The Reasons for Failure to Treat Thoracolumbar Tuberculosis by Anterior Internal Fixation and Its Countermeasures_West China Medical Journal

Authors：

 YANGJian ,  KANGJian-ping , WANGSong , LEIFei

Department of Spine Surgery, Affiliated Hospital of Luzhou Medical College, Luzhou, Sichuan 646000, P. R. China;

Corresponding?author：

KANGJian-ping, Email: kjp8@163.com

Keywords：

Spinal tuberculosis; Thoracolumbar tuberculosis; Internal fixation failure

DOI：

10.7507/1002-0179.20150007

Video：

Export PDF Favorites Scan Get Citation

Abstract Full text Figures/Tables Video References Cited by

Objective To investigate the reasons for failure to treat thoracolumbar tuberculosis by anterior internal fixation and its countermeasures. Methods A total of 485 patients with thoracolumbar spinal tuberculosis underwent anterior focus clearance and fixation from January 2005 to January 2012. Eighteen of them failed with a rate of 3.71%. Screws were pulled out in two patients. Vertebra cutted by screws occurred in three patients. In another three patients, screws dropped into the intervertebral disc. Tuberculosis relapsed in 10 patients (5 accompanied with spinal deformity, 2 with pure malunion, 2 with abscess formation, and 1 with sequestra). Twelve of the patients underwent two-stage posterior pedicle screw internal fixation and anterior focus clearance and autogenous bone grafts fusion. Four were treated by shifting antituberculosis drugs and staying in bed. Two were cured by multiple abscesses puncture and antituberculosis injection. Results These patients were followed up for 15~30 months. Twelve cases of spinal tuberculosis were completely cured and 6 cases of them got clinical cure. However, 3 cases of them had scoliosis deformity followed and 1 had kyphosis. No tuberculosis relapse, cold abscess or sinus formation, or pedicle screw internal fixation failure occurred again. Conclusion Although there are many complications of anterior internal fixation for spinal tuberculosis, anterior internal fixation is still a perfect choice if we can make an appropriate choice of operation and strengthen the management after operation.

Citation： YANGJian, KANGJian-ping, WANGSong, LEIFei. The Reasons for Failure to Treat Thoracolumbar Tuberculosis by Anterior Internal Fixation and Its Countermeasures. West China Medical Journal, 2015, 30(1): 30-34. doi: 10.7507/1002-0179.20150007 Copy

1.	郭立新, 馬遠征, 陳興, 等.脊柱結核的外科治療與術后療效評估[J].中華骨科雜志, 2008, 28(12):979-982.
2.	Hodgson AR, Stock FE. Anterior spine fusion for treatment of tuberculosis of the spine[J]. J Bone Joint surg (AM), 1960, 42:295-310.
3.	葉偉, 李春海, 梁安靖, 等.脊柱結核一期手術治療的并發癥分析及對策[J].中國醫師進修雜志, 2010, 33(17):18-20.
4.	Chen WJ, Chen CH, Shi CH, et al. Surgical treatment of tuberculous spondylitis:50 patients followed for 2-8 years[J]. Acta Orthop Scand, 1995, 66(2):137-142.
5.	吳啟秋.脊柱結核的化學治療[J].中國脊柱脊髓雜志, 2004, 14(12):766-768.
6.	Bakhsh A. Medical management of spinal tuberculosis an experience from Pakistan[J]. Spine (Phila Pa 1976), 2010, 35(16):E787-E791.
7.	Konstam PG, Blesovsky A. The ambulant treatment of spinal tuberculosis[J]. Neurosurg Rev, 2001, 24(2):8-13.
8.	施建黨, 王自立, 耿廣起, 等.單純應用抗結核藥物治療早期脊柱結核的療效觀察[J].中國脊柱脊髓雜志, 2011, 21(10):798-801.
9.	Rafailidis PI, Avramopoulos I, Sapkas G, et al. Multidrug-resistant tuberculous spondylodiscitis:need for aggressive management and drug susceptibility testing of Mycobacterium tuberculosis isolates[J]. J Infect, 2006, 52(2):e35-e37.
10.	Valsalan R, Purushothaman R, Raveendran M, et al. Efficacy of directly observed treatment short-course intermittent regimen in spinal tuberculosis[J]. Indian J Othop, 2012, 46(2):138-144.
11.	Rajasekaran S, Khandelwal G. Drug therapy in spinal tuberculosis[J]. Eur Spine J, 2013, 22(4):587-593.
12.	瞿東濱, 金大地.正確認識脊柱結核病灶清除術[J].中國脊柱脊髓雜志, 2008, 18(8):565-567.
13.	王自立.脊柱結核的病灶清除與融合固定問題[J].中國脊柱脊髓雜志, 2006, 16(12):888-889.
14.	林羽.淺談脊柱結核的手術治療[J].中國脊柱脊髓雜志, 2006, 16(12):885-887.
15.	戈朝暉, 王自立, 魏敏吉.脊柱結核病灶中抗癆藥物濃度的測定[J].中華骨科雜志, 2005, 25(2):97-101.
16.	Parthasarathy R, Sriram K, Santha T, et al. Short-course chemotherapy for tuberculosis of the spine[J]. J Bone Joint Surg Br, 1999, 81(3):464-471.
17.	王自立, 楊偉宇, 金衛東, 等.病變椎體部分切除、髂骨植骨及內固定術治療脊柱結核[J].中國脊柱脊髓雜志, 2004, 14(12):716-719, 723.
18.	林羽.科學務實, 進一步提高我國脊柱結核診療水平[J].中國脊柱脊髓雜志, 2004, 14(12):709-711.
19.	Zhang HQ, Wang YX, Guo CF, et al. One-stage posterior approach and combined interbody and posterior fusion for thoracolumbar spinal tuberculosis with kyphosis in children[J]. Orthopedics, 2010, 33(11):808.
20.	Christodoulou AG, Givissis P, Karataglis D, et al. Treatment of tuberculous spondylitis with anterior stabilization and titanium cage[J]. Clin Orthop Relat Res, 2006, 44(444):60-65.
21.	Ha KY, Chung YG, Ryoo SJ. Adherence and biofilm formation of Staphylococcus epidermidis and Mycobacterium tuberculosis on various spinal implants[J]. Spine (Phila Pa 1976), 2005, 30(1):38-43.
22.	Jain AK, Jain S. Instrumented stabilization in spinal tuberculosis[J]. Int Orthop, 2012, 36(2):285-292.
23.	Jain AK, Dhammi IK, Jain S, et al. Kyphosis in spinal tuberculosis:prevention and correction[J]. Indian J Orthop, 2010, 44(2):127-136.

