Outcomes of radical debridement versus no debridement for the treatment of thoracic and lumbar spinal tuberculosis

Qian, Jun; Rijiepu, Aierken; Zhu, Bin; Tian, Dan; Chen, Lei; Jing, Juehua

doi:10.1007/s00264-016-3234-z

Cited by 28 publications

(33 citation statements)

References 24 publications

(25 reference statements)

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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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“…Based on the three-column theory of Denis [23] and load-sharing principles [24], anterior column reconstruction by a structural bone grafting was mandatory after removing the affected vertebral bones and intervertebral discs. Many types of bone grafts have been used, such as tricortical iliac bone, titanium mesh cage lled with bone granules, rib bone and so on [10,[25][26]. The autogenous strut harvested from iliac was frequently used to repair bone defects due to good osteogenesis, bone induction, bone conductibility and biocompatibility [27].…”

Section: Discussionmentioning

confidence: 99%

“…Posterior xation played a signi cant role in the correction of kyphosis deformity and prevention of correction loss [6][7]. Anterior bone grafting requires the removal of the affected vertebral bone and intervertebral discs, which may be not necessary as reported by some studies [8][9][10]. Many types of bone grafting have been reported for successful usage, such as iliac bone, titanium mesh cage lled with bone granules, rib bone and so on [11].…”

Section: Introductionmentioning

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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“…Zhang et al [8] suggested that spinal stability should be prioritized as TB lesion could not be radically eliminated at the microbiological level. Qian et al [9] compared the clinical outcomes between the patients who underwent the procedure of radical debridement, bone graft, instrumentation, and the patients who underwent the procedure of isolated posterior instrumentation without debridement. No signi cant differences of VAS, kyphotic angle and neurological function improvement were observed between the two groups.…”

Section: Discussionmentioning

confidence: 99%

Comparative study of a single posterior approach and combined posterior-anterior approach for patients with lower lumbar tuberculosis

Cui¹,

Gong²,

Zhou³

et al. 2020

Preprint

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Background To compare the surgical effect of a single posterior approach with a combined posterior-anterior approach for patients with lower lumbar tuberculosis (TB). Method: 119 cases of lower lumbar TB were conducted from January 2008 to December 2016 using two procedures. Out of 119 cases, 73 patients were operated with a single posterior approach (group A), whereas, 46 patients were operated using the combined posterior-anterior approach (group B). The evaluative items were compared between two groups, including operation time, blood loss, surgical complication rate, cure rate, Visual Analog Scale (VAS) score, Japanese Orthopaedic Association (JOA) score, kyphosis Cobb’s angle, and time of abscess disappearance. Furthermore, the period between bone graft fusion and the patients’ return to regular activity were compared between the two groups to evaluate the therapeutic effects. Results No significant differences of gender, age, BMI, illness duration, and preoperative indexes of VAS, JOA, ESR, CRP, and kyphosis Cobb’s angle were found between the two groups of patients, who were followed-up for 24–60 months. Although the operation time and blood loss rate were less in group A as compared to group B, no remarkable differences in VAS, JOA, ESR, CRP and kyphosis Cobb’s angle were found. Furthermore, the rate of surgical complications, cure rate, and time of bone graft fusion did not show appreciable differences between the two groups. However, the time of abscess disappearance and time return to regular activity were less in group B as opposed to patients of group A. Conclusion Both single posterior approach and combined posterior-anterior approach are effective for the treatment of lower lumbar TB with a high cure rate and low surgical complication rate. Addtionally, single posterior approach is less traumatic than the combined posterior-anterior approach, but with a much slower lesion healing and activity recovery.

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Outcomes of radical debridement versus no debridement for the treatment of thoracic and lumbar spinal tuberculosis

Abstract: Isolated posterior instrumentation without debridement is a suitable treatment for selected patients because of minor surgical trauma, fewer complications, and spontaneous fusion.

Cited by 28 publications

References 24 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

Comparative study of a single posterior approach and combined posterior-anterior approach for patients with lower lumbar tuberculosis

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