Single stage decompression, anterior interbody fusion and posterior instrumentation for tuberculous kyphosis of the dorso-lumbar spine
Single stage decompression, anterior interbody fusion and posterior instrumentation for tuberculous kyphosis of the dorso-lumbar spine
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DOI：
10.1038/sj.sc.3101185
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发表时间：
2001-08-01
期刊：
影响因子：
2.2
通讯作者：
Dewnany, GT
中科院分区：
文献类型：
--
作者：
Laheri, VJ;Badhe, NP;Dewnany, GT
研究设计：评价一期减压前路椎间融合后路内固定和畸形矫正在有/无神经功能缺损患者的背腰椎结核性后凸畸形中的作用。目的：（1）评价一期手术后凸畸形矫正量及其随时间的进展。(2)评估神经功能恢复情况。(3)目的：评价前路椎体间融合术的疗效。地点：印度孟买爱德华国王纪念医院。方法：28例结核后凸畸形患者，平均64.3度（17 ~ 105例）采用一期后外侧减压、矫正后凸畸形、前路椎间融合和后路内固定术治疗。获得的平均后凸矫正率为62.5%，术后平均后凸角度降至24.1（范围5-60）。平均随访5.8年（4-7年），平均后凸角丢失为3.2度（范围0-5度）。23例神经功能缺损患者中，21例（91.3%）恢复，1例（4.3%）恶化。其余5例患者术前神经功能完好。9个月时，所有病例均观察到骨融合。术后死亡1例，死亡率3.5%。然而，一期减压融合和脊柱后凸矫正是一项非常苛刻的手术，应在考虑到相关风险和受益后进行。在发展中国家，这种手术可能防止这些复杂病例的神经功能缺损进展和迟发性截瘫复发。
Study design: To evaluate the role of single stage decompression with anterior interbody fusion with posterior instrumentation and deformity correction of tuberculous kyphosis of the dorso-lumbar spine in patients with/without neurological deficit.Objectives: (1) To evaluate the amount of kyphosis correction with single stage surgery and its progression with time. (2) To evaluate the neurological recovery. (3) To evaluate the bony anterior interbody fusion.Setting: King Edward Memorial Hospital, Bombay, India.Methods: Twenty-eight patients with post-tuberculous kyphosis deformity averaging 64.3 degrees (range 17 to 105) were treated by a single stage posterolateral decompression, correction of kyphosis, anterior interbody fusion and posterior instrumentation.Results: The mean kyphosis correction obtained was 62.5% with the mean post-operative kyphosis angle reducing to 24.1 (range 5-60). At a mean follow-up of 5.8 years (4-7 years) the mean kyphosis angle loss was 3.2 degrees (range 0-5 degrees). Of the 23 patients with neurological deficit, recovery was seen in 21 cases (91.3%) while deterioration was seen in one case (4.3%). The remaining five patients were neurologically intact pre-operatively. Bony fusion was seen in all cases at 9 months. One patient with subpulmonary function died post-operatively (mortality 3.5%).Conclusion: The results of our series are encouraging. However single stage decompression with fusion and kyphosis correction is a very demanding surgery and should be performed after taking into account the risks and benefits involved. This surgery perhaps prevents progression of neurological deficit and recurrence of late onset paraplegia in these complex cases in developing countries.