Park Clinic, 4 Gorky Terrace, Kolkata, India.
Eur Spine J. 2012 Oct;21(10):2011-8. doi: 10.1007/s00586-012-2259-2. Epub 2012 Mar 29.
The purpose of the study was to find out if transpedicular decancellation osteotomy (TDO) is recommendable for neurological recovery in patients with myelopathy due to tubercular rigid kyphosis. We have analyzed the pattern of recovery seen after the surgery and also made an effort to correlate the neurological recovery with preoperative clinical and radiological features.
The clinical parameters used were (1) ASIA impairment scale for motor and sensory function, (2) sphincter dysfunction score, (3) time duration from the onset of myelopathy till the date of surgery, and (4) SRS 30 outcomes questionnaire. Radiological parameters used were (1) Cobb's angle in standing/sitting radiographs, (2) levels of gibbus, (3) cord changes in sagittal T2 MRI images, and (4) percentage of cord compression. Assessment was done preoperatively and at 1 month, 3 months, 6 months, 1 year and at 2 years postoperatively.
Seventeen patients were included. The follow-up period was 2 years. We had one patient in ASIA A, nine patients in ASIA C and seven patients in ASIA D. Four patients with ASIA C presented with mild sphincter disturbance (score 2) and one presented with severe disturbance (score 1). The ASIA A patient had complete retention (score 0). The ASIA impairment scale improved after surgery, with maximum improvement at 3 months and improvement continuing up to 6 months. 16 (94 %) patients had improvement in lower limb function and 5 (83 %) patients had improvement of sphincter function. 94 % patients had neurological recovery after the operation. The neurological recovery reached a plateau at 6 months with no significant improvement in the further follow-up. Preoperative MRI changes, cord compression and duration from onset of myelopathy to day of surgery were not predictive of the final neurological outcome after surgery.
TDO gives good results in delayed onset neurological deficits in caries spine with rigid kyphosis. At least, one grade improvement in the neurological status of patients with ASIA C and ASIA D can be expected. Maximum improvement in the neurology is seen in the first 3 months and up to 6 months from the date of surgery, without much improvement thereafter. Level of evidence Level IV.
本研究旨在探讨经椎弓根楔形截骨术（TDO）是否有助于结核性僵直性后凸脊柱畸形所致脊髓病患者的神经恢复。我们分析了手术后的恢复模式，并努力将神经恢复与术前的临床和影像学特征相关联。
临床参数包括（1）ASIA 运动和感觉功能损伤量表，（2）括约肌功能障碍评分，（3）从脊髓病发病到手术日期的时间间隔，以及（4）SRS 30 结果问卷。影像学参数包括（1）站立/坐位 X 线片上的 Cobb 角，（2）后凸的水平，（3）矢状位 T2 MRI 图像上的脊髓变化，以及（4）脊髓压迫的百分比。评估在术前和术后 1 个月、3 个月、6 个月、1 年和 2 年进行。
纳入 17 例患者，随访 2 年。ASIA 分级为 A 级 1 例，C 级 9 例，D 级 7 例。C 级 4 例有轻度括约肌障碍（评分 2），1 例有严重障碍（评分 1）。A 级患者完全保留（评分 0）。ASIA 损伤量表在手术后得到改善，最大改善在 3 个月，持续改善至 6 个月。16（94%）例下肢功能改善，5（83%）例括约肌功能改善。术后 94%的患者神经功能恢复。术后 6 个月神经恢复达到平台期，进一步随访无明显改善。术前 MRI 变化、脊髓压迫和从脊髓病发病到手术日的时间与术后最终神经结局无关。
TDO 对伴有僵直性后凸的陈旧性神经功能缺损的脊柱结核有较好的效果。至少可以预期 ASIA C 和 D 级患者的神经状态有一级改善。神经功能的最大改善发生在手术前 3 个月和手术后 6 个月，此后改善不大。证据水平为 IV 级。
