SURGICAL TREATMENT OF THORACIC AND LUMBAR TUBERCULOSIS COMPLICATED WITH SEVERE KYPHOTIC DEFORMITY AND PARAPLEGIA_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

HUJiang ,  WANGYue , LIUZhongqian , TANGLiuyi , WANLun , ZHANGYaoming , DENGJuncai

Department of Spinal Surgery, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, Chengdu Sichuan, 610072, P. R. China;

Corresponding?author：

WANGYue, Email: wangyue@medmail.com.cn

Keywords：

Thoracic and lumbar tuberculosis; Kyphosis deformity; Paraplegia; One-stage surgery; Posterior vertebral column resection

DOI：

10.7507/1002-1892.20140242

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Objective To explore an method and the effectiveness of surgical treatment of thoracic and lumbar tuberculosis complicated with severe kyphotic deformity (Cobb angle≥55°) and paraplegia. Methods Between January 2009 and January 2013, 13 cases of thoracic and lumbar tuberculosis complicated with severe kyphotic deformity and paraplegia were treated by one-stage posterior vertebral column resection (PVCR), debridement, bone grafting, and instrumentation fixation. Of 13 patients, 7 were male and 6 were female with an average age of 23.5 years (range, 14-49 years). The disease duration was 13-38 months (mean, 19 months). The Cobb angle of kyphosis was (65.23±7.95)°. The visual analogue scale score (VAS) was 7.38±0.31. In 13 patients with incomplete paraplegia, 1 case was classified as Frankel grade B, 7 cases as grade C, and 5 cases as grade D. The lesion involved 2 vertebrae bodies in 7 cases (T_{8, 9} in 1 case, T_{11, 12} in 2 cases, and T₁₂, L₁ in 4 cases), 3 vertebrae bodies in 4 cases (T_10-12 in 2 cases, T_9-11 in 1 case, and T₁₁-L₁ in 1 case), and 4 vertebrae bodies in 2 cases (T_4-7 in 1 case and T_6-9 in 1 case). Imaging examination showed paravertebral abscess in 10 cases. Results Healing of incision by first intention was obtained in all patients. The neurological injury and pulmonary infection occurred in 3 cases and 2 cases respectively, which were cured after symptomatic treatment. Thirteen patients were followed up 12-48 months (mean, 17 months). The erythrocyte sedimentation rate restored to normal level in all cases at 3-7 months after operation. All the patients achieved bony fusion at 10-20 months (mean, 14 months) after operation. No fixation loosening, displacement, or fracture occurred during follow-up. Common toxic symptom of tuberculosis disappeared, and there was no recurrence of local tuberculosis. The Cobb angle of kyphosis was corrected to (22.38±1.76)° at 1 week and (22.15±1.83)° at last follow-up, showing significant difference when compared with preoperative one (P < 0.05). There was no significant difference in Cobb angle of kyphosis between at 1 week after operation and at last follow-up (P > 0.05). The Frankel grading was grade B in 1 case, grade C in 10 cases, and grade D in 2 cases at 1 week after operation; and it was grade D in 1 case and grade E in 12 cases at last follow-up; significant differences were found between at pre-and post-operation (P < 0.05), and between at 1 week after operation and at last follow-up (P < 0.05). The VAS score was 4.08±0.76 at 1 week and 0.62±0.14 at last follow-up, showing significant differences between at pre-and post-operation (P < 0.05) and between at 1 week after operation and at last follow-up (P < 0.05). Conclusion One-stage PVCR, debridement, bone grafting, and instrumentation fixation is proved to be successful in treating thoracic and lumbar tuberculosis complicated with severe kyphotic deformity and paraplegia.

Citation： HUJiang, WANGYue, LIUZhongqian, TANGLiuyi, WANLun, ZHANGYaoming, DENGJuncai. SURGICAL TREATMENT OF THORACIC AND LUMBAR TUBERCULOSIS COMPLICATED WITH SEVERE KYPHOTIC DEFORMITY AND PARAPLEGIA. Chinese Journal of Reparative and Reconstructive Surgery, 2014, 28(9): 1110-1114. doi: 10.7507/1002-1892.20140242 Copy

1.	馬遠征, 王自立, 金大地, 等.脊柱結核.北京:人民衛生出版社, 2013:3-185.
2.	胡云洲, 沈懷信, 饒書城, 等.脊柱結核截癱259例治療方法的選擇與療效分析.中華骨科雜志, 1981, 1(4):195-199.
3.	金大地.關于脊柱結核手術入路的選擇--脊柱結核手術入路的合理選擇.中國脊柱脊髓雜志, 2012, 22(9):771.
4.	Li M, Du J, Meng H, et al.One-stage surgical management for thoracic tuberculosis by anterior debridement, decompression and autogenous rib grafts, and instrumentation.Spine J, 2011, 11(8):726-733.
5.	Jain AK.Treament of tuberculosis of spine with neurologic complications.Clin Orthop Relat Res, 2002, (398):75-84.
6.	李大偉, 馬遠征, 李力韜, 等.脊柱結核伴截癱外科治療的療效分析.中華骨科雜志, 2014, 34(2):156-161.
7.	李晶, 呂國華, 王孝賓, 等.一期前后路手術治療合并嚴重后凸畸形的胸腰椎活動性結核.中華外科雜志, 2010, 48(8):597-600.
8.	盛偉斌, 華強, 曹力, 等.一期后路病灶清除、楔形截骨矯形治療胸腰椎結核并后凸或側后凸畸形.中華外科雜志, 2005, 43(4):205-209.
9.	Suk SