Musali Siddartha Reddy, Karla Ravi, Gollapudi Prakash Rao, Mohammed Imran, Nandigama Prathap Kumar
Department of Neurosurgery, Gandhi Medical College and Hospital, Secunderabad, Telangana, India.
Br J Neurosurg. 2023 Oct;37(5):1028-1030. doi: 10.1080/02688697.2020.1849540. Epub 2020 Nov 26.
To assess and compare the clinical, radiological, and functional outcomes of anterolateral and posterolateral decompression and spinal stabilization in the thoracolumbar tuberculous spine.
30 patients with thoracolumbar spinal tuberculosis were treated surgically between September 2014 and 2018. Fifteen patients underwent anterolateral decompression and spinal stabilization from September 2014 to September 2016. These patients were studied retrospectively (group A). Fifteen patients underwent posterolateral decompression by costotransversectomy and spinal stabilization from September 2016 to September 2017 were studied prospectively. Neurological recovery, correction of kyphotic deformity, pain (visual analog score) and ESR, and duration of stay were assessed. Neurological outcome was assessed using Frankel grading, and pain was assessed using visual analog scale.
The average follow-up period in both the groups is 12 months. There was a statistically significant difference in the kyphotic angle correction between anterolateral and posterolateral groups at the end of 12 months (follow up). No statistically significant difference was found between the two groups for ESR, visual analog scale for pain, and neurological recovery (Frankel's grading) at the end of 12 months.
Both anterolateral and posterolateral approaches are sufficient thoracic and thoracolumbar tuberculous spine but, the posterolateral approach allows a significant correction of kyphotic angle, better improvement of pain and lesser duration of stay.
评估和比较胸腰椎结核性脊柱前路减压与后路减压及脊柱稳定术的临床、影像学和功能结果。
2014年9月至2018年期间对30例胸腰椎脊柱结核患者进行了手术治疗。2014年9月至2016年9月,15例患者接受了前路减压及脊柱稳定术。对这些患者进行回顾性研究(A组)。2016年9月至2017年9月,对15例行经肋横突切除术的后路减压及脊柱稳定术的患者进行前瞻性研究。评估神经功能恢复情况、后凸畸形矫正情况、疼痛程度(视觉模拟评分)、血沉以及住院时间。使用Frankel分级评估神经功能结果,使用视觉模拟量表评估疼痛程度。
两组的平均随访期均为12个月。在12个月随访结束时,前路和后路组在后凸角矫正方面存在统计学显著差异。在12个月结束时,两组在血沉、疼痛视觉模拟量表评分及神经功能恢复(Frankel分级)方面未发现统计学显著差异。
前路和后路手术方式对于胸椎及胸腰椎结核性脊柱均有效,但后路手术方式能显著矫正后凸角,更好地缓解疼痛,且住院时间更短。