Advertisement

International Orthopaedics

, Volume 42, Issue 8, pp 1883–1890 | Cite as

A comparative study of single-stage transpedicular debridement, fusion, and posterior long-segment versus short-segment fixation for the treatment of thoracolumbar spinal tuberculosis in adults: minimum five year follow-up outcomes

  • Zheng Liu
  • Penghui Zhang
  • Hao Zeng
  • Zhengquan Xu
  • Xiyang Wang
Original Paper

Abstract

Design

This a retrospective study in single centre.

Objective

The objective of this retrospective clinical study is to compare the long-term clinical efficacy of posterior long-segment and short-segment fixation with single-stage transpedicular debridement and fusion for the treatment of thoracolumbar spinal tuberculosis in adults.

Methods

Sixty-six cases of thoracolumbar tuberculosis were treated by single-stage transpedicular debridement, bone graft fusion, and pedicle screw fixation. Thirty-five cases were under long-segment fixation (group A) and 31 cases were under short-segment fixation (group B). These patients were followed up for a minimum of five years. The clinical and radiographic results for these patients were analyzed and compared.

Results

All 66 patients were completely cured during the follow-up. All patients had significant improvement of neurological condition and visual analogue scale pain scores at the final follow-up. The average operation duration and blood loss in group A were more than that in group B. Kyphosis Cobb angle of both groups was significantly corrected after surgical management. The correction rate of Cobb angle in group A was significantly higher than that in group B at the time of immediate post-operative period or the last follow-up (P < 0.05). The correction loss of group A was significantly less than that in group B (P < 0.05).

Conclusion

Both posterior long-segment and short-segment pedicle screw fixations for the treatment of thoracolumbar spinal tuberculosis have significant effects in the correction of kyphosis and the improvement of neurological function. Although the blood loss and operation time of long-segment fixation were more than that of short-segment fixation, long-segment fixation was superior to the short-segment fixation in the correction of kyphosis and the maintenance of spinal stability, especially in the prevention of long-term correction loss.

Keywords

Long-segment fixation Short-segment fixation Thoracolumbar spinal tuberculosis 

Notes

Funding information

The work was supported by the National Natural Science Foundation of China (No.81672191) and clinical scientific research funds of Xiangya Hospital (2016L07). No benefit in any form has been or will be received from a commercial party related directly or indirectly to the subject of this manuscript

Compliance with ethical standards

Conflict of interest

The authors declare that there is no conflict of interest.

