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[Treatment of thoracolumbar spinal tuberculosis by posterior focus debridement and bone grafting and fixation combined with psoas abscess debridement and local chemotherapy via different approachs].
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2018 07 15; 32(7):912-919.ZX

Abstract

Objective

To compare the effectiveness of posterior and anterior psoas abscess debridement and local chemotherapy in abscess cavity combined with focus debridement, bone grafting, and fixation via posterior approach in treatment of thoracolumbar spinal tuberculosis, and explore the feasibility of psoas abscess debridement via posterior approach.

Methods

Between June 2012 and December 2015, the clinical data of 37 patients with thoracolumbar spine tuberculosis and psoas abscess were retrospectively analyzed. All the patients underwent posterior focus debridement, bone grafting, and internal fixation, and were divided into two groups according to different approaches to psoas abscess debridement. Twenty-one patients in group A underwent abscess debridement and local chemotherapy in abscess cavity via posterior approach; 16 patients in group B underwent abscess debridement and local chemotherapy in abscess cavity via anterior approach. No significant difference was found between two groups in gender, age, disease duration, involved segments, preoperative erythrocyte sedimentation rate (ESR), preoperative C-reactive protein (CRP), side of psoas abscess, maximum transverse diameter and sagittal diameter of psoas abscess, accompanying abscess, abscess cavity separation, preoperative Cobb angle of involved segments, preoperative American Spinal Injury Association (ASIA) classification (P>0.05). The operation time, intraoperative blood loss, hospitalization time, time of abscess absorption and bone fusion were recorded and compared between 2 groups. The change of pre- and post-operative involved segments Cobb angle was observed. Neurological function was assessed according to ASIA classification.

Results

Except that the operation time of group B was significantly longer than that of group A (t=-2.985, P=0.005), there was no significant difference in intraoperative blood loss, hospitalization time, time of abscess absorption and bone fusion between 2 groups (P>0.05). All patients were followed up 18-47 months (mean, 31.1 months). No cerebrospinal fluid leakage occurred intra- and post-operation. Four patients in group A underwent second-stage operation of abscess debridement and local chemotherapy in abscess cavity via anterior approach. All patients got abscess absorption, meanwhile ESR and CRP level normalized at last follow-up. The involved segments Cobb angle improved significantly when compared with preoperative values in both 2 groups (P<0.05); and there was no significant difference between 2 groups at last follow-up (P>0.05). Nine patients with spinal cord injury had significant neurological recovery at last follow-up (Z=-2.716, P=0.007).

Conclusion

Posterior focus debridement, bone grafting, and internal fixation combined with abscess debridement and local chemotherapy in abscess cavity is effective in treatment of thoracolumbar spinal tuberculosis, but in some cases anterior abscess debridement is still required.

Authors+Show Affiliations

Department of Orthopedics, the First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, P.R.China.Department of Orthopedics, the First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, P.R.China.ouyunsheng2001@163.com.Department of Orthopedics, the First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, P.R.China.Department of Orthopedics, the First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, P.R.China.Department of Orthopedics, the First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, P.R.China.Department of Orthopedics, the First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, P.R.China.Department of Orthopedics, the First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, P.R.China.

Pub Type(s)

