Huang Jia, Zhang Hongqi, Zeng Kefeng, Gao Qile
From the Department of Spine Surgery, Xiangya Hospital of Central South University, Changsha, China.
PLoS One. 2014 Apr 3;9(4):e93648. doi: 10.1371/journal.pone.0093648. eCollection 2014.
A retrospective clinical study.
To evaluate the clinical efficacy of the surgical treatment of noncontiguous spinal tuberculosis (NSTB), and to discuss its therapeutic strategies.
We performed a retrospective review of clinical and radiographic data that were prospectively collected on 550 consecutive spinal tubercular patients including 27 patients who were diagnosed and treated as NSTB in our institution from June 2005 to June 2011. Apart from 4 patients being treated conservatively, the remainder received surgery by posterior transforaminal debridement, interbody fusion with instrumentation, posterior instrumentation and anterior debridement with fusion in a single or two-stage operation. The clinical outcomes were evaluated before and after treatment in terms of hematologic and radiographic examinations, bone fusion and neurologic status. The Oswestry Disability Index score was determined before treatment and at the last follow-up visit.
23 patients (15 M/8F), averaged 44.6 ± 14.2 years old (range, 19 to 70 yd), who received surgical treatment, were followed up after surgery for a mean of 52.5 ± 19.5 months (range, 24 to 72 months). The kyphotic angle was changed significantly between pre- and postoperation (P<0.05). The mean amount of correction was 12.6 ± 7.2 degrees, with a small loss of correction at last follow-up. All patients achieved solid bone fusion. No patients with neurological deficit deteriorated postoperatively. Neither mortalities nor any major complications were found. There was a significant difference of Oswestry Disability Index scores between preoperation and the final follow-up.
The outcomes of follow-up showed that posterior and posterior-anterior surgical treatment methods were both viable surgical options for NSTB. Posterior transforaminal debridement, interbody fusion and posterior instrumentation, as a less invasive technique, was feasible and effective to treat specific tubercular foci.
一项回顾性临床研究。
评估非连续性脊柱结核（NSTB）手术治疗的临床疗效，并探讨其治疗策略。
我们对550例连续性脊柱结核患者的临床和影像学数据进行了回顾性分析，这些数据是在2005年6月至2011年6月期间前瞻性收集的，其中包括在我们机构被诊断并治疗为NSTB的27例患者。除4例患者接受保守治疗外，其余患者接受了后路经椎间孔清创术、椎间融合内固定术、后路内固定术以及一期或二期前路清创融合术。通过血液学和影像学检查、骨融合情况及神经功能状态对治疗前后的临床结果进行评估。在治疗前及最后一次随访时测定Oswestry功能障碍指数评分。
23例接受手术治疗的患者（15例男性/8例女性），平均年龄44.6±14.2岁（范围19至70岁），术后平均随访52.5±19.5个月（范围24至72个月）。术前和术后的后凸角有显著变化（P<0.05）。平均矫正角度为12.6±7.2度，在最后一次随访时矫正角度略有丢失。所有患者均实现了牢固的骨融合。没有神经功能缺损的患者术后病情恶化。未发现死亡病例及任何严重并发症。术前和最后一次随访时的Oswestry功能障碍指数评分有显著差异。
随访结果表明，后路及前后路联合手术治疗方法对于NSTB均是可行的手术选择。后路经椎间孔清创、椎间融合及后路内固定术作为一种侵入性较小的技术，对于治疗特定结核病灶是可行且有效的。
