Spine Unit, Orthopaedic Department, Combined Military Hospital, Rawalpindi, Pakistan.
Eur Spine J. 2013 Jun;22 Suppl 4(Suppl 4):618-23. doi: 10.1007/s00586-012-2459-9. Epub 2012 Aug 15.
Tuberculous spondylitis (TBS) is the most common form of extra-pulmonary tuberculosis. The mainstay of TBS management is anti-tuberculous chemotherapy. Most of the patients with TBS are treated conservatively; however in some patients surgery is indicated. Most common indications for surgery include neurological deficit, deformity, instability, large abscesses and necrotic tissue mass or inadequate response to anti-tuberculous chemotherapy. The most common form of TBS involves a single motion segment of spine (two adjoining vertebrae and their intervening disc). Sometimes TBS involves more than two adjoining vertebrae, when it is called multilevel TBS. Indications for correct surgical management of multilevel TBS is not clear from literature.
We have retrospectively reviewed 87 patients operated in 10 years for multilevel TBS involving the thoracolumbar spine at our spine unit. Two types of surgeries were performed on these patients. In 57 patients, modified Hong Kong operation was performed with radical debridement, strut grafting and anterior instrumentation. In 30 patients this operation was combined with pedicle screw fixation with or without correction of kyphosis by osteotomy. Patients were followed up for correction of kyphosis, improvement in neurological deficit, pain and function. Complications were noted. On long-term follow-up (average 64 months), there was 9.34 % improvement in kyphosis angle in the modified Hong Kong group and 47.58 % improvement in the group with pedicle screw fixation and osteotomy in addition to anterior surgery (p < 0.001). Seven patients had implant failures and revision surgeries in the modified Hong Kong group. Neurological improvement, pain relief and functional outcome were the same in both groups.
We conclude that pedicle screw fixation with or without a correcting osteotomy should be added in all patients with multilevel thoracolumbar tuberculous spondylitis undergoing radical debridement and anterior column reconstruction.
结核性脊柱炎（TBS）是最常见的肺外结核形式。TBS 管理的主要方法是抗结核化学疗法。大多数 TBS 患者接受保守治疗；然而，在某些患者中，手术是指征。手术的最常见指征包括神经功能缺损、畸形、不稳定、大脓肿和坏死组织肿块或对抗结核化学疗法反应不足。最常见的 TBS 形式涉及脊柱的单个运动节段（两个相邻的椎体及其之间的椎间盘）。有时 TBS 涉及两个以上相邻的椎体，称为多节段 TBS。文献中没有明确指出多节段 TBS 正确手术治疗的指征。
我们回顾性分析了在我们脊柱外科单元在 10 年内接受多节段胸腰椎 TBS 手术的 87 例患者。对这些患者进行了两种类型的手术。在 57 例患者中，进行了改良香港手术，包括彻底清创、支撑植骨和前路器械固定。在 30 例患者中，该手术结合了经皮螺钉固定，必要时通过截骨术矫正后凸畸形。随访患者的后凸畸形矫正、神经功能缺损、疼痛和功能改善情况。记录并发症。在长期随访（平均 64 个月）中，改良香港组的后凸角改善了 9.34%，而经皮螺钉固定和截骨术加前路手术组的后凸角改善了 47.58%（p<0.001）。改良香港组中有 7 例患者发生植入物失败和翻修手术。两组的神经功能改善、疼痛缓解和功能结果相同。
我们的结论是，在所有接受彻底清创和前柱重建的多节段胸腰椎结核患者中，应添加经皮螺钉固定和/或矫正性截骨术。
