Huang Yi, Hu Wenhao, Li Jing, Wang Tianhao, Liu Huawei, Zheng Guoquan, Zhang Xuesong, Wang Yan
Nankai University School of Medicine, Nankai University, 300071, Tianjin, China.
Department of Orthopedics, General Hospital of Chinese People's Liberation Army, 100853, Beijing, China.
BMC Musculoskelet Disord. 2021 Apr 12;22(1):345. doi: 10.1186/s12891-021-04220-w.
In the late stage of spinal tuberculosis, the bony destruction and vertebral collapse often leads to significant kyphosis, presenting clinically as a painful gibbus deformity, with increased instability, vertebral body translations and increased risk of neurologic involvement. Spinal osteotomy is thought to be suitable for most patients with severe rigid kyphosis. The aim of this study was to evaluate the efficacy of transpedicular bi-vertebrae osteotomy technique in the patients with Pott's kyphosis and other post-tubercular spinal deformity.
Between January 2012 and December 2015, 18 patients with post-tubercular spinal deformity underwent the transpedicular bi-vertebrae wedge osteotomy, with a minimum follow up of 27.0 months. Preoperative and postoperative kyphotic angle, sagittal plane parameters (TK for thoracic deformity, TLK for thoracolumbar and LL for lumbar deformity) and sagittal vertical axis (SVA) were measured. Oswestry Disability Index (ODI), Visual analog scale (VAS) and modified American Spinal Injury Association grading (ASIA) of preoperative and final follow-up were documented and compared.
The average operation time was 305 minutes (range, 200-430 minutes) with a mean intraoperative blood loss of 425 mL (range, 200-700 mL). The kyphotic angles decreased from 80.3° (range, 28.5°-130.8°) preoperatively to 26.1° (range, 7.0°-63.3°) at the final follow-up (P<0.01). The mean VAS score was reduced from preoperative 5.2(range, 2-9) to 0.9(range, 0-2, P<0.01) and the ODI improved from 55.3% (range, 46%-76%) to 6.3% (range, 2%-18%, P<0.01). At final follow-up, there was radiographic evidence of solid fusion at the osteotomy site and fixed segments in all patients. Neurological function improved from ASIA scale D to E in 7 patients, C to D in 3 patients.
Our results suggest that transpedicular bi-vertebrae wedge osteotomy is a safe and effective treatment option for post-tubercular spinal deformity. This technique achieves satisfying correction and fusion rates with adequate decompression of neurological elements.
在脊柱结核晚期，骨质破坏和椎体塌陷常导致严重的后凸畸形，临床上表现为疼痛性驼背畸形，稳定性增加、椎体移位以及神经受累风险增加。脊柱截骨术被认为适用于大多数严重僵硬性后凸畸形患者。本研究的目的是评估经椎弓根双椎体截骨技术治疗结核性后凸畸形及其他结核后脊柱畸形患者的疗效。
2012年1月至2015年12月期间，18例结核后脊柱畸形患者接受了经椎弓根双椎体楔形截骨术，最短随访时间为27.0个月。测量术前和术后的后凸角、矢状面参数（胸椎畸形的TK、胸腰段畸形的TLK和腰椎畸形的LL）以及矢状垂直轴（SVA）。记录并比较术前和末次随访时的Oswestry功能障碍指数（ODI）、视觉模拟评分（VAS）和改良的美国脊髓损伤协会分级（ASIA）。
平均手术时间为305分钟（范围200 - 430分钟），平均术中出血量为425毫升（范围200 - 700毫升）。后凸角从术前的80.3°（范围28.5° - 130.8°）降至末次随访时的26.1°（范围7.0° - 63.3°，P<0.01）。平均VAS评分从术前的5.2（范围2 - 9）降至0.9（范围0 - 2，P<0.01），ODI从55.3%（范围46% - 76%）改善至6.3%（范围2% - 18%，P<0.01）。在末次随访时，所有患者的截骨部位和固定节段均有影像学证据显示坚固融合。7例患者的神经功能从ASIA D级改善至E级，3例患者从C级改善至D级。
我们的数据表明，经椎弓根双椎体楔形截骨术是治疗结核后脊柱畸形的一种安全有效的选择。该技术能实现令人满意的矫正率和融合率，并能充分减压神经结构。
