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[Surgical treatment of thoracic and lumbar tuberculosis complicated with severe kyphotic deformity and paraplegia].
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2014 Sep; 28(9):1110-4.ZX

Abstract

OBJECTIVE

To explore an method and the effectiveness of surgical treatment of thoracic and lumbar tuberculosis complicated with severe kyphotic deformity (Cobb angle ≥ 55°) and paraplegia.

METHODS

Between January 2009 and January 2013, 13 cases of thoracic and lumbar tuberculosis complicated with severe kyphotic deformity and paraplegia were treated by one-stage posterior vertebral column resection (PVCR), debridement, bone grafting, and instrumentation fixation. Of 13 patients, 7 were male and 6 were female with an average age of 23.5 years (range, 14-49 years). The disease duration was 13-38 months (mean, 19 months). The Cobb angle of kyphosis was (65.23 ± 7.95)°. The visual analogue scale score (VAS) was 7.38 ± 0.31. In 13 patients with incomplete paraplegia, 1 case was classified as Frankel grade B, 7 cases as grade C, and 5 cases as grade D. The lesion involved 2 vertebrae bodies in 7 cases (T8, 9 in 1 case, T11, 12 in 2 cases, and T12, L1 in 4 cases), 3 vertebrae bodies in 4 cases (T10-12 in 2 cases, T9-11 in 1 case, and T11-L1 in 1 case), and 4 vertebrae bodies in 2 cases (T4-7 in 1 case and T6-9 in 1 case). Imaging examination showed paravertebral abscess in 10 cases.

RESULTS

Healing of incision by first intention was obtained in all patients. The neurological injury and pulmonary infection occurred in 3 cases and 2 cases respectively, which were cured after symptomatic treatment. Thirteen patients were followed up 12-48 months (mean, 17 months). The erythrocyte sedimentation rate restored to normal level in all cases at 3-7 months after operation. All the patients achieved bony fusion at 10-20 months (mean, 14 months) after operation. No fixation loosening, displacement, or fracture occurred during follow-up. Common toxic symptom of tuberculosis disappeared, and there was no recurrence of local tuberculosis. The Cobb angle of kyphosis was corrected to (22.38 ± 1.76)° at 1 week and (22.15 ± 1.83)° at last follow-up, showing significant difference when compared with preoperative one (P < 0.05). There was no significant difference in Cobb angle of kyphosis between at 1 week after operation and at last follow-up (P > 0.05). The Frankel grading was grade B in 1 case, grade C in 10 cases, and grade D in 2 cases at 1 week after operation; and it was grade D in 1 case and grade E in 12 cases at last follow-up; significant differences were found between at pre- and post-operation (P < 0.05), and between at 1 week after operation and at last follow-up (P < 0.05). The VAS score was 4.08 ± 0.76 at 1 week and 0.62 ± 0.14 at last follow-up, showing significant differences between at pre- and post-operation (P < 0.05) and between at 1 week after operation and at last follow-up (P < 0.05).

CONCLUSION

One-stage PVCR, debridement, bone grafting, and instrumentation fixation is proved to be successful in treating thoracic and lumbar tuberculosis complicated with severe kyphotic deformity and paraplegia.

Authors

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Pub Type(s)

