Ifthekar Syed, Yadav Gagandeep, Ahuja Kaustubh, Mittal Samarth, P Venkata Sudhakar, Kandwal Pankaj
Department of Orthopaedics, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India.
J Clin Orthop Trauma. 2022 Feb 2;26:101788. doi: 10.1016/j.jcot.2022.101788. eCollection 2022 Mar.
The advanced stage of vertebral involvement in spinal tuberculosis (STB) can cause vertebral body collapse, which leads to kyphotic deformity and paraplegia in severe cases. Surgery is indicated in patients having disabling back pain, progressive neurological deficit, and instability in spine despite conservative management. The derangement of lumbar parameters, especially the loss of lumbar lordosis has been found to cause functional deterioration in patients. With the current evidences in place, this study was done to evaluate the correlation between the restoration of lumbar lordosis, pelvic parameters, and functional outcome when posterior only approach was used to manage the lumbar STB.
Active Tuberculosis of lumbar vertebra (L1-S1) confirmed by radiology (X-ray, MRI) and histopathological examination were included. All the cases scheduled for surgery underwent radiographs, CT scan, and MRI scans. Lumbar lordosis and other pelvic parameters were calculated on X-rays. VAS scores and ODI scores were documented during the follow-up to assess functional well-being.
A total of 33 (22 M:11 F) patients were included in the study. The mean lumbar lordosis pre-operatively was -22.84 ± 11.19° which was corrected to -37.03 ± 9.02° (p < 0.05) post-operatively. The pelvic tilt pre-operatively was 25.33 ± 6.75° which was corrected to 19.63 ± 5.84° (p < 0.05) post-operatively. The mean ODI improved from 84.33 ± 11.84 to 26.93 ± 8.74 (p < 0.05) at the final follow-up. The mean VAS score pre-operatively was 8.06 ± 1.27 which improved to 2.45 ± 0.93 (p < 0.05) in the post-operative period.
The study found a strong negative correlation between ODI scores and lumbar lordosis and a strong positive correlation between pelvic tilt and ODI scores. But the correlation needs to be further studied and evaluated by a well-constructed study especially with a control group treated conservatively.
脊柱结核（STB）中椎体受累的晚期可导致椎体塌陷，严重时可导致脊柱后凸畸形和截瘫。对于经保守治疗后仍有严重背痛、进行性神经功能缺损和脊柱不稳定的患者，建议进行手术治疗。已发现腰椎参数紊乱，尤其是腰椎前凸的丧失会导致患者功能恶化。基于目前的证据，本研究旨在评估单纯后路手术治疗腰椎STB时腰椎前凸恢复、骨盆参数与功能结果之间的相关性。
纳入经放射学检查（X线、MRI）及组织病理学检查确诊的腰椎（L1-S1）活动性结核患者。所有计划手术的病例均接受了X线片、CT扫描和MRI扫描。通过X线计算腰椎前凸和其他骨盆参数。随访期间记录视觉模拟评分（VAS）和Oswestry功能障碍指数（ODI）评分，以评估功能状态。
本研究共纳入33例患者（男22例，女11例）。术前平均腰椎前凸为-22.84±11.19°，术后矫正至-37.03±9.02°（p<0.05）。术前骨盆倾斜度为25.33±6.75°，术后矫正至19.63±5.84°（p<0.05）。末次随访时，平均ODI从84.33±11.84改善至26.93±8.74（p<0.05）。术前平均VAS评分为8.06±1.27，术后改善至2.45±0.93（p<0.05）。
本研究发现ODI评分与腰椎前凸呈强负相关，骨盆倾斜度与ODI评分呈强正相关。但这种相关性需要通过精心设计的研究，尤其是与保守治疗的对照组进行进一步研究和评估。