Journal Article

Language

chi

PubMed ID

30129317

Citation

Peng, Qiqi, et al. "[Treatment of Thoracolumbar Spinal Tuberculosis By Posterior Focus Debridement and Bone Grafting and Fixation Combined With Psoas Abscess Debridement and Local Chemotherapy Via Different Approachs]." Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi = Zhongguo Xiufu Chongjian Waike Zazhi = Chinese Journal of Reparative and Reconstructive Surgery, vol. 32, no. 7, 2018, pp. 912-919.
Peng Q, Ou Y, Zhu Y, et al. [Treatment of thoracolumbar spinal tuberculosis by posterior focus debridement and bone grafting and fixation combined with psoas abscess debridement and local chemotherapy via different approachs]. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2018;32(7):912-919.
Peng, Q., Ou, Y., Zhu, Y., Zhao, Z., Luo, W., Du, X., & Li, J. (2018). [Treatment of thoracolumbar spinal tuberculosis by posterior focus debridement and bone grafting and fixation combined with psoas abscess debridement and local chemotherapy via different approachs]. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi = Zhongguo Xiufu Chongjian Waike Zazhi = Chinese Journal of Reparative and Reconstructive Surgery, 32(7), 912-919. https://doi.org/10.7507/1002-1892.201801068
Peng Q, et al. [Treatment of Thoracolumbar Spinal Tuberculosis By Posterior Focus Debridement and Bone Grafting and Fixation Combined With Psoas Abscess Debridement and Local Chemotherapy Via Different Approachs]. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2018 07 15;32(7):912-919. PubMed PMID: 30129317.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - [Treatment of thoracolumbar spinal tuberculosis by posterior focus debridement and bone grafting and fixation combined with psoas abscess debridement and local chemotherapy via different approachs]. AU - Peng,Qiqi, AU - Ou,Yunsheng, AU - Zhu,Yong, AU - Zhao,Zenghui, AU - Luo,Wei, AU - Du,Xing, AU - Li,Jianxiao, PY - 2018/8/22/entrez PY - 2018/8/22/pubmed PY - 2019/2/26/medline KW - Thoracolumbar spinal tuberculosis KW - focus debridement KW - local chemotherapy KW - psoas abscess SP - 912 EP - 919 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 - 32 IS - 7 N2 - Objective: To compare the effectiveness of posterior and anterior psoas abscess debridement and local chemotherapy in abscess cavity combined with focus debridement, bone grafting, and fixation via posterior approach in treatment of thoracolumbar spinal tuberculosis, and explore the feasibility of psoas abscess debridement via posterior approach. Methods: Between June 2012 and December 2015, the clinical data of 37 patients with thoracolumbar spine tuberculosis and psoas abscess were retrospectively analyzed. All the patients underwent posterior focus debridement, bone grafting, and internal fixation, and were divided into two groups according to different approaches to psoas abscess debridement. Twenty-one patients in group A underwent abscess debridement and local chemotherapy in abscess cavity via posterior approach; 16 patients in group B underwent abscess debridement and local chemotherapy in abscess cavity via anterior approach. No significant difference was found between two groups in gender, age, disease duration, involved segments, preoperative erythrocyte sedimentation rate (ESR), preoperative C-reactive protein (CRP), side of psoas abscess, maximum transverse diameter and sagittal diameter of psoas abscess, accompanying abscess, abscess cavity separation, preoperative Cobb angle of involved segments, preoperative American Spinal Injury Association (ASIA) classification (P>0.05). The operation time, intraoperative blood loss, hospitalization time, time of abscess absorption and bone fusion were recorded and compared between 2 groups. The change of pre- and post-operative involved segments Cobb angle was observed. Neurological function was assessed according to ASIA classification. Results: Except that the operation time of group B was significantly longer than that of group A (t=-2.985, P=0.005), there was no significant difference in intraoperative blood loss, hospitalization time, time of abscess absorption and bone fusion between 2 groups (P>0.05). All patients were followed up 18-47 months (mean, 31.1 months). No cerebrospinal fluid leakage occurred intra- and post-operation. Four patients in group A underwent second-stage operation of abscess debridement and local chemotherapy in abscess cavity via anterior approach. All patients got abscess absorption, meanwhile ESR and CRP level normalized at last follow-up. The involved segments Cobb angle improved significantly when compared with preoperative values in both 2 groups (P<0.05); and there was no significant difference between 2 groups at last follow-up (P>0.05). Nine patients with spinal cord injury had significant neurological recovery at last follow-up (Z=-2.716, P=0.007). Conclusion: Posterior focus debridement, bone grafting, and internal fixation combined with abscess debridement and local chemotherapy in abscess cavity is effective in treatment of thoracolumbar spinal tuberculosis, but in some cases anterior abscess debridement is still required. SN - 1002-1892 UR - https://www.unboundmedicine.com/medline/citation/30129317/[Treatment_of_thoracolumbar_spinal_tuberculosis_by_posterior_focus_debridement_and_bone_grafting_and_fixation_combined_with_psoas_abscess_debridement_and_local_chemotherapy_via_different_approachs]_ L2 - http://www.diseaseinfosearch.org/result/7252 DB - PRIME DP - Unbound Medicine ER -