Shen Xiongjie, Huang Xiangwang, Xiao Sheng, Liu Hongzhe, Zhang Yi, Xiang Tiecheng, Wang Guoping, Sheng Bin, Huang Shu, Liu Xiangyang
Department of Spine Surgery, Hunan Provincial People's Hospital Changsha 410005, Hunan, People's Republic of China.
Int J Clin Exp Med. 2015 Oct 15;8(10):18611-9. eCollection 2015.
The retrospective clinical study is to determine the feasibility and efficacy of surgical management of multilevel contiguous thoracolumbar spinal tuberculosis (MCTLST) by only posterior instrumentation without posterior or anterior bone fusion and without anterior fixation in the study of eleven selected cases. Eleven selected cases with MCTLST were treated with combined posterior instrumentation and debridement and/or decompression without any bone fusion. The mean follow-up was 33.1 months (range 20-48 months). The kyphosis angle ranged from 9.2 to 40.4° before operation, 27.8° in average. The American Spinal Injury Association (ASIA) score system was used to evaluate the neurological deficits and erythrocytesedimentationrate (ESR) used to judge the activity of tuberculosis, which were collected at certain time. Spinal tuberculosis (STB) was completely cured in all eleven patients. There was no recurrent tuberculosis infection. The postoperative kyphosis angle was 7.1° to 12.5°, 9.6° in average and there was no significant loss of the correction at the final follow-up. Solid fusion was achieved in all cases. Neurological condition in all patients was improved after surgery. In conclusions, combined posterior instrumentation and debridement and/or decompression without any bone fusion can be a feasible and effective method in treatment of patients with MCTLST. However, the strict selection of patients was the critical of the surgery success.
本回顾性临床研究旨在通过仅采用后路内固定，不进行后路或前路植骨融合且不进行前路固定，来确定手术治疗多节段连续性胸腰椎脊柱结核（MCTLST）的可行性和疗效，研究选取了11例患者。11例选取的MCTLST患者接受了后路内固定联合清创和/或减压治疗，未进行任何植骨融合。平均随访时间为33.1个月（范围20 - 48个月）。术前后凸角范围为9.2°至40.4°，平均为27.8°。采用美国脊髓损伤协会（ASIA）评分系统评估神经功能缺损情况，并在特定时间收集红细胞沉降率（ESR）以判断结核活动度。11例患者的脊柱结核（STB）均完全治愈，无结核复发感染。术后后凸角为7.1°至12.5°，平均为9.6°，末次随访时矫正度无明显丢失。所有病例均实现了牢固融合。所有患者术后神经功能均有改善。总之，后路内固定联合清创和/或减压且不进行任何植骨融合可能是治疗MCTLST患者的一种可行且有效的方法。然而，严格选择患者是手术成功的关键。
