Liu Shaohua, Deng Zhansheng, Chen Jing, Wang An, Jiang Liyuan
Department of Spinal Surgery, Xiangya Hospital, Central South University, Changsha 410008, China.
Zhong Nan Da Xue Xue Bao Yi Xue Ban. 2015 Dec;40(12):1345-51. doi: 10.11817/j.issn.1672-7347.2015.12.010.
To investigate the clinical efficacy and feasibility of surgical treatment for thoracic spinal tuberculosis with intraspinal abscesses by internal fixation, unilateral vertebral lamina limited decompression, debridement, together with interbody and posterior fusion via a posterior only approach.
A total of 37 pantients (24 males and 13 females) with thoracic spinal tuberculosis complicated with intraspinal abscess lesions were admitted to our hospital, with age 13-68(39.7 ± 9.1) years old. Spinal lesions of segmental kyphosis Cobb angle was 8°-62° (29.6° ± 3.6°). Frankel grade system was used to assess neurological function. According to the system, there were 3, 7, 19 and 8 cases for grade B, C, D and E, respectively. All 37 cases were treated with internal fixation, unilateral vertebral lamina limited decompression, debridement, together with interbody and posterior fusion via a posterior only approach.
The mean duration for follow-up was 24-90 (53.0 ± 15.7) months. Intraoperative dural tear occurred in 1 cases with cerebrospinal fluid leakage after operation; 2 cases showed postoperative neurological complications; delayed wound healing occurred in 2 cases. The postoperative kyphotic angle was 5°-21° (8.3° ± 1.3°). The kyphotic angle was 8°-26° (10.1° ± 1.9°) at the last follow-up. By the time of the last follow-up, all patients with preoperative neurological symptoms improved at different degree. According to Frankel classification, 2 cases recovered from grade B to D, 1 case from grade B to E, 3 cases from grade C to D, 4 cases from grade C to E, 13 cases from grade D to E. No failure in fixation and pseudarthrosis. All patients obtained satisfactory bone graft fusion.
Posterior internal fixation, unilateral vertebral lamina limited decompression, debridement, together with interbody and posterior fusion might be a effective and feasible method for treatment of thoracic spinal tuberculosis with intraspinal abscess lesions.
探讨后路内固定、单侧椎板有限减压、病灶清除、椎间植骨融合及后路融合术治疗胸椎结核伴椎管内脓肿的临床疗效及可行性。
收治胸椎结核合并椎管内脓肿患者37例（男24例，女13例），年龄13～68岁（39.7±9.1岁）。脊柱病变节段后凸Cobb角为8°～62°（29.6°±3.6°）。采用Frankel分级系统评估神经功能。根据该系统，B、C、D、E级分别为3例、7例、19例和8例。37例均采用后路内固定、单侧椎板有限减压、病灶清除、椎间植骨融合及后路融合术治疗。
平均随访时间24～90个月（53.0±15.7个月）。术中硬脊膜撕裂1例，术后出现脑脊液漏；术后神经功能并发症2例；伤口延迟愈合2例。术后后凸角为5°～21°（8.3°±1.3°）。末次随访时后凸角为8°～26°（10.1°±1.9°）。末次随访时，所有术前有神经症状的患者均有不同程度改善。按Frankel分级，2例从B级恢复至D级，1例从B级恢复至E级，3例从C级恢复至D级，4例从C级恢复至E级，13例从D级恢复至E级。无内固定失败及假关节形成。所有患者均获得满意的植骨融合。
后路内固定、单侧椎板有限减压、病灶清除、椎间植骨融合及后路融合术可能是治疗胸椎结核伴椎管内脓肿的一种有效可行的方法。
