Shetty Ajoy Prasad, Bosco Aju, Rajasekaran Shanmuganathan, Kanna Rishi Mugesh
Department of Orthopaedics and Spine Surgery, Ganga Hospital, 313, Mettupalayam Road, Coimbatore 641043, India.
Department of Orthopaedics and Spine Surgery, Ganga Hospital, 313, Mettupalayam Road, Coimbatore 641043, India.
Spine Deform. 2019 Mar;7(2):356-363. doi: 10.1016/j.jspd.2018.08.005.
Single-center retrospective cohort analysis.
To analyze the impact of loss of global lumbar lordosis (GLL) on functional outcomes in tuberculosis of the lumbar and lumbosacral spine and to define strategies to restore or preserve the physiological lumbar lordosis.
In tuberculosis of lumbosacral spine, loss of lumbar lordosis (LL) leads to altered lumbosacral biomechanics. All available studies have assessed treatment outcomes with respect to physical well-being, neurologic improvement, bone healing, and changes in radiologic parameters. None have studied the correlation between functional outcomes and LL following treatment. We reviewed 63 patients with tuberculosis of lumbar and lumbosacral spine, with an attempt to analyze the impact of loss of GLL on functional outcomes and have defined strategies to restore the same.
We retrospectively reviewed 63 patients with lumbar and lumbosacral tuberculosis, treated conservatively (n = 33) or surgically (n = 30) from March 2007 to July 2013. Average follow-up was 43.1±7.2 months. The correlation between posttreatment GLL and the functional outcome (Oswestry Disability Index), measured at 36 months' follow-up, was analyzed.
All patients showed good bone healing (at 8.4±1.5 months), significant improvement in neurology, VAS scores, ESR and CRP, p<0.001. Mean loss of GLL in the conservatively treated group was 6.4°±5.7°, whereas there was an average gain of 10.9°±9.9° of GLL with surgery. In all patients with minimal disability at the end of treatment, the final GLL was above 40°. In patients with severe disability and in a few with moderate disability, the posttreatment GLL was below 40°. Pearson's test showed a strong negative correlation between final posttreatment GLL and the degree of disability (r = -0.867, p<0.001).
Early disease with minimal loss of lordosis can be managed conservatively, whereas in advanced disease with gross hypolordosis/kyphosis, posterior stabilization with or without global spinal reconstruction is essential to regain LL. The management of lumbosacral tuberculosis should aim at preserving or restoring the normal LL to achieve good functional outcomes.
Level III.
单中心回顾性队列分析。
分析腰椎和腰骶椎结核中整体腰椎前凸（GLL）丧失对功能结局的影响，并确定恢复或保留生理性腰椎前凸的策略。
在腰骶椎结核中，腰椎前凸（LL）丧失会导致腰骶部生物力学改变。所有现有研究均评估了身体状况、神经功能改善、骨愈合及放射学参数变化方面的治疗结局。尚无研究探讨治疗后功能结局与LL之间的相关性。我们回顾了63例腰椎和腰骶椎结核患者，试图分析GLL丧失对功能结局的影响，并确定恢复GLL的策略。
我们回顾性分析了2007年3月至2013年7月间接受保守治疗（n = 33）或手术治疗（n = 30）的63例腰椎和腰骶椎结核患者。平均随访时间为43.1±7.2个月。分析了治疗后GLL与随访36个月时的功能结局（Oswestry功能障碍指数）之间的相关性。
所有患者均显示良好的骨愈合（8.4±1.5个月），神经功能、视觉模拟评分（VAS）、红细胞沉降率（ESR）和C反应蛋白（CRP）均有显著改善，p<0.001。保守治疗组GLL平均丧失6.4°±5.7°，而手术治疗后GLL平均增加10.9°±9.9°。在治疗结束时残疾程度最小的所有患者中，最终GLL均高于40°。在重度残疾患者及少数中度残疾患者中，治疗后GLL低于40°。Pearson检验显示治疗后最终GLL与残疾程度之间存在强负相关（r = -0.867，p<0.001）。
前凸丧失最小的早期疾病可采用保守治疗，而在存在严重腰椎前凸减少/后凸畸形的晚期疾病中，则必须进行后路稳定术，可联合或不联合全脊柱重建以恢复LL。腰骶椎结核的治疗应旨在保留或恢复正常LL以获得良好的功能结局。
三级。
