Huang Yun-Peng, Lin Jian-Hua, Chen Xiao-Ping, Wu Gui, Chen Xuan-Wei
Department of Spine Surgery, The First Affiliated Hospital of Fujian Medical University, 20 Chazhong Road, Fuzhou City, 350005, Fujian Province, China.
School of Mathematics and Informatics, Fujian Normal University, Fuzhou City, 350117, Fujian Province, China.
J Orthop Surg Res. 2018 Nov 20;13(1):292. doi: 10.1186/s13018-018-0994-8.
Posterior transfacet approach has been proved to be a safe and effective access to treat thoracic disc herniation. However, the therapeutic effect and safety of modified transfacet approach for treating thoracic spinal tuberculosis (TST) has not been reported in the clinical literature. In this study, the clinical efficacy and safety of a single-stage posterior modified transfacet debridement, posterior instrumentation, and interbody fusion for treating TST were retrospectively evaluated.
From 2009 to 2014, 37 patients with TST underwent a posterior modified transfacet debridement, interbody fusion following posterior instrumentation, under the cover of 18 months of antituberculosis chemotherapy. The patients were evaluated preoperatively and postoperatively in terms of Frankel Grade, visual analog scale (VAS) pain score, kyphotic Cobb angle, and bony fusion.
The follow-up time was 39.8 ± 5.1 months (29-50 months). No postoperative complication or recurrence of spinal tuberculosis was observed. Definitive bony fusion was achieved in all patients. At the final follow-up, 2 cases were rated as Frankel grade D, 35 as grade E. VAS was recovered from 8.4 ± 1.0 cm to 0.4 ± 0.8 cm. The kyphotic angles were corrected from 29.4 ± 10.9° to 17.6 ± 6.3°. Using the Kirkaldy-Willis criteria, functional outcome was excellent in 29 patients, good in 7, and fair in 1.
Our preliminary results showed that single-stage posterior modified transfacet debridement, posterior instrumentation, and interbody fusion are effective and safe surgical options for treating TST.
后路经关节突入路已被证明是治疗胸椎间盘突出症的一种安全有效的入路。然而，改良经关节突入路治疗胸椎结核（TST）的治疗效果和安全性在临床文献中尚未见报道。本研究回顾性评估了一期后路改良经关节突清创、后路内固定及椎间融合治疗TST的临床疗效和安全性。
2009年至2014年，37例TST患者在接受18个月抗结核化疗的掩护下，接受了后路改良经关节突清创、后路内固定后椎间融合术。对患者术前和术后进行Frankel分级、视觉模拟量表（VAS）疼痛评分、后凸Cobb角和骨融合情况评估。
随访时间为39.8±5.1个月（29 - 50个月）。未观察到术后并发症或脊柱结核复发。所有患者均实现了确定性骨融合。末次随访时，2例患者Frankel分级为D级，35例为E级。VAS评分从8.4±1.0 cm恢复至0.4±0.8 cm。后凸角从29.4±10.9°矫正至17.6±6.3°。根据Kirkaldy-Willis标准，29例患者功能结果为优，7例为良，1例为中。
我们的初步结果表明，一期后路改良经关节突清创、后路内固定及椎间融合是治疗TST的有效且安全的手术选择。
