Orthopedics Department, the First College of Clinical Medical Science, China Three Gorges University, Yichang, China.
BMC Musculoskelet Disord. 2023 Oct 17;24(1):821. doi: 10.1186/s12891-023-06935-4.
Treating complex cases of spinal tuberculosis (STB) that involve multiple vertebral bodies and cause destruction of the spinal structure, kyphotic deformity, and acute nerve injury can be challenging. This report describes the course of treatment and 5-year follow-up of a complex case of multisegmental STB.
This report describes a case of tuberculosis affecting the vertebrae extending from thoracic 12 to lumbar 5 in a 60-year-old woman who suffered sudden paralysis in both lower extremities. The patient underwent emergency posterior paraspinal abscess clearance, laminectomy with spinal decompression. Partial correction of the kyphotic deformity via long-segment fixation from the T9 vertebral body to the ilium in a one-stage posterior procedure. The patient's neurological status was diagnosed as grade E on the American Spinal Injury Association (ASIA) scale after the one-stage operation. Following standardized 4-combination anti-tuberculosis drug therapy for three months in postoperative patients, the patient underwent two-stage transabdominal anterior abscess removal, partial debridement of the lesion and bilateral fibula graft support. One year after the two-stage operation, the patient's visual analog scale (VAS) score of back pain was 1 point, and the patient's erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) levels returned to normal. Five years after the second-stage operation, the Oswestry disability index (ODI) of patient quality of life was 14 points. There was a 4-degree change in the Cobb angle over five years. During the five-year follow-up period, the grafted fibula did not experience any subsidence.
For patients with spinal tuberculosis and acute paralysis, it is essential to relieve spinal cord compression as soon as possible to recover spinal cord function. For lesions that cannot be debrided entirely, although limited debridement combined with anti-tuberculosis drug therapy has the risk of sinus formation and tuberculosis recurrence, it is much safer than the risk of thorough debridement surgery. In this case, an unconventional long-segment fibula graft, pelvis-vertebral support, was an effective reconstruction method.
治疗涉及多个椎体并导致脊柱结构破坏、后凸畸形和急性神经损伤的复杂脊柱结核（STB）病例具有挑战性。本报告描述了一例多节段 STB 复杂病例的治疗过程和 5 年随访结果。
本报告描述了一例 60 岁女性胸椎 12 至腰椎 5 节段脊柱结核病例，该患者突发双下肢瘫痪。患者行后路脊柱旁脓肿清除术，行椎板切除术减压。一期后路手术中，从 T9 椎体至髂骨行长节段固定，部分矫正后凸畸形。一期手术后，患者美国脊髓损伤协会（ASIA）评分神经功能为 E 级。术后患者接受标准化四联抗结核药物治疗 3 个月后，行二期经腹前路脓肿清除术，病变部分清创及双侧腓骨植骨支撑。二期手术后 1 年，患者腰痛视觉模拟评分（VAS）为 1 分，红细胞沉降率（ESR）和 C 反应蛋白（CRP）水平恢复正常。二期手术后 5 年，患者生活质量 Oswestry 功能障碍指数（ODI）为 14 分。5 年内 Cobb 角变化 4 度。随访 5 年内，植骨腓骨无沉降。
对于合并急性瘫痪的脊柱结核患者，需要尽快解除脊髓压迫以恢复脊髓功能。对于不能彻底清创的病变，虽然有限清创联合抗结核药物治疗存在窦道形成和结核复发的风险，但比彻底清创手术的风险安全得多。在这种情况下，非常规的长节段腓骨植骨、骨盆-脊柱支撑是一种有效的重建方法。
