T Zin-Naing Mrcs
Department of Orthopaedic Surgery, Yangon Orthopaedic Hospital, Yangon, Myanmar.
Malays Orthop J. 2014 Nov;8(3):15-21. doi: 10.5704/MOJ.1411.004.
The aims of spinal tuberculosis treatment are to eradicate the disease, to prevent the development of paraplegia and kyphotic deformity, to manage the existing deformity and neurological deficit, to allow early ambulation and to return the patient back to daily life. Methods for the treatment of tuberculosis of vertebra are still controversial. Conservative treatment includes medical therapy as well as external supports and surgery is indicated for deformity of spine, severe pain, or neurological compromise conditions. Most cases in our country were late presentations with disc space already infected, and after débridement there was a large gap needing bone graft to enhance bony fusion and anterior column support. Although the spine was infected, instrumentation posed no additional hazard in terms of tuberculous discitis. Oga et al. reported that M. tuberculosis has low adhesion capability and forms only a few microcolonies surrounded by a biofilm. Moon et al. stated that interbody fusion performed with classical anterior radical surgery per se was ineffective in the correction of kyphosis and did not prevent the increase in kyphosis angle. The present study focuses on collected clinical and radiographic outcomes in ten patients who underwent Posterior Lumbar Interbody Fusion (PLIF) for tuberculous lumbosacral spine. All the cases had instability with kyphotic deformity or loss of lordosis. Clinical outcomes were measured by Visual Analogue Scale (VAS), modified MacNab Criteria, and radiographic outcomes (segmental kyphotic angle and total lumbar lordotic, TLL, angle) on follow-up to six months. The mean VAS back scores showed decrease, and kyphotic angles and lordotic angles improved. Three cases had excellent results, six good and one fair using the modified MacNab criteria.
脊柱结核治疗的目的是根除疾病，预防截瘫和脊柱后凸畸形的发生，处理现有的畸形和神经功能缺损，使患者能够早期行走并回归日常生活。脊椎结核的治疗方法仍存在争议。保守治疗包括药物治疗以及外部支撑，而对于脊柱畸形、严重疼痛或神经功能受损的情况则需要进行手术治疗。我国大多数病例就诊时病情已较晚，椎间盘间隙已被感染，清创后存在较大间隙，需要植骨以促进骨融合和增强前柱支撑。尽管脊柱已被感染，但内固定在结核性椎间盘炎方面并未带来额外风险。奥加等人报告称，结核分枝杆菌的黏附能力较低，仅形成少数被生物膜包围的微菌落。穆恩等人指出，采用经典前路根治性手术进行椎间融合本身在矫正脊柱后凸方面效果不佳，且无法防止后凸角度增加。本研究聚焦于10例因腰骶部脊柱结核接受后路腰椎椎间融合术（PLIF）患者的临床和影像学结果。所有病例均存在脊柱后凸畸形或腰椎前凸消失导致的不稳定。通过视觉模拟量表（VAS）、改良MacNab标准评估临床结果，并在随访至6个月时测量影像学结果（节段性后凸角和腰椎总前凸角，TLL）。VAS背部评分均值下降，后凸角和前凸角均有所改善。采用改良MacNab标准评估，3例结果优秀，6例良好，1例一般。