Journal Article

Language

chi

PubMed ID

25509776

Citation

Hu, Jiang, et al. "[Surgical Treatment of Thoracic and Lumbar Tuberculosis Complicated With Severe Kyphotic Deformity and Paraplegia]." Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi = Zhongguo Xiufu Chongjian Waike Zazhi = Chinese Journal of Reparative and Reconstructive Surgery, vol. 28, no. 9, 2014, pp. 1110-4.
Hu J, Wang Y, Liu Z, et al. [Surgical treatment of thoracic and lumbar tuberculosis complicated with severe kyphotic deformity and paraplegia]. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2014;28(9):1110-4.
Hu, J., Wang, Y., Liu, Z., Tang, L., Wan, L., Zhang, Y., & Deng, J. (2014). [Surgical treatment of thoracic and lumbar tuberculosis complicated with severe kyphotic deformity and paraplegia]. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi = Zhongguo Xiufu Chongjian Waike Zazhi = Chinese Journal of Reparative and Reconstructive Surgery, 28(9), 1110-4.
Hu J, et al. [Surgical Treatment of Thoracic and Lumbar Tuberculosis Complicated With Severe Kyphotic Deformity and Paraplegia]. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2014;28(9):1110-4. PubMed PMID: 25509776.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - [Surgical treatment of thoracic and lumbar tuberculosis complicated with severe kyphotic deformity and paraplegia]. AU - Hu,Jiang, AU - Wang,Yue, AU - Liu,Zhongqian, AU - Tang,Liuyi, AU - Wan,Lun, AU - Zhang,Yaoming, AU - Deng,Juncai, PY - 2014/12/17/entrez PY - 2014/12/17/pubmed PY - 2015/6/16/medline SP - 1110 EP - 4 JF - Zhongguo xiu fu chong jian wai ke za zhi = Zhongguo xiufu chongjian waike zazhi = Chinese journal of reparative and reconstructive surgery JO - Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi VL - 28 IS - 9 N2 - OBJECTIVE: To explore an method and the effectiveness of surgical treatment of thoracic and lumbar tuberculosis complicated with severe kyphotic deformity (Cobb angle ≥ 55°) and paraplegia. METHODS: Between January 2009 and January 2013, 13 cases of thoracic and lumbar tuberculosis complicated with severe kyphotic deformity and paraplegia were treated by one-stage posterior vertebral column resection (PVCR), debridement, bone grafting, and instrumentation fixation. Of 13 patients, 7 were male and 6 were female with an average age of 23.5 years (range, 14-49 years). The disease duration was 13-38 months (mean, 19 months). The Cobb angle of kyphosis was (65.23 ± 7.95)°. The visual analogue scale score (VAS) was 7.38 ± 0.31. In 13 patients with incomplete paraplegia, 1 case was classified as Frankel grade B, 7 cases as grade C, and 5 cases as grade D. The lesion involved 2 vertebrae bodies in 7 cases (T8, 9 in 1 case, T11, 12 in 2 cases, and T12, L1 in 4 cases), 3 vertebrae bodies in 4 cases (T10-12 in 2 cases, T9-11 in 1 case, and T11-L1 in 1 case), and 4 vertebrae bodies in 2 cases (T4-7 in 1 case and T6-9 in 1 case). Imaging examination showed paravertebral abscess in 10 cases. RESULTS: Healing of incision by first intention was obtained in all patients. The neurological injury and pulmonary infection occurred in 3 cases and 2 cases respectively, which were cured after symptomatic treatment. Thirteen patients were followed up 12-48 months (mean, 17 months). The erythrocyte sedimentation rate restored to normal level in all cases at 3-7 months after operation. All the patients achieved bony fusion at 10-20 months (mean, 14 months) after operation. No fixation loosening, displacement, or fracture occurred during follow-up. Common toxic symptom of tuberculosis disappeared, and there was no recurrence of local tuberculosis. The Cobb angle of kyphosis was corrected to (22.38 ± 1.76)° at 1 week and (22.15 ± 1.83)° at last follow-up, showing significant difference when compared with preoperative one (P < 0.05). There was no significant difference in Cobb angle of kyphosis between at 1 week after operation and at last follow-up (P > 0.05). The Frankel grading was grade B in 1 case, grade C in 10 cases, and grade D in 2 cases at 1 week after operation; and it was grade D in 1 case and grade E in 12 cases at last follow-up; significant differences were found between at pre- and post-operation (P < 0.05), and between at 1 week after operation and at last follow-up (P < 0.05). The VAS score was 4.08 ± 0.76 at 1 week and 0.62 ± 0.14 at last follow-up, showing significant differences between at pre- and post-operation (P < 0.05) and between at 1 week after operation and at last follow-up (P < 0.05). CONCLUSION: One-stage PVCR, debridement, bone grafting, and instrumentation fixation is proved to be successful in treating thoracic and lumbar tuberculosis complicated with severe kyphotic deformity and paraplegia. SN - 1002-1892 UR - https://www.unboundmedicine.com/medline/citation/25509776/[Surgical_treatment_of_thoracic_and_lumbar_tuberculosis_complicated_with_severe_kyphotic_deformity_and_paraplegia]_ L2 - http://www.diseaseinfosearch.org/result/5593 DB - PRIME DP - Unbound Medicine ER -