Tobing S Dohar Al, Junaidi Muhammad Ade
Department of Orthopaedics and Traumatology, Faculty of Medicine-Universitas Indonesia, Cipto Mangunkusumo Hospital, Jakarta, Indonesia.
Department of Orthopaedics and Traumatology, Fatmawati General Hospital, Jakarta, Indonesia.
Ann Med Surg (Lond). 2021 Jan 30;62:463-468. doi: 10.1016/j.amsu.2021.01.074. eCollection 2021 Feb.
Spondylitis tuberculosis can cause changes in spinopelvic parameters including pelvic incidence, pelvic tilt, and sacral slope due to biomechanical changes of the spine. Posterior instrumentation is one of the modality for the treatment of spondylitis tuberculosis. However, in Indonesia, clinical and radiological outcomes after posterior instrumentation in tuberculosis of lumbar vertebrae are still rare. This study aims to investigate the clinical and radiological outcomes of patients with spondylitis tuberculosis of the lumbar vertebrae after posterior instrumentation.
This study was a cross-sectional study in patients with spondylitis tuberculosis of the lumbar vertebrae who underwent posterior instrumentation in Cipto Mangunsukumo and Fatmawati Hospital. Subjects were collected through consecutive sampling. 23 subjects were collected and analyzed. Clinical and radiological outcomes before and after posterior instrumentation were compared. The clinical outcome included the Visual Analog Scale (VAS) and Oswestry Disability Index (ODI). The radiological outcome included sacral slope, pelvic tilt, pelvic incidence, and lumbar lordosis.
The median age of the subjects was 31 (9-57) years with a female-majority (60,9%). The median of the total vertebral infected was 2 (1-4). Median of VAS score before surgery, 6 months after surgery, and 12 months after surgery were 9 (4-10), 4 (1-7), dan 2 (1-6) (p < 0,001) consecutively. Median of ODI score before surgery, 6 months after surgery, and 12 months after surgery were 70 (40-86), 34 (10-74), dan 12 (2-74) (p < 0,001) consecutively. There was no significant difference in spinopelvic parameters before and after the surgery. The difference of ODI score before and after the surgery inversely correlated with the difference of lumbar lordotic and sacral slope.
Posterior instrumentation could improve clinical outcomes in patients with spondylitis tuberculosis of the lumbar. Change of lumbar lordotic and sacral slope after posterior instrumentation led to an improvement of quality of life marked by the reduction of the ODI score.
由于脊柱的生物力学变化，脊柱结核可导致包括骨盆倾斜度、骨盆入射角和骶骨倾斜度在内的脊柱骨盆参数发生改变。后路内固定术是治疗脊柱结核的一种方式。然而，在印度尼西亚，腰椎结核后路内固定术后的临床和放射学结果仍然少见。本研究旨在探讨腰椎脊柱结核患者后路内固定术后的临床和放射学结果。
本研究是一项对在芝多·曼贡苏库莫医院和法特玛瓦蒂医院接受后路内固定术的腰椎脊柱结核患者的横断面研究。通过连续抽样收集研究对象。共收集并分析了23例研究对象。比较后路内固定术前和术后的临床和放射学结果。临床结果包括视觉模拟评分（VAS）和奥斯维斯特残疾指数（ODI）。放射学结果包括骶骨倾斜度、骨盆倾斜度、骨盆入射角和腰椎前凸。
研究对象的中位年龄为31（9 - 57）岁，女性居多（60.9%）。椎体感染总数的中位数为2（1 - 4）。术前、术后6个月和术后12个月的VAS评分中位数分别为9（4 - 10）、4（1 - 7）和2（1 - 6）（p < 0.001）。术前、术后6个月和术后12个月的ODI评分中位数分别为70（40 - 86）、34（10 - 74）和12（2 - 74）（p < 0.001）。手术前后脊柱骨盆参数无显著差异。手术前后ODI评分的差异与腰椎前凸和骶骨倾斜度的差异呈负相关。
后路内固定术可改善腰椎脊柱结核患者的临床结果。后路内固定术后腰椎前凸和骶骨倾斜度的改变导致以ODI评分降低为标志的生活质量改善。
