Chengke Luo

Single-stage transpedicular decompression, debridement, posterior instrumentation, and fusion for thoracic tuberculosis with kyphosis and spinal cord compression in aged individuals

BACKGROUND CONTEXT The single-stage posterior approach only for spinal tuberculosis (TB) has been reported by some surgeons recently, but few studies have reported single-stage transpedicular decompression, debridement, posterior instrumentation, and fusion in treatment of thoracic TB with kyphosis and spinal cord compression in patients older than 65 years. PURPOSE The purpose of this study was to investigate the effectiveness and feasibility of single-stage transpedicular decompression, debridement, posterior instrumentation, and fusion in the treatment of thoracic TB with kyphosis and spinal cord compression in aged individuals. STUDY DESIGN The study used a retrospective review. PATIENT SAMPLE Between January 2004 and March 2010, 37 cases of thoracic TB with kyphosis and spinal cord compression in individuals older than 65 were treated with single-stage transpedicular decompression, debridement, posterior instrumentation, and fusion. OUTCOME MEASURES The patients were evaluated based on ASIA (American Spinal Injury Association) classification, kyphotic Cobb angle, fusion status of affected segment via computed tomography scans, and visual analog scale pain score. METHODS There were 23 men and 14 women with an average age of 72.08±4.49 years (range, 65-81 years). The mean disease duration was 6 months (range, 3 to 21 months). The involved vertebral bodies were T2-T11, including two segments in 29 cases and three segments in 8 cases. The kyphosis Cobb angle was 39.46±4.71° before operation. RESULTS The follow-up period ranged from 24 to 61 months (mean 41.43±3.40 months). No mortality occurred. One case of recurrence due to irregular antitubercular treatment was cured by abscess clearing and regular chemotherapy. A solid fusion was achieved in the other 36 cases. According to the ASIA score system, 10 cases were rated as grade D, and 27 cases as grade E at last follow-up. The kyphosis Cobb angle was 22.32±3.41°, showing significant difference when compared with the value before operation (t=17.146, p<.001). CONCLUSION Single-stage transpedicular decompression, debridement, posterior instrumentation, and fusion is an effective and safe method in treatment of thoracic TB with kyphosis and spinal cord compression in aged individuals.

Minimum 5-year follow-up outcomes for single-stage transpedicular debridement, posterior instrumentation and fusion in the management of thoracic and thoracolumbar spinal tuberculosis in adults

Abstract Aim: The aim of this retrospective clinical study is to evaluate the long-term outcomes for single-stage transpedicular debridement, posterior instrumentation and fusion in the management of thoracic and thoracolumbar spinal tuberculosis in adults. Methods: Fifty-nine adult patients with thoracic and thoracolumbar spinal tuberculosis underwent single-stage transpedicular debridement, posterior instrumentation and fusion. These patients were followed for a minimum of 5 years. Patients were assigned to one of two groups according to the infected anatomic segment. In the thoracic spinal tuberculosis group, there were 28 cases (17 males, 11 females) with a mean age of 38.9 years; in the thoracolumbar spinal tuberculosis group, there were 31 cases (19 males, 12 females) with a mean age of 40.3 years. All cases were evaluated clinically using the visual analog scale (VAS), Kirkaldy–Willis criteria and the American Spinal Injury Association (ASIA) impairment scale. Radiographs were performed for measuring the angle of kyphosis and scoliosis. Complications related to surgery were recorded. Results: All patients successfully resolved their infections, experienced one or more ASIA grades of improvement, and improved in their VAS pain scores at final follow-up. In both groups, patient-reported outcomes reached over 90% excellent or good results using Kirkaldy–Willis criteria. The loss of kyphotic angle correction was 2.6° in the thoracic spinal tuberculosis group and 3.2° in the thoracolumbar spinal tuberculosis group. No scoliosis was observed in either group. Fifty-eight (98.3%) cases achieved solid bony fusion. In the thoracolumbar spinal tuberculosis group, one patient experienced screw loosening, and another patient with nonunion and rod breakage underwent revision surgery. Conclusions: The technique of single-stage transpedicular debridement, posterior instrumentation and fusion is an effective method for the treatment of thoracic and thoracolumbar spinal tuberculosis in adults. Long-term postoperative clinical and radiological outcomes were satisfactory.

Comparison of three surgical approaches for cervicothoracic spinal tuberculosis: a retrospective case–control study

Study designThis is a retrospective case–control study.ObjectivesThe surgical approaches to cervicothoracic spinal tuberculosis (CTSTB) were controversial. The aim of this research is to retrospectively compare the efficacy and feasibility of anterior-only (AO) approach, combined anterior and posterior (AP) surgeries, and posterior-only (PO) approach for the treatment of CTSTB.MethodsAO approach was undertaken in 20 patients (group A), AP fusion was carried out in 18 patients (group B), and PO surgery was performed in 21 patients (group C). Surgery duration, intraoperative blood loss, length of hospitalization, neurological status, kyphosis angle correction, loss of correction, and complications of the three groups were compared.ResultsThree surgical approaches all improved the kyphosis deformity and neurological function significantly (P < 0.05). The mean loss of correction in group A in the final follow-up was higher than in groups B and C (P < 0.05), and the difference between groups B and C was not significant (P > 0.05). The mean operation time, blood loss, and hospitalization days in group B were greater than in groups A and C. Complications were most prevalent in group A, more in group B, and the least in group C.ConclusionThe AO approach surgery should be limitedly used for severe CTSTB. The AP approach had got satisfactory clinical and radiographic outcomes, but with larger trauma and more complications, which should be reservedly performed for mild CTSTB. Compared to traditional surgery, PO surgery can significantly improve clinical results and obviously relieve postoperative complications.

