Ling Tingxian, Liu Limin, Yang Xi, Qiang Zhe, Hu Xinxing, An Yonggang
Department of Orthopedics, West China Hospital, Sichuan University, 37 Guoxue Rd, Chengdu, 610041, China,
Eur Spine J. 2015 Mar;24(3):577-85. doi: 10.1007/s00586-014-3742-8. Epub 2014 Dec 27.
To discuss the cause and clinical efficacy of revision surgery for secondary deformity after treatment of spinal tuberculosis with debridement, instrumentation, and fusion.
From September 2007 to March 2013, 15 patients with postoperative secondary deformity after treatment of spinal tuberculosis were enrolled. Constitutional symptoms, laboratory findings, and radiographic evidence were used to evaluate the secondary deformity conditions and diagnose the recurrence of spinal tuberculosis. All patients underwent revision surgery. The clinical and radiographic data from before and after previous surgery, before and after revision surgery, and after a minimum follow-up of 9 months were retrospectively reviewed.
Among 15 cases of secondary deformity, there were 8 recurrences of spinal tuberculosis. Anterior instrumentation was used in 9 patients, and posterior instrumentation in 6. Regarding previous surgery, the mean number of involved segments was 2 vertebral bodies; a mean of 4 vertebral bodies were fused; the mean preoperative scoliosis of 14.5° was corrected to 6.5° (52.08 % correction); the mean preoperative kyphosis of 56.4° was corrected to 28.9° (44.8 % correction). Before revision surgery, the mean kyphotic angle increased to 58.6° and the mean scoliosis angle increased to 19.6°. New deformity occurred at the primary levels in 11 patients and at the level adjacent to fused segments in 4. After revision surgery, a mean of 8 vertebral bodies were fused; at final follow-up, the mean kyphotic angle was corrected to 26.7° and the mean scoliosis angle was corrected to 2.4°. No neurologic complications were observed during or after revision surgery. No complications with instrumentation and recurrence of spinal tuberculosis were found at final follow-up.
Recurrence of spinal tuberculosis, incorrect choice of internal fixation strategy, unsuitable fused segments, and poor achievement of sagittal and coronal balance after surgery may lead to secondary deformity postoperatively. Good clinical outcomes were obtained by revision surgery to extend the fused segments, albeit with decreased spinal range of motion.
探讨脊柱结核病灶清除、内固定及融合术后继发畸形翻修手术的原因及临床疗效。
选取2007年9月至2013年3月期间15例脊柱结核术后继发畸形患者。采用全身症状、实验室检查结果及影像学证据评估继发畸形情况并诊断脊柱结核复发。所有患者均接受翻修手术。回顾性分析患者初次手术前后、翻修手术前后及至少9个月随访后的临床及影像学资料。
15例继发畸形患者中，8例为脊柱结核复发。9例患者采用前路内固定，6例采用后路内固定。初次手术时，平均受累节段为2个椎体；平均融合4个椎体；术前平均脊柱侧弯14.5°矫正至6.5°（矫正率52.08%）；术前平均后凸畸形56.4°矫正至28.9°（矫正率44.8%）。翻修手术前，平均后凸角增至58.6°，平均脊柱侧弯角增至19.6°。11例患者在原手术节段出现新畸形，4例在融合节段相邻节段出现新畸形。翻修手术后，平均融合8个椎体；末次随访时，平均后凸角矫正至26.7°，平均脊柱侧弯角矫正至2.4°。翻修手术期间及术后未观察到神经并发症。末次随访时未发现内固定相关并发症及脊柱结核复发。
脊柱结核复发、内固定策略选择不当、融合节段不合适及术后矢状面和冠状面平衡不佳可能导致术后继发畸形。翻修手术通过延长融合节段取得了良好的临床效果，尽管脊柱活动度有所下降。
