Thoracic and lumbar tuberculous spondylitis treated by posterior debridement, graft placement, and instrumentation:: a retrospective analysis in 19 cases
Thoracic and lumbar tuberculous spondylitis treated by posterior debridement, graft placement, and instrumentation:: a retrospective analysis in 19 cases
复制标题
DOI：
10.3171/spi.2005.3.6.0450
复制
发表时间：
2005-12-01
影响因子：
2.8
通讯作者：
Sel, B
中科院分区：
文献类型：
--
作者：
Güzey, FK;Emel, E;Sel, B
目的。胸腰椎结核性脊柱炎的手术治疗存在争议。通常建议采用前路入路。本研究的目的是评估后路清创和后路内固定装置治疗胸腰椎结核性脊柱炎患者的疗效。方法。 19 名胸腰椎结核性脊柱炎患者接受了一期后路减压和清创术，必要时放置后路椎间移植物、器械和后侧或后外侧移植物。术后未发现神经功能恶化。一名患者在第 10 天死于心肌梗塞。排除一名死亡者，平均随访时间为 52.7 个月（范围 16-125 个月）。一名 70 岁患者的单个椎弓根螺钉在 3 个月后断裂。所有患者在手术后和最后一次随访检查时神经系统状况均较好。在最后一次随访时，只有两名患者出现神经功能缺损（一名美国脊柱损伤协会术前 B 级和一名 C 级缺损）。另外3名患者出现间歇性背部或腰部疼痛。13名后凸畸形患者术前测量的平均角度为18.2度（范围5-42度）；手术后该角度降低至 17.3 度（范围 0-42 度）。 44.3 个月（16-64 个月）后矫正损失 2.8 度（范围 2-5 度）。任何患者的脊柱后凸都没有进展超过 15 个月。结论。后路入路结合内固定和后路或后外侧融合（有或没有放置后路椎间移植物）可能足以清除感染，并使胸椎和腰椎结核性脊柱炎患者的脊柱稳定。该手术可以轻松进入椎管进行神经减压，防止长期矫正的椎骨排列丧失，并促进早期活动。
Object. Surgical treatment of thoracic and lumbar tuberculous spondylitis is controversial. An anterior approach is usually recommended. The aim of the present study was to assess the efficacy of posterior debridement and the placement of posterior instrumentation for the treatment of patients with thoracic and lumbar tuberculous spondylitis.Methods. Nineteen patients with thoracic and lumbar tuberculous spondylitis underwent single-stage posterior decompression and debridement as well as the placement of posterior interbody grafts if necessary, instrumentation and posterior or posterolateral g-rafts.No postoperative neurological deterioration was noted. One patient died of myocardial infarction on Day 10. The mean follow-up duration, excluding the one death, was 52.7 months (range 16-125 months). In a 70-year-old patient, a single pedicle screw broke after 3 months. All patients were in better neurological condition after surgery and at the last follow-up examination. Neurological deficits were present in only two patients at the last follow up (one American Spinal Injury Association Grade B and one Grade C deficit preoperatively). Three other patients suffered intermittent back or low-back pain.The mean angulation measured in 13 patients with kyphotic deformity was 18.2 degrees (range 5-42 degrees) preoperatively; this was reduced to 17.3 degrees (range 0-42 degrees) after surgery. There was a 2.8 degrees loss of correction (range 2-5 degrees) after 44.3 months (16-64 months). Kyphosis did not progress beyond 15 months in any patient.Conclusions. A posterior approach in combination with internal fixation and posterior or posterolateral fusion (with or without placement of posterior interbody grafts) may be sufficient for the debridement of the infection and to allow spinal stabilization in patients with thoracic and lumbar tuberculous spondylitis. This procedure is associated with easy access to the spinal canal for neural decompression, prevention of loss of corrected vertebral alignment in the long term, and facilitation of early mobilization.