Comparison of clinical efficacy and safety among three surgical approaches for the treatment of spinal tuberculosis: a meta-analysis

Yang, Pengliang; Zang, Quanjin; Kang, Jian; Li, Haopeng; He, Xijing

doi:10.1007/s00586-016-4546-9

Cited by 44 publications

(40 citation statements)

References 58 publications

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“…Because drug-resistant TB has the characteristics of a long onset time, wide range of lesions and easy recurrence, it is very important to adopt the complete debridement and stable internal fixation. The operative indications should be strictly controlled for the DR-TB, and individualised surgical procedures should be developed according to the location, nature and extent of the lesion [26,27]. In the study, 137 drug resistance patients underwent surgical treatment combined with individualised chemotherapy and achieved clinical cure.…”

Section: Discussionmentioning

confidence: 99%

Multi-drug resistant spinal tuberculosis-epidemiological characteristics of in-patients: a multicentre retrospective study

Yang

et al. 2020

Epidemiol. Infect.

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Tuberculosis (TB) is the leading cause of death among infectious diseases. China has a high burden of TB and accounted for almost 13% of the world's cases of multi-drug resistant (MDR) TB. Spinal TB is one reason for the resurgence of TB in China. Few large case studies of MDR spinal TB in China have been conducted. The aim of this research was to observe the epidemiological characteristics of inpatients with MDR spinal TB in six provinces and cities of China from 1999–2015. This is a multicentre retrospective observational study. Patients' information was collected from the control disease centre and infectious disease database of hospitals in six provinces and cities in China. A total of 3137 patients with spinal TB and 272 patients with MDR spinal TB were analysed. The result showed that MDR spinal TB remains a public health concern and commonly affects patients 15–30 years of age (34.19%). The most common lesions involved the thoracolumbar spine (35.66%). Local pain was the most common symptom (98.53%). Logistic analysis showed that for spinal TB patients, reside in rural district (OR 1.79), advanced in years (OR 1.92) and high education degree (OR 2.22) were independent risk factors for the development of MDR spinal TB. Women were associated with a lower risk of MDR spinal TB (OR 0.48). The most common first-line and second-line resistant drug was isoniazid (68.75%) and levofloxacin (29.04%), respectively. The use of molecular diagnosis resulted in noteworthy clinical advances, including earlier initiation of MDR spinal TB treatment, improved infection control and better clinical outcome. Chemotherapy and surgery can yield satisfactory outcomes with timely diagnosis and long-term treatment. These results enable a better understanding of the MDR spinal TB in China among the general public.

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Section: Discussionmentioning

confidence: 99%

Multi-drug resistant spinal tuberculosis-epidemiological characteristics of in-patients: a multicentre retrospective study

Yang

et al. 2020

Epidemiol. Infect.

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“…The anterior approach enables to direct removal of the TB lesions, but the risks of injuring great vessels are relatively large especially at lower lumbar spine [18]. Combined anterior and posterior surgery improves the effects of debridement and spinal reconstruction, but the surgical trauma is enlarged [19]. The single posterior surgery become popular as the advantages of less surgical trauma, easier kyphosis correction, stable…”

Section: Discussionmentioning

confidence: 99%

Nonstructural versus structural bone grafting in the treatment of lumbar tuberculosis: a retrospective cohort study

Zhao

Peng³

et al. 2020

Preprint

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Background Various bone grafting have been reported to achieve anterior column support and bone fusion after one stage posterior debridement in the treatment of lumbar tuberculosis. However, nonstructural bone grafting has been rarely studied. This study aimed to compare the efficacy of nonstructural bone grafting versus structural bone grafting in the treatment of lumbar tuberculosis.Patients and methods We retrospectively reviewed patients with nonstructural (n=27) and structural (n=22) bone grafting after single-stage posterior debridement and instrumentation for lumbar tuberculosis with at least 24 months of follow-up. Plain radiographs, magnetic resonance imaging, computed tomography scans, and health-related outcomes (e.g. Visual Analog Scale for back pain, the Oswestry Disability Index) were collected before surgery and at follow-up.Results Both nonstructural and structural bone grafting were associated with significant improvements in the quality of life parameters, the laboratory tests and the Cobb angle of local kyphosis. A slight loss of Cobb angle correction was observed in two groups. Nonstructural bone grafting resulted in the significantly less operation duration, blood loss and lower bone fusion rate than structural bone grafting group. There were three complications in the nonstructural bone grafting and four complications in the structural bone grafting group, with no significant difference between two groups. Conclusions Nonstructural bone grafting can achieve anterior column support with less surgical trauma and simpler surgical procedure than structural bone grafting, but the lower rate of grafted bone fusion should be taken into consideration when choosing nonstructural bone grafting. Key words Lumbar tuberculous; Single-stage posterior debridement; Anterior column support; Bone fusion; Nonstructural bone grafting; Structural bone grafting

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“…The choice of surgical approach was reported to be linked to the intraoperative blood loss. 28,29 Previous studies reported that one-stage anterior operation had advantages when compared to posterior instrumentation, as both instrumentation and grafting are done as single-stage surgery through the same incision, which may minimize total blood loss. 12,29 In contrast, other studies illustrated that posterior approach favors less intraoperative blood loss.…”

Section: Discussionmentioning

confidence: 99%

Predictors associated with perioperative blood transfusion and intraoperative blood loss in thoracolumbar tuberculosis

Song

Liu

Wei

et al. 2020

Preprint

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Background During operation on thoracic and lumbar tuberculosis infection, patients can lose a significant amount of blood and receive a perioperative blood transfusion. However, the risk factors were not identified for increased intraoperative blood loss and perioperative blood transfusion. The aim of this retrospective study is to determine the predictors associated with perioperative blood transfusion and intraoperative blood loss in thoracolumbar tuberculosis. Methods From 2008 to 2018, 336 patients who met the inclusion criteria were enrolled in the study. The predictors of allogenic blood transfusion were identified in a univariate and multivariate logistic regression analysis. Univariate and multivariate linear regression was attempted to investigate the factors influencing intraoperative blood loss. Results Altogether, 336 adult patients with thoracic and lumbar tuberculosis were included in this study. The mean patient age was 49.6 ± 15.5 (range 14-85) years for those patients. Our data revealed a significant relationship between blood transfusions and female gender, BMI, vertebral collapse/Kyphosis and intraoperative blood loss. Multivariable linear regression analysis revealed that BMI, levels of instrumentation, surgical approach and operative time were independent factors influencing intraoperative blood loss. Conclusions This study identified some clinical predictors for perioperative blood transfusion and intraoperative blood loss in patients undergoing thoracic and lumbar tuberculosis surgery. These results may contribute to preoperative blood transfusion planning and minimize intra- or post-operative complications.

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Comparison of clinical efficacy and safety among three surgical approaches for the treatment of spinal tuberculosis: a meta-analysis

Abstract: Posterior approach has better clinical outcomes than anterior or combined approach for spinal tuberculosis. However, individual assessment of each case should be considered in the clinical application of these surgical approaches.

Cited by 44 publications

References 58 publications

Multi-drug resistant spinal tuberculosis-epidemiological characteristics of in-patients: a multicentre retrospective study

Multi-drug resistant spinal tuberculosis-epidemiological characteristics of in-patients: a multicentre retrospective study

Nonstructural versus structural bone grafting in the treatment of lumbar tuberculosis: a retrospective cohort study

Predictors associated with perioperative blood transfusion and intraoperative blood loss in thoracolumbar tuberculosis

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