References

  1. 1.
    Organization WH. (2016). Global tuberculosis report 2016. Global Tuberculosis Report 6(2)Google Scholar
  2. 2.
    Jain AK, Kumar J (2013) Tuberculosis of spine: neurological deficit. Eur Spine J 22(4):624–633CrossRefPubMedGoogle Scholar
  3. 3.
    Lee CK, Vessa P, Lee JK (1995) Chronic disabling low back pain syndrome caused by internal disc derangements. The results of disc excision and posterior lumbar interbody fusion. Spine 20(3):356–361CrossRefPubMedGoogle Scholar
  4. 4.
    Oga M, Arizono T, Takasita M, Sugioka Y (1993) Evaluation of the risk of instrumentation as a foreign body in spinal tuberculosis. Clinical and biologic study. Spine 18(13):1890–1894CrossRefPubMedGoogle Scholar
  5. 5.
    Altman GT, Altman DT, Frankovitch KF (1996) Anterior and posterior fusion for children with tuberculosis of the spine. Clin Orthop Relat Res 325(325):225–231CrossRefGoogle Scholar
  6. 6.
    Lee TC, Lu K, Yang LC, Huang HY, Liang CL (1999) Transpedicular instrumentation as an adjunct in the treatment of thoracolumbar and lumbar spine tuberculosis with early stage bone destruction. J Neurosurg 91(2 Suppl):163–169PubMedGoogle Scholar
  7. 7.
    Ma YZ, Cui X, Chen X, Cai XJ, Bai YB (2012) Outcomes of anterior and posterior instrumentation under different surgical procedures for treating thoracic and lumbar spinal tuberculosis in adults. Int Orthop 36(2):299–305CrossRefPubMedGoogle Scholar
  8. 8.
    Pu X, Zhou Q, He Q, Dai F, Xu J, Zhang Z, Branko K (2012) A posterior versus anterior surgical approach in combination with debridement, interbody autografting and instrumentation for thoracic and lumbar tuberculosis. Int Orthop 36(2):307–313CrossRefPubMedGoogle Scholar
  9. 9.
    Zhang P, Wei P, Wang X, Luo C, Xu Z, Hao Z, Zheng L, Zhang Y, Lei G (2016) 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. Br J Neurosurg 30(6):1–6Google Scholar
  10. 10.
    Wang B, Lv G, Liu W, Cheng I (2010) Anterior radical debridement and reconstruction using titanium mesh cage for the surgical treatment of thoracic and thoracolumbar spinal tuberculosis: minimum five-year follow-up. Turkish Neurosurg 21(4):575–581Google Scholar
  11. 11.
    Tezeren G, Kuru I (2005) Posterior fixation of thoracolumbar burst fracture: short-segment pedicle fixation versus long-segment instrumentation. J Spinal Disord Tech 18(6):485CrossRefPubMedGoogle Scholar
  12. 12.
    Mclain RF (2006) The biomechanics of long versus short fixation for thoracolumbar spine fractures. Spine 31(11 Suppl):S70–S79 discussion S104CrossRefPubMedGoogle Scholar
  13. 13.
    Altay M, Ozkurt B, Cn, Ozturk A, Dogan O, Tabak A (2007) Treatment of unstable thoracolumbar junction burst fractures with short- or long-segment posterior fixation in magerl type a fractures. Eur Spine J 16(8):1145CrossRefPubMedPubMedCentralGoogle Scholar
  14. 14.
    Fakurnejad S, Scheer JK, Patwardhan AG, Havey RM, Voronov LI, Smith ZA (2014) Biomechanics of thoracolumbar burst fractures: methods of induction and treatments. J Clin Neurosci 21(12):2059–2064CrossRefPubMedGoogle Scholar
  15. 15.
    Dai LY, Yao WF, Cui YM, Zhou Q (2004) Thoracolumbar fractures in patients with multiple injuries: diagnosis and treatment-a review of 147 cases. J Trauma 56(2):348–355CrossRefPubMedGoogle Scholar
  16. 16.
    Wood KB, Li W, Lebl DR, Lebl DS, Ploumis A (2014) Management of thoracolumbar spine fractures. Spine J 14(1):145–164CrossRefPubMedGoogle Scholar
  17. 17.
    Dick JC, Jones MP, Zdeblick TA, Kunz DN, Horton WC (1994) A biomechanical comparison evaluating the use of intermediate screws and cross-linkage in lumbar pedicle fixation. J Spinal Disord 7(5):402-407CrossRefGoogle Scholar
  18. 18.
    Alanay A, Acaroglu E, Yazici M, Oznur A, Surat A (2001) Short-segment pedicle instrumentation of thoracolumbar burst fractures: does transpedicular intracorporeal grafting prevent early failure? Spine 26(2):213CrossRefPubMedGoogle Scholar
  19. 19.
    Speth MJ, Oner FC, Kadic MA, de Klerk LW, Verbout AJ (1995) Recurrent kyphosis after posterior stabilization of thoracolumbar fractures. 24 cases treated with a Dick internal fixator followed for 1.5-4 years. Acta Orthop Scand 66(5):406–410CrossRefPubMedGoogle Scholar
  20. 20.
    Müller U, Berlemann U, Sledge J, Schwarzenbach O (1999) Treatment of thoracolumbar burst fractures without neurologic deficit by indirect reduction and posterior instrumentation: bisegmental stabilization with monosegmental fusion. Eur Spine J 8(4):284–289CrossRefPubMedPubMedCentralGoogle Scholar
  21. 21.
    Chesnut RM (1994) Early failure of short-segment pedicle instrumentation for thoracolumbar fractures. A preliminary report. J Bone Joint Surg (Am Vol) 76(1):153–154CrossRefGoogle Scholar
  22. 22.
    Verlaan JJ, Diekerhof CH, Buskens E, Van dTI, Verbout AJ, Dhert WJ, Oner FC (2004) Surgical treatment of traumatic fractures of the thoracic and lumbar spine: a systematic review of the literature on techniques, complications, and outcome. Spine 29(7):803–814CrossRefPubMedGoogle Scholar
  23. 23.
    Yong-Gang WU (2005) The expression of BMP-2/4 in the focus of spinal tuberculosis. Ningxia Med J 2005Google Scholar
  24. 24.
    Mccormack T, Karaikovic E, Gaines RW (1994) The load sharing classification of spine fractures. Spine 19(15):1741CrossRefPubMedGoogle Scholar
  25. 25.
    Jain AK, Jain S (2012) Instrumented stabilization in spinal tuberculosis. Int Orthop 36(2):285–292CrossRefPubMedGoogle Scholar

Copyright information

© SICOT aisbl 2018

Authors and Affiliations

  1. 1.Department of Spine Surgery, Xiangya HospitalCentral South UniversityChangshaPeople’s Republic of China
  2. 2.Hunan Engineering Laboratory of Advanced Artificial Osteo-MaterialsChangshaPeople’s Republic of China
  3. 3.The Orthopedics Department, The Seventh Affiliated HospitalSun Yat-sen UniversityShenzhenPeople’s Republic of China
  4. 4.The Department of Spine and Osteopathia SurgeryThe First Affiliated Hospital of Guangxi Medical UniversityNanningPeople’s Republic of China
  5. 5.The Orthopedics Department, The First Affiliated HospitalFujian Medical UniversityFuzhouPeople’s Republic of China

Personalised recommendations