受影响的椎弓根中，以稳定受影响的节段。没有尝试进行彻底清创或神经减压。随访期为21至40个月。术后，7 名和 8 名患者的不稳定症状分别在 10 天内（良好结果）和 1 个月内（良好结果）得到缓解，2 名患者在 3 个月（一般结果）内得到缓解：其余患者的症状没有缓解（不良结果）。在取得良好或极好的结果的患者中观察到症状持续时间短（通常< 3个月）并且受累椎体骨质破坏低于50%。在随访期间，脊柱排列保持良好，相关节段稳定，炎症过程消退。然而，没有强有力的证据表明骨缺损处发生了融合。获得公平结果的患者经历了较长的症状持续时间，并且每例患者的一个椎体都有超过 50% 的骨质破坏。然而，在随访期间也显示出脊柱排列的良好维持。结果较差的患者有最长的症状史（6个月）和最广泛的脊柱受累（两个相邻腰椎椎体破坏> 50%）。术后发生种植失败，患者出现伤口感染。结论。经椎弓根器械可快速缓解不稳定卡顿，并预防胸腰椎和腰椎结核患者的晚期成角畸形，这些患者所涉及的椎体骨破坏有限（<50%），其主要症状是不稳定卡顿。
Object. Because modern imaging techniques now allow for early diagnosis of spinal tuberculosis, more conservative management options are possible. The authors evaluated the effectiveness of transpedicular instrumentation for treatment of thoracolumbar and lumbar spinal tuberculosis in patients with mild bone destruction and the main symptom of "instability catch" (a sudden painful "snap" that occurs when one extends from a forward bent to an upright position).Methods. Eighteen patients (nine men and nine women, age range 49-71 years) with spinal tuberculosis were treated with transpedicular instrumentation that was supplemented with posterolateral fusion and chemotherapy. All patients were wheelchair dependent or bed-ridden due to severe instability catch, with a mean symptom duration of 2.5 months (ran,ae 1-6 months). Two contiguous vertebrae were involved in 17 patients, and a single vertebrae was involved in one. In five patients mild neurological deficits (Frankel Grade D) were present. During surgery, the screws were implanted into the two nonaffected pedicles nearest the lesion to stabilize the involved segments. No attempt at radical debridement or neural decompression was undertaken. The follow-up period ranged from 21 to 40 months. Postoperatively the instability catch was relieved within 10 days (excellent outcome) and within 1 month (good outcome) in seven and eight patients, respectively, and within 3 months (fair outcome) in two: in the remaining patient, the symptom did not resolve (poor outcome). A short duration of symptoms (generally < 3 months) and bone destruction of less than 50% in the involved vertebral bodies were observed in patients who made a good or excellent outcome. During dhe follow-up period, good maintenance of spinal alignment, stabilization of the involved segment, and resolution of the inflammatory process were shown. however, there was no strong evidence that fusion had occurred at the bony defect. Patients in whom a fair outcome was achieved experienced a longer duration of symptoms, and in each, one vertebral body with greater than 50% bone destruction was demonstrated. However, good maintenance of spinal alignment was also shown during the follow-up period. The patient whose outcome was poor had the longest history (6 months) of symptoms and the most extensive involvement of the spine (> 50% destruction of two adjacent lumbar vertebral bodies). Postoperatively, implant failure occurred and the patient developed a wound infection.Conclusions. Transpedicular instrumentation provides rapid relief of instability catch and prevents late angular deformity in patients with thoracolumbar and lumbar spinal tuberculosis in whom limited (< 50%) bone destruction of the involved vertebral bodies has been shown and whose main symptom is instability catch.