Department of Spine Surgery, Tianjin Hospital, 406 Jiefang Nan Road, Hexi District, Tianjin, 300211, China.
Department of Orthopedics, No. 1 Medical Center of Tianjin Hospital, Tianjin, 300211, China.
BMC Surg. 2022 Apr 29;22(1):154. doi: 10.1186/s12893-022-01612-0.
The local anatomy of the lumbosacral region of spine is complicated, with special biomechanical characteristics. For surgical management of tuberculous spondylitis reported in the literature, the methods would be two-stage anterior and posterior approaches or one-stage anterior and posterior approach with patient's intraoperative position being changed. These types of surgery approaches would result in long operative duration and more intraoperative blood loss, and most important there is no coordination between anterior and posterior procedures.
The purpose of this study was to introduce a new procedure called in the lateral position single -stage combined anteriorposterior approaches for treatment of lumbosacral tuberculous spondylitis and to evaluate its preliminary surgical outcomes. Fifteen patients with lumbosacral tuberculous spondylitis who underwent single-stage anterior and posterior radical focal debridement and reconstruction in lateral position in our hospital from April 2005 to June 2012 were included in the study. There were 6 males and 9 females with the average age of 46.8 years. The tuberculous lesions involved the following regions: L3-4 in 5cases, L4-5 in 5 cases, L5-S1 in 2 cases, L4 in one case, and L5 in 2 cases. The assessment of surgical outcomes was conducted with clinical symptoms and radiological findings,including operative time, blood loss. deformity angle, Frankel grade and Kirkaldy-Willis evaluation.
Operation posture: The right lateral position was used for 11 patients and the left lateral position was used for the remaining 4 patients. The average duration of operation for the 15 patients was 270 min. The average intraoperative blood loss was 1720 ml. The mean follow-up period was 4.2 years. There was no recurrence. The postoperative radiological findings showed that the interbody bone grafts were fixed without any dislodgment. There was significant difference between preoperative and postoperative lumbosacral lordotic angles. Kirkaldy-Willis classification rating for the 13 cases with satisfactory results.
Single-stage combined anterior and posterior surgical management of lumbosacral tuberculous spondylitis with patient in lateral position can achieve radical focal debridement, anterior and posterior procedure coordination and spinal reconstruction.
腰骶部脊柱的局部解剖结构复杂，具有特殊的生物力学特性。对于文献中报道的脊柱结核的手术治疗，方法是前后两阶段入路或前后一阶段入路并改变患者的术中体位。这些手术入路会导致手术时间延长和术中出血量增加，最重要的是，前后程序之间没有协调。
本研究旨在介绍一种新的手术方法，即侧卧位一期前后联合入路治疗腰骶段结核性脊柱，评估其初步手术效果。2005 年 4 月至 2012 年 6 月，我院采用侧卧位一期前后根治性病灶清创和重建治疗腰骶段结核性脊柱炎 15 例，男 6 例，女 9 例，平均年龄 46.8 岁。结核病变累及以下部位：L3-4 5 例，L4-5 5 例，L5-S1 2 例，L4 1 例，L5 2 例。手术疗效评估包括临床症状和影像学检查，包括手术时间、出血量、畸形角度、Frankel 分级和 Kirkaldy-Willis 评价。
手术体位：11 例采用右侧侧卧位，4 例采用左侧侧卧位。15 例患者的平均手术时间为 270 分钟，平均术中出血量为 1720 毫升。平均随访时间为 4.2 年，无复发。术后影像学检查显示椎间植骨固定无移位。术前与术后腰骶角有显著差异。Kirkaldy-Willis 分类评价满意 13 例。
侧卧位一期前后联合手术治疗腰骶段结核性脊柱炎可实现病灶彻底清创、前后程序协调和脊柱重建。
