Sudprasert Weera, Piyapromdee Urawit, Lewsirirat Supphamard
J Med Assoc Thai. 2015 Oct;98(10):993-1000.
C-reactive protein (CRP) or erythrocyte sedimentation rate (ESR) not only are useful in the diagnosis but also are reliable parameters in evaluating the response to treatment and prognosis of tuberculous spondylodiscitis.
To analyze the correlation between neurological recovery and declination of CRP or ESR after two different posterior spinal procedures.
The patients who had neurological deficit due to spinal tuberculosis and undergone spinal surgery between January 2009 and June 2013 were analyzed retrospectively. Posterior transforaminal decompression and interbody fusion were done in group I, whereas posterior transpedicular decompression and posterolateralfusion were performed on group II. Both groups were stabilized with pedicle screw instrumentation. Rapid recovery represented by improvement of at least one Frankel grade within 6 weeks after operation, otherwise it was slow recovery. Inflammatory markers were evaluated at initial diagnosis and at 6-week, 3-month, 6-month, and 1-year post-operation.
There were 31 patients. Group I included 14 cases and group II consisted of 17 cases. The median CRP and ESR at diagnosis were 80.4 mg/L and 78.0 mm/hour respectively. Rapid neurological recovery significantly related to the earlier declination of CRP within the first 6 weeks (p < 0.001). Considering the type of spinal procedures especially at thoracic and thoracolumbar level, neurological recovery in group I was significantly faster than in group II (p = 0.02; relative risk, 2.67; 95% confidence interval, 1.02 to 6.91).
Earlier declination of CRP within six weeks post-operation could determine rapid neurological recovery. Posterior transforaminal decompression and interbody fusion with instrumentation may be a suitable optionfor thoracic and thoracolumbar lesions.
C反应蛋白（CRP）或红细胞沉降率（ESR）不仅在结核病性脊椎椎间盘炎的诊断中有用，而且是评估治疗反应和预后的可靠参数。
分析两种不同的后路脊柱手术后神经功能恢复与CRP或ESR下降之间的相关性。
回顾性分析2009年1月至2013年6月因脊柱结核导致神经功能缺损并接受脊柱手术的患者。第一组行后路经椎间孔减压及椎间融合术，而第二组行后路椎弓根减压及后外侧融合术。两组均采用椎弓根螺钉内固定。术后6周内至少提高一个Frankel分级为快速恢复，否则为缓慢恢复。在初始诊断时以及术后6周、3个月、6个月和1年时评估炎症指标。
共31例患者。第一组14例，第二组17例。诊断时CRP和ESR的中位数分别为80.4mg/L和78.0mm/小时。快速神经功能恢复与术后前6周内CRP较早下降显著相关（p<0.001）。考虑到脊柱手术的类型，尤其是在胸段和胸腰段，第一组的神经功能恢复明显快于第二组（p = 0.02；相对风险，2.67；95%置信区间，1.02至6.91）。
术后6周内CRP较早下降可确定神经功能快速恢复。后路经椎间孔减压及椎间融合内固定术可能是胸段和胸腰段病变的合适选择。
