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[Effect of surgical timing on effectiveness of thoracic spinal tuberculosis with myelopathy].
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2019 Mar 15; 33(3):273-279.ZX

Abstract

Objective

To explore the feasibility of posterior debridement, decompression, bone grafting, and fixation in treatment of thoracic spinal tuberculosis with myelopathy, and investigate the effects of surgical timing on postoperative outcomes.

Methods

The clinical data of 26 patients with thoracic spinal tuberculosis with myelopathy between August 2012 and October 2015 was retrospectively analyzed. All patients underwent posterior unilateral transpedicular debridement, decompression, bone grafting, and fixation and were divided into two groups according to surgical timing. Group A included 11 patients with neurological dysfunction lasting less than 3 months; group B included 15 patients with neurological dysfunction lasting more than 3 months. No significant difference was found between the two groups in gender, age, involved segments, preoperative erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), Cobb angle of involved segment, and preoperative American Spinal Injury Association (ASIA) classification (P>0.05). The operation time, intraoperative blood loss, hospitalization stay, perioperative complications, and bone fusion time were recorded and compared between the two groups. The change of pre- and post-operative Cobb angle of involved segments was calculated. Neurological function was assessed according to ASIA classification.

Results

All patients were followed up 25-60 months (mean, 41.6 months). No cerebrospinal fluid leakage occurred intra- and post-operation. The hospitalization stay and perioperative complications in group A were significantly less than those of group B (P<0.05). There was no significant difference in operation time, intraoperative blood loss, and bone fusion time between the two groups (P>0.05). At last follow-up, there was no significant difference in ESR and CRP between groups A and B (P>0.05), but they were all significantly lower than those before operation (P<0.05). In group A, 1 patient with T 6, 7 tuberculosis developed sinus that healed after dressing; the implants were removed at 20 months with bony union and no recurrence was found after 36 months of follow-up. One patient with T 4, 5 tuberculosis in group B underwent revision because of recurrence and distal junctional kyphosis of the thoracic spine at 26 months after operation. There was no internal fixation-related complications or tuberculosis recurrence occurred in the remaining patients. At last follow-up, the Cobb angles in the two groups significantly improved compared with those before operation (P<0.05), but there was no significant difference in the Cobb angle and correction degree between the two groups (P>0.05). At last follow-up, the ASIA classification of spinal cord function was grade C in 1 case and grade E in 10 cases in group A, and grade D in 2 cases and grade E in 13 cases in group B; the ASIA classification results in the two groups significantly improved compared with preoperative ones (P<0.05), but no significant difference was found between the two groups (Z=-0.234, P=1.000).

Conclusion

Posterior unilateral transpedicular debridement, decompression, bone grafting, and fixation is effective in treatment of thoracic spinal tuberculosis with myelopathy. Early surgery can reduce the hospitalization stays and incidence of perioperative complications.

Authors+Show Affiliations

Department of Orthopedics, Wushan County People's Hospital, Wushan Chongqing, 404700, 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.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

