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

Zhang, Xu; Wang, Xiyang; Wu, Ping; Pang, Xiaoyang; Luo, Chengke; Zhang, Penghui; Zeng, Hao; Wei, Peng

doi:10.1016/j.injury.2015.03.023

Cited by 28 publications

(29 citation statements)

References 40 publications

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“…The most concern about nonstructural bone grafting is the failure of support and breakage of instrumentation as it seems to violate the rule of anterior column reconstruction. Nevertheless, several studies have reported the success of using nonstructural bone graft for lumbar STB [13][14][15]. Our previous study also demonstrated the nonstructural bone graft had comparable bony fusion rate and even shorter fusion time than titanium cage containing bone granules in single segment thoracic tuberculosis [12].…”

Section: Discussionmentioning

confidence: 67%

“…This study aimed to investigate the anterior column support and bone fusion of nonstructural bone graft after one stage posterior debridement in the treatment of lumbar TB. We have reported the successful use of nonstructural bone graft for lumbar STB [13][14], but these studies did not set control and the conclusions may be biased. Liu compared the clinical e cacy of one-stage posterior debridement with nonstructural autogenous bone graft versus anterior debridement, structural bone graft combined with posterior instrumentation [15].…”

Section: Introductionmentioning

confidence: 99%

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

Zhao

Peng³

et al. 2020

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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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Section: Discussionmentioning

confidence: 67%

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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“…Liu et al [25] compared the results of mono-segment xation versus short-segment xation for the treatment of single-segment lumbar spinal TB and found that mono-segment xation was more suitable since the normal motion was preserved. Xu et al [26] reported that single-segment xation and bone fusion was effective in maintaining the stability of the spine and retaining normal motion units. In the present study, the lordosis and lumbosacral angle was increased from preoperative 20.4 ± 2.9° and 14.7 ± 3.4° to postoperative 32.8 ± 3.6° and 22.4 ± 5.5.…”

Section: Discussionmentioning

confidence: 99%

One-stage posterior debridement, titanium mesh cage bone grafting and single-segment fixation for treating mono-segmental lumbar and lumbosacral spinal tuberculosis in adult patients following minimum 5-year follow-up

Zhang¹,

Wang²,

Z³

2020

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Background To evaluate the mid-long term outcomes of surgical management of mono-segmental lumbar and lumbosacral spinal tuberculosis (TB) by one-stage posterior debridement, titanium mesh cage bone grafting and single-segment fixation. Methods A total of 62 patients with mono-segmental lumbar or lumbosacral spinal tuberculosis were enrolled. One-stage posterior debridement, titanium mesh cage bone grafting and single-segment fixation was performed. Clinical and radiographic outcomes were compared and analyzed. Results All patients were followed up for an average of 75.0 ± 11.5 months and completely cured at the final follow-up. C-reactive protein (CRP) and Erythrocyte sedimentation rate (ESR) returned to normal within three months postoperatively. Postoperative Japanese Orthopedic Association (JOA) score, visual analog scale (VAS) and Oswestry Disability index (ODI) were significantly improved compared with preoperative values. Bony fusion occurred after an average of 9.8 ± 2.6 months. The lordosis angle and lumbosacral angle were increased from preoperative 20.4 ± 2.9° and 14.7 ± 3.4°to postoperative 32.8 ± 3.6° and 22.4 ± 5.5°, with the angle loss of 1.0 ± 0.7° and 0.8 ± 0.7° at the final follow-up, respectively. No significant differences between preoperative and postoperative adjacent segment disc height (DH) were found. Conclusions one-stage posterior debridement, titanium mesh cage bone grafting and single-segment fixation can be an effective and feasible treatment option for mono-segmental lumbar and lumbosacral spinal tuberculosis in adults. It may preserve lumbar normal motor units and decrease adjacent segment degeneration (ASD) with the advantages of minimally invasion and rapid postoperative rehabilitation.

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“…This gives a tough holding force on the vertebrae with tuberculous lesions. Hence, we can adopt mono-segment fixation and avoid fixing across the normal intervertebral space (8,16).…”

Section: Discussionmentioning

confidence: 99%

Mono-segment fixation method versus short-segment fixation methods, in treatment of mono-segmental lumbar tuberculosis; using titanium mesh cage with interbody fusion retrospective case-control study.

Author)¹,

Manini

Wang

2020

Preprint

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Background ： 1/3rd-2/3rd of the remaining vertebral height can hold and withstand the standard pedicle screws; some surgeons have adopted affected vertebral fixation to avoid the complications of both long and short segment fixation during surgical correction of lumbar tuberculosis (TB).This study aimed to compare efficacy of mono-segment-fixation versus the short-segment fixation methods with the use of titanium mesh-cage (TMCs) and interbody fusion in the treatment of mono-segmental lumbar spinal TB via single stage posterior-only approach. Methods ： A retrospective review was done among 34 lumbar spinal TB patients. These patients underwent debridement, interbody fusion with (TMCs) by either Mono-segment fixation or short-segment fixation methods. Eighteen patients underwent mono-segment fixation method, group (A). While 16 patients underwent short-segment fixation method, group (B). Fusion, deformity correction, and decompression were done within the affected segment in group (A), while for group (B) fusion extended one level above and below the affected vertebrae . Operation time, intra-operative blood loss, degree of deformity correction and neurological functions were analyzed. Results: Comparing group (A) vs (B), average operation time in minutes (mins) for group A was 144.2±16.5, group B was 170.3 ± 25.0 (P=0.001). Average intraoperative blood loss in milliliter (mls) was 502.8±151.9 for group (A) and 742.5±143.2 for group (B) (p ˂0.05). The mean cobb’s angle between group A versus group B; preoperative was 23.8 ± 6.5 0 vs 22.2±9.2 0 (p=0.6), immediate post operatively was 8.0±3.5 0 vs 8.3±5.7 0 (p=0.847) and at final follow-up was 8.9±3.1 0 vs 9.2 ± 5.9 0 (p=0.866) respectively. Correction rate between group (A) vs group (B) was 15.7±3.8 0 vs 13.9±5.5 0 (p=0.285) and loss of correction was 1.2±0.7 0 vs 1.1±0.7 (p=0.817) respectively. No significant differences in neurological recovery between the two groups were founds. Conclusion: Under precise conditions: mono-segment fixation method, debridement, interbody fusion with TMCs, and posterior instrumentation can effectively reconstruct the spine, maintain stability and correct kyphosis deformity similar to short-segment fixation method. Also, it can relieve pain and improve neurological symptoms. When used in combination with anti-TB chemotherapy in the treatment of mono-segmental lumbar TB via a single-stage posterior-only approach.

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

Cited by 28 publications

References 40 publications

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

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

One-stage posterior debridement, titanium mesh cage bone grafting and single-segment fixation for treating mono-segmental lumbar and lumbosacral spinal tuberculosis in adult patients following minimum 5-year follow-up

Mono-segment fixation method versus short-segment fixation methods, in treatment of mono-segmental lumbar tuberculosis; using titanium mesh cage with interbody fusion retrospective case-control study.

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