1. 郭立新, 馬遠征, 陳興, 等.脊柱結核的外科治療與術后療效評估[J].中華骨科雜志, 2008, 28(12):979-982.
2. Hodgson AR, Stock FE. Anterior spine fusion for treatment of tuberculosis of the spine[J]. J Bone Joint surg (AM), 1960, 42:295-310.
3. 葉偉, 李春海, 梁安靖, 等.脊柱結核一期手術治療的并發癥分析及對策[J].中國醫師進修雜志, 2010, 33(17):18-20.
4. Chen WJ, Chen CH, Shi CH, et al. Surgical treatment of tuberculous spondylitis:50 patients followed for 2-8 years[J]. Acta Orthop Scand, 1995, 66(2):137-142.
5. 吳啟秋.脊柱結核的化學治療[J].中國脊柱脊髓雜志, 2004, 14(12):766-768.
6. Bakhsh A. Medical management of spinal tuberculosis an experience from Pakistan[J]. Spine (Phila Pa 1976), 2010, 35(16):E787-E791.
7. Konstam PG, Blesovsky A. The ambulant treatment of spinal tuberculosis[J]. Neurosurg Rev, 2001, 24(2):8-13.
8. 施建黨, 王自立, 耿廣起, 等.單純應用抗結核藥物治療早期脊柱結核的療效觀察[J].中國脊柱脊髓雜志, 2011, 21(10):798-801.
9. Rafailidis PI, Avramopoulos I, Sapkas G, et al. Multidrug-resistant tuberculous spondylodiscitis:need for aggressive management and drug susceptibility testing of Mycobacterium tuberculosis isolates[J]. J Infect, 2006, 52(2):e35-e37.
10. Valsalan R, Purushothaman R, Raveendran M, et al. Efficacy of directly observed treatment short-course intermittent regimen in spinal tuberculosis[J]. Indian J Othop, 2012, 46(2):138-144.
11. Rajasekaran S, Khandelwal G. Drug therapy in spinal tuberculosis[J]. Eur Spine J, 2013, 22(4):587-593.
12. 瞿東濱, 金大地.正確認識脊柱結核病灶清除術[J].中國脊柱脊髓雜志, 2008, 18(8):565-567.
13. 王自立.脊柱結核的病灶清除與融合固定問題[J].中國脊柱脊髓雜志, 2006, 16(12):888-889.
14. 林羽.淺談脊柱結核的手術治療[J].中國脊柱脊髓雜志, 2006, 16(12):885-887.
15. 戈朝暉, 王自立, 魏敏吉.脊柱結核病灶中抗癆藥物濃度的測定[J].中華骨科雜志, 2005, 25(2):97-101.
16. Parthasarathy R, Sriram K, Santha T, et al. Short-course chemotherapy for tuberculosis of the spine[J]. J Bone Joint Surg Br, 1999, 81(3):464-471.
17. 王自立, 楊偉宇, 金衛東, 等.病變椎體部分切除、髂骨植骨及內固定術治療脊柱結核[J].中國脊柱脊髓雜志, 2004, 14(12):716-719, 723.
18. 林羽.科學務實, 進一步提高我國脊柱結核診療水平[J].中國脊柱脊髓雜志, 2004, 14(12):709-711.
19. Zhang HQ, Wang YX, Guo CF, et al. One-stage posterior approach and combined interbody and posterior fusion for thoracolumbar spinal tuberculosis with kyphosis in children[J]. Orthopedics, 2010, 33(11):808.
20. Christodoulou AG, Givissis P, Karataglis D, et al. Treatment of tuberculous spondylitis with anterior stabilization and titanium cage[J]. Clin Orthop Relat Res, 2006, 44(444):60-65.
21. Ha KY, Chung YG, Ryoo SJ. Adherence and biofilm formation of Staphylococcus epidermidis and Mycobacterium tuberculosis on various spinal implants[J]. Spine (Phila Pa 1976), 2005, 30(1):38-43.
22. Jain AK, Jain S. Instrumented stabilization in spinal tuberculosis[J]. Int Orthop, 2012, 36(2):285-292.
23. Jain AK, Dhammi IK, Jain S, et al. Kyphosis in spinal tuberculosis:prevention and correction[J]. Indian J Orthop, 2010, 44(2):127-136.

West China Medical Journal

The Reasons for Failure to Treat Thoracolumbar Tuberculosis by Anterior Internal Fixation and Its Countermeasures

Abstract Full text Figures/Tables Video References Cited by

Previous Article

Next Article

Format

Content