BackgroundTo investigate the clinical efficacy of minimally invasive direct lateral approach debridement, interbody bone grafting, and interbody fusion in the treatment of the thoracic and lumbar spinal tuberculosis.MethodsFrom January 2013 to January 2016, 35 cases with thoracic and lumbar spinal tuberculosis received direct lateral approach debridement, interbody bone grafting, and interbody fusion. Of the 35 cases, 16 patients were male and 19 were female and the median age was 55.2 (range 25–83). The affected segments were single interspace, and the involved vertebral bodies included: 15 cases of thoracic vertebrae (1 cases of T5/6, 2 cases of T6/7, 4 cases of T7/8, 3 cases of T8/9, 5 cases of T9/10) and 20 cases of lumbar spine (2 cases of L1/2, 6 cases of L2/3, 6 cases of L3/4, 6 cases of L4/5). After MIDLIF operation, all the patients received medication of four anti-tubercular drugs for 12 to18 months.ResultsThe patients were followed up for 7 to 40 months with an average of 18.5 months. The visual analogue scale (VAS) at the last follow-up was 2.8 ± 0.5, which was significantly different from the preoperative VAS (8.2 ± 0.7). After MIDLIF, there was 5 cases occurred with transient numbness in one side of the thigh or inguinal region, and 10 cases suffered from flexion hip weakness. All the bone grafts were fused within 6~ 18 months (average of 11.5 months) after the operation.ConclusionMinimally invasive lateral approach interbody fusion technology have the advantage of less injury and quick recovery after surgery, which is the effective and safe treatment for thoracic and lumbar spinal tuberculosis.
The benefits of navigation-assisted technologies are not entirely understood. Therefore, this study aimed to examine the outcomes of patients with lumbar tuberculosis who received computer navigation-assisted minimally invasive direct lateral interbody fusion (DLIF).This was a retrospective study of 33 patients with lumbar tuberculosis who underwent minimally invasive DLIF at the Department of Spine and Orthopedics of Guigang People's Hospital (Guangxi, China) between January 2015 and December 2016. The patients were pathologically diagnosed as lumbar tuberculosis and grouped into the navigation-assisted fluoroscopy (NAV; n = 18) and non-navigation-assisted fluoroscopy (non-NAV; n = 15) groups. X-ray exposure and operation times were assessed in all patients.All surgical procedures were successfully completed. No case was converted into open surgery. The NAV group had longer surgical preparation time but shorter operation time compared with the non-NAV group (both P <.01). Total operation time showed no significant difference between the 2 groups (P = .1). The time of radiation exposure in the non-NAV group was longer compared with that of the NAV group (53.2 ± 9.9 vs 13.5 ± 2.6 s; P <.01). There were no significant differences regarding intraoperative blood loss, postoperative drainage volume, length of hospital stay, bone fusion and complications between the 2 groups (all P >.05).Computer navigation-assisted minimally invasive DLIF could significantly reduce intraoperative radiation exposure, with no increase in total operation time.
Background Supercapsular percutaneously-assisted total hip (SuperPATH) approach has been regarded as as one of minimally invasive and muscle sparing technique, whcih accesses the hip maintaining integrity of the external rotators and capsule.The purpose of this study was to compare the SuperPATH approach with the conventional posterolateral approach in terms of early clinical outcomes and radiological results. Methods This prospective randomized controlled single blinded study enrolled patients who underwent unilateral primary THA between March 2018 and December 2019.The demographic data,perioperative status [operative time, incision length, total blood loss, serum marker, and length of hospital stay (LHS)], pain visual analog scale (VAS), and Harris Score (HS) were evaluated and compared between the groups. Results Compared with the PLA group, the SuperPATH group had a shorter incision length, lower pain VAS sores within 1 months and better HS within 3 months after operation,the difference was statistically significant(P < 0.05).However, the SuperPATH group had a longer operative time ,more total blood loss,the difference was statistically significant(P < 0.05).The mean complication rate, blood transfusion rate and LHS were similar between two groups(P > 0.05).The VAS and HS were similar between the two groups at 1 year after surgery(P > 0.05). Serum levels of C-reactive protein (CRP), erythrocyte sedimentation rate (ESR) and creatine kinase(CK) (within 2 weeks postoperatively) were similar between the groups(P > 0.05). The SuperPATH group had a larger acetabular inclination and anteversion(P < 0.05),but it was all within Lewinnek’s safe zone.Leg length discrepancy > 1 cm were more common in the SuperPATH group,but the difference was not significant(P > 0.05). Conclusion This study reveals that the SuperPATH technique was associated with lower pain levels, and higher physical function than conventional posterolateral approach .However, it had a longer operative time and more blood loss.
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