Surgical treatment for mono-segmental lumbar tuberculosis by single-stage posterior debridement, compact bone grafting and posterior single-segment fixation.

PURPOSE To evaluate the efficacy and safety of single-stage posterior debridement, compact bone grafting and posterior single-segment fixation for the treatment of mono-segmental lumbar tuberculosis. METHODS We enrolled 32 patients with mono-segmental lumbar tuberculosis from January 2005 to April 2011. The severity of damage to the vertebral bodies is not more than 2/3 height. All the patients were treated by single-stage posterior debridement, compact bone grafting and posterior single-segment fixation. RESULTS Patients were followed 21-63 months (43.5±9.5 months). The average Cobb angle decreased to 5.3±3.0° postoperatively from 22.1±6.1° preoperatively. Meanwhile, average 1.8±1.0° loss was observed at last visit. Fusion occurred at 3-9 months (mean 5.1 months). All patients with preoperative neurologic deficit recovered in different degree. 1 with grade B recovered to grade D; 2 with grade C recovered to grade E; 18 with grade D recovered to grade E. No mortality occurred. One patient experienced anti-tuberculosis drug-induced liver dysfunction which was managed successfully with modified anti-TB treatment and hepato-protective treatment. The Oswestry Disability Index decreased from 40.1±4.0 preoperatively to 13.7±3.1 postoperatively. CONCLUSIONS Single-stage posterior debridement, compact bone grafting and posterior single-segment fixation is an effective method for the treatment of mono-segmental lumbar tuberculosis.

Hemangioendothelioma of the cervical spine: report of a rare case

Primary vascular tumors of the bone are rare and comprise a variety of neoplasms characterized by varying degrees of vasoformation. Most vascular tumors involving the spine are hemangiomas, which are benign in nature and generally do not need treatment. The concept of hemangioendothelioma (HE), including various benign, intermediate, and malignant vascular lesions, has been a controversial topic in the past. According to the 2002 WHO classification of tumors of soft tissue and bone, HE falls into the category of intermediate vascular tumors with biological characteristics of being locally aggressive and rarely metastasizing [1]. HE can occur at any age, but is more frequently seen in adults. The male:female incidence ratio is 2:1 [2]. These lesions predominantly affect the long bones, with more than half located in the tibia or femur; less than 10 % are seen in the vertebral column [3]. HE of the cervical spine is especially rare. Here, we report a unique case of primary hemangioendothelioma of the cervical spine.

Halo traction, single-segment circumferential fixation treating cervical tubercular spondylitis with kyphosis

OBJECTIVE To evaluate the clinical efficacy and feasibility of twenty patients with cervical tubercular spondylitis with kyphosis (CTSK) treated by halo traction, single-segment circumferential instrumented fusion combined anterior debridement, decompression and bone grafting. METHODS Retrospective review of data on twenty patients who suffered from CTSK admitted to our hospital between January 2007 and December 2012. All of them were performed by halo traction, single-segment circumferential instrumented fusion (anterior titanium plate and posterior pedicle or lateral mass fixation) combined anterior debridement, decompression and titanium mesh cage (TMC) filled with allograft bone particles. X-ray and computed tomographic (CT) images were used to determined sagittal balance and bone fusion. The clinical efficacy was evaluated using statistical analysis about the visual analogue scale (VAS) scores of pain, neurological status according to the Frankel classification and erythrocyte sedimentation rate (ESR), which were collected at certain time. RESULTS The average follow-up period was 34.1 ± 7.0 months (24-48 months). In the 20 cases, no obvious postoperative complications related to instrumentation and bone grafting and neurologic function was improved in various degrees. The average pretreatment ESR was 46.4 ± 21.7 mm/h, which got normal within 3 months in all patients. The average VAS on admission was 6.7 ± 1.7, which decreased to 1.6 ± 1.1 postoperatively. All patients got bony fusion within 3.4-5.5 months after surgery. The Cobb angle of 30.8 ± 10.5° on admission reduced to 2.9 ± 3.9° performed by preoperative halo traction, became to -5.1 ± 4.0° after operation and remained at -4.3 ± 3.8°, with 0.9 ± 0.7° of correction loss. CONCLUSIONS Halo traction, single-segment circumferential instrumented fusion combined anterior debridement, decompression and TMC can be an effective and safe treatment method for the treatment of cervical tubercular spondylitis with kyphosis and the preoperative halo traction should be laid on much emphasis.