Sahoo Madan M, Mahapatra Sudhir K, Sethi Gopal C, Dash Sunil K
Department of Orthopedics, VSS Medical College, Burla-Sambalpur, India.
J Spinal Disord Tech. 2012 Oct;25(7):E217-23. doi: 10.1097/BSD.0b013e31826a088e.
A retrospective case study series.
To evaluate the results of posterior decompression and transpedicular screw fixation in 18 cases of thoracolumbar spinal tuberculosis with neurological deficit.
Spinal tuberculosis has been managed with various modalities of treatment ranging from only antitubercular drugs to radical procedures such as anterior or combined approach surgeries. However, although the former method of treatment sometimes is met with unacceptable kyphosis, the later is considered to be too drastic. In the present study, authors have shown the results of posterior decompression and pedicle screw fixation in selected cases of Pott paraplegia.
The cases (12 males and 6 females) were operated with a posterior decompression and transpedicular screw fixation in a single stage along with antitubercular drug treatment. All of these patients had varying degrees of neurological deficit (4 with Frankel grade A, 8 Frankel B, 4 Frankel C, and 2 Frankel D) and single level involvement with <50% vertebral body destruction and mild kyphosis of 8-27 degrees. Short-segment pedicle screw fixation, posterior decompression, and correction of kyphosis were performed in single stage.
Kyphosis improved from preoperative value of 17.7±5.8 degrees to 9.4±4.6 degrees postoperatively. At a follow-up period of 24-46 months, final kyphosis correction was maintained at 11.6±5.4 degrees. Bony fusion was achieved in 55.5% cases. Neurological recovery occurred in 17 patients (94.4%). All patients became pain free, with final visual analogue score 0-2.
The procedure in safe and has satisfactory results in early active cases of Pott paraplegia with less destruction of vertebral bodies.
回顾性病例系列研究。
评估18例伴有神经功能缺损的胸腰椎脊柱结核患者行后路减压及经椎弓根螺钉内固定术的效果。
脊柱结核的治疗方式多种多样，从单纯抗结核药物治疗到诸如前路或联合入路手术等根治性手术。然而，尽管前一种治疗方法有时会导致不可接受的后凸畸形，但后一种方法又被认为过于激进。在本研究中，作者展示了在部分波特氏截瘫病例中行后路减压及椎弓根螺钉内固定术的效果。
对12例男性和6例女性患者进行一期后路减压及经椎弓根螺钉内固定术，并给予抗结核药物治疗。所有这些患者均有不同程度的神经功能缺损（Frankel A级4例，Frankel B级8例，Frankel C级4例，Frankel D级2例），且为单节段受累，椎体破坏<50%，后凸畸形8 - 27度。一期行短节段椎弓根螺钉内固定、后路减压及后凸畸形矫正。
后凸畸形从术前的17.7±5.8度改善至术后的9.4±4.6度。在24 - 46个月的随访期内，最终后凸畸形矫正维持在11.6±5.4度。55.5%的病例实现了骨性融合。17例患者（94.4%）神经功能恢复。所有患者均不再疼痛，最终视觉模拟评分0 - 2分。
该手术安全，对于椎体破坏较轻的早期活动性波特氏截瘫病例效果满意。