30874381

Citation

Peng, Qiqi, et al. "[Effect of Surgical Timing On Effectiveness of Thoracic Spinal Tuberculosis With Myelopathy]." Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi = Zhongguo Xiufu Chongjian Waike Zazhi = Chinese Journal of Reparative and Reconstructive Surgery, vol. 33, no. 3, 2019, pp. 273-279.
Peng Q, Ou Y, Zhu Y, et al. [Effect of surgical timing on effectiveness of thoracic spinal tuberculosis with myelopathy]. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2019;33(3):273-279.
Peng, Q., Ou, Y., Zhu, Y., Zhao, Z., Luo, W., Du, X., & Li, J. (2019). [Effect of surgical timing on effectiveness of thoracic spinal tuberculosis with myelopathy]. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi = Zhongguo Xiufu Chongjian Waike Zazhi = Chinese Journal of Reparative and Reconstructive Surgery, 33(3), 273-279. https://doi.org/10.7507/1002-1892.201808071
Peng Q, et al. [Effect of Surgical Timing On Effectiveness of Thoracic Spinal Tuberculosis With Myelopathy]. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2019 Mar 15;33(3):273-279. PubMed PMID: 30874381.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - [Effect of surgical timing on effectiveness of thoracic spinal tuberculosis with myelopathy]. AU - Peng,Qiqi, AU - Ou,Yunsheng, AU - Zhu,Yong, AU - Zhao,Zenghui, AU - Luo,Wei, AU - Du,Xing, AU - Li,Jianxiao, PY - 2019/3/16/entrez PY - 2019/3/16/pubmed PY - 2019/8/24/medline KW - Surgical timing KW - decompression KW - myelopathy KW - thoracic spinal tuberculosis SP - 273 EP - 279 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 - 33 IS - 3 N2 - Objective: To explore the feasibility of posterior debridement, decompression, bone grafting, and fixation in treatment of thoracic spinal tuberculosis with myelopathy, and investigate the effects of surgical timing on postoperative outcomes. Methods: The clinical data of 26 patients with thoracic spinal tuberculosis with myelopathy between August 2012 and October 2015 was retrospectively analyzed. All patients underwent posterior unilateral transpedicular debridement, decompression, bone grafting, and fixation and were divided into two groups according to surgical timing. Group A included 11 patients with neurological dysfunction lasting less than 3 months; group B included 15 patients with neurological dysfunction lasting more than 3 months. No significant difference was found between the two groups in gender, age, involved segments, preoperative erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), Cobb angle of involved segment, and preoperative American Spinal Injury Association (ASIA) classification (P>0.05). The operation time, intraoperative blood loss, hospitalization stay, perioperative complications, and bone fusion time were recorded and compared between the two groups. The change of pre- and post-operative Cobb angle of involved segments was calculated. Neurological function was assessed according to ASIA classification. Results: All patients were followed up 25-60 months (mean, 41.6 months). No cerebrospinal fluid leakage occurred intra- and post-operation. The hospitalization stay and perioperative complications in group A were significantly less than those of group B (P<0.05). There was no significant difference in operation time, intraoperative blood loss, and bone fusion time between the two groups (P>0.05). At last follow-up, there was no significant difference in ESR and CRP between groups A and B (P>0.05), but they were all significantly lower than those before operation (P<0.05). In group A, 1 patient with T 6, 7 tuberculosis developed sinus that healed after dressing; the implants were removed at 20 months with bony union and no recurrence was found after 36 months of follow-up. One patient with T 4, 5 tuberculosis in group B underwent revision because of recurrence and distal junctional kyphosis of the thoracic spine at 26 months after operation. There was no internal fixation-related complications or tuberculosis recurrence occurred in the remaining patients. At last follow-up, the Cobb angles in the two groups significantly improved compared with those before operation (P<0.05), but there was no significant difference in the Cobb angle and correction degree between the two groups (P>0.05). At last follow-up, the ASIA classification of spinal cord function was grade C in 1 case and grade E in 10 cases in group A, and grade D in 2 cases and grade E in 13 cases in group B; the ASIA classification results in the two groups significantly improved compared with preoperative ones (P<0.05), but no significant difference was found between the two groups (Z=-0.234, P=1.000). Conclusion: Posterior unilateral transpedicular debridement, decompression, bone grafting, and fixation is effective in treatment of thoracic spinal tuberculosis with myelopathy. Early surgery can reduce the hospitalization stays and incidence of perioperative complications. SN - 1002-1892 UR - https://www.unboundmedicine.com/medline/citation/30874381/[Effect_of_surgical_timing_on_effectiveness_of_thoracic_spinal_tuberculosis_with_myelopathy]_ L2 - http://www.diseaseinfosearch.org/result/7252 DB - PRIME DP - Unbound Medicine ER -