Sheng Xiaolong, Guo Zhu, Deng Zhansheng, Jiang Liyuan, Hu Jianzhong
Department of Spine Surgery and Orthopaedics, Xiangya Hospital, Central South University, Changsha, China.
Key Laboratory of Organ Injury, Aging and Regenerative Medicine of Hunan Province, Changsha, 410008, China.
Acta Neurochir (Wien). 2022 Oct;164(10):2637-2644. doi: 10.1007/s00701-022-05342-3. Epub 2022 Sep 7.
Posterior limited unilateral fenestration approach is extensively used in the treatment of many spinal diseases. But whether it is suitable for spinal tuberculosis (TB) is rarely reported. Hence, the current study evaluated the feasibility and efficacy of the posterior limited unilateral fenestration (PLUF) debridement, bone grafting fusion, and instrumentation to treat single-segment thoracic and lumbar TB.
Eighty-three patients (45 male and 38 female) aged 17-79 years old with the single-segment thoracic and lumbar TB who underwent PLUF debridement, bone grafting fusion, and instrumentation from our hospital were recruited for this study. The operation time, blood loss volume, postoperative complication rate, kyphotic Cobb angle, neurological functional improvement defined by the American Spinal Injury Association (ASIA) classification, the visual analogue scale (VAS) score, and the bone fusion time were utilized for assessing the clinical feasibility and efficacy.
The average follow-up time was 46.9 ± 13.1 (24-72) months. At the last follow-up, the mean kyphotic Cobb angle was significantly reduced from preoperative 23.0° ± 15.3° to postoperative 8.3° ± 11.0° (p < 0.001). Based on the ASIA classification, 89.2% (33 out of 37) patients with preoperative neurological impairment indicated good neurological improvement after the surgery. The VAS pain score significantly decreased from preoperative 6.9 ± 1.1 to 1.3 ± 0.7 3 months after operation (p < 0.001). All the patients achieved solid bony fusion within 13 months of surgery.
For patients with single-segment thoracic and lumbar TB, PLUF debridement, bone grafting fusion, and instrumentation are a feasible and effective surgical treatment.
后路有限单侧开窗入路广泛应用于多种脊柱疾病的治疗。但该方法是否适用于脊柱结核（TB）鲜有报道。因此，本研究评估了后路有限单侧开窗（PLUF）清创、植骨融合及内固定治疗单节段胸腰椎结核的可行性和疗效。
本研究纳入了我院83例年龄在17 - 79岁之间、接受PLUF清创、植骨融合及内固定治疗的单节段胸腰椎结核患者（45例男性，38例女性）。采用手术时间、失血量、术后并发症发生率、后凸Cobb角、美国脊髓损伤协会（ASIA）分级定义的神经功能改善情况、视觉模拟评分（VAS）以及骨融合时间来评估临床可行性和疗效。
平均随访时间为46.9±13.1（24 - 72）个月。末次随访时，平均后凸Cobb角从术前的23.0°±15.3°显著降至术后的8.3°±11.0°（p < 0.001）。根据ASIA分级，术前有神经功能损害的患者中，89.2%（37例中的33例）术后神经功能有明显改善。术后3个月，VAS疼痛评分从术前的6.9±1.1显著降至1.3±0.7（p < 0.001）。所有患者均在术后13个月内实现了牢固的骨融合。
对于单节段胸腰椎结核患者，PLUF清创、植骨融合及内固定是一种可行且有效的手术治疗方法。
