Jain Mantu, Sahu Rabi Narayan, Behera Sudarsan, Rana Rajesh, Tripathy Sujit Kumar, Pattnaik Ashish
Department of Orthopedics, AIIMS, Bhubaneswar, Odisha, India.
Department of Neurosurgery, AIIMS, Bhubaneswar, Odisha, India.
J Neurosci Rural Pract. 2019 Apr-Jun;10(2):225-233. doi: 10.4103/jnrp.jnrp_294_18.
Surgical management of spinal tuberculosis (TB) has been classically the anterior, then combined, and of late increasingly by the posterior approach. The posterior approach has been successful in early disease. There has been a paradigm shift and inquisitive to explore this approach in the more advanced and even long-segment disease. Our study is a retrospective analysis by authors in variable disease pattern of TB Spine operated at an institute using a single posterior approach.
A retrospective case study series in a tertiary level hospital.
The aim of this study is to evaluate the functional and radiological results of an all posterior instrumented approach used as a "universal approach" in tubercular spondylodiscitis of variable presentation.
The study is from January 2015 to May 2018. Twenty-four of 38 patients met the inclusion criterion with a male: female = 8:16, and mean age 44.26 years. The initial diagnosis of TB was based on clinic-radiologic basis. Their level of affection, number of vertebrae affected, and vertebral body collapse, the kyphosis (preoperative, predicted, postoperative, and final residual) and bony fusion were measured in the preoperative, postoperative, and final X rays. Functional scoring regarding visual analog scale and Frankel neurology grading was done at presentation and follow-up of patients. Histopathological data of all patients were collected and anti-tubercular therapy completed for a period of 1 year with 4 drugs (HRZE) for 2 months and 2 drugs (HR) for rest of period.
The descriptive data were analyzed by descriptive statistics, and other parameters were calculated using the appropriate statistical tests such as the Student paired -test for erythrocyte sedimentation rate, visual analog scale score, and kyphosis.
The mean number of vertebrae involved was 3.29 ± 0.86 (2-6) with mean vertebral body destruction was 0.616. Preoperatively, the mean kyphosis angle was 22.42° ± 12.56° and was corrected postoperatively to 13.08° ± 11.34° with an average correction of 9.34° (41.66%). At the latest follow-up, there was mean loss of correction of 0.80° resulting in 13.88° of final correction. Bony fusion was achieved in 20 patients (83.33%) cases. Neurological recovery occurred in all patients (100%), and 92% could be ambulatory at 1 year follow-up. There was improvement of visual analog scale from 6.33 ± 1.05 preoperatively to 1.042 ± 0.75 at 3 months of postoperative period. Two patients had bed sore, two had urinary infection, and one had neurological worsening requiring re exploration and cage removal eventually recovering to Frankel E. Two patients died due to unrelated cause.
The procedure in safe and has satisfactory results in variable group affection of Pott's spine including early and late disease, multisegment involvement using pedicle screw fixation with/without cage support.
脊柱结核的外科治疗传统上先是前路手术，然后是联合手术，近来越来越多地采用后路手术。后路手术在早期疾病治疗中已取得成功。目前出现了一种模式转变，人们开始探究在病情更严重甚至累及长节段的疾病中采用这种手术方式的效果。我们的研究是作者对在一家机构采用单一后路手术治疗的不同病情模式的脊柱结核病例进行的回顾性分析。
在一家三级医院进行的回顾性病例研究系列。
本研究的目的是评估在不同表现形式的结核性脊椎间盘炎中，将全后路器械辅助手术作为“通用手术方式”的功能和影像学结果。
本研究时间跨度为2015年1月至2018年5月。38例患者中有24例符合纳入标准，男女比例为8:16，平均年龄44.26岁。结核病的初步诊断基于临床影像学依据。在术前、术后及最终的X线片上测量其受累节段、受累椎体数量、椎体塌陷情况、后凸畸形（术前、预测值、术后及最终残余值）以及骨融合情况。在患者就诊及随访时进行视觉模拟评分和Frankel神经功能分级的功能评分。收集所有患者的组织病理学数据，并采用4种药物（HRZE）治疗2个月、其余时间采用2种药物（HR）进行为期1年的抗结核治疗。
描述性数据采用描述性统计进行分析，其他参数使用适当的统计检验进行计算，如用于红细胞沉降率、视觉模拟评分和后凸畸形的学生配对检验。
受累椎体的平均数量为3.29±0.86（2 - 6个），椎体平均破坏程度为0.616。术前，平均后凸角为22.42°±12.56°，术后矫正至13.08°±11.34°，平均矫正9.34°（41.66%）。在最近一次随访时，平均矫正丢失0.80°，最终矫正角度为13.88°。20例患者（83.33%）实现了骨融合。所有患者（100%）神经功能均有恢复，在1年随访时92%的患者能够行走。视觉模拟评分从术前的6.33±1.05改善至术后3个月时的1.042±0.75。2例患者发生压疮，2例发生泌尿系统感染，1例神经功能恶化，需要再次手术并取出椎间融合器，最终恢复至Frankel E级。2例患者因无关原因死亡。
该手术安全，在包括早期和晚期疾病、多节段受累的脊柱结核不同病情组中，采用带/不带椎间融合器支撑的椎弓根螺钉固定术，均取得了满意的结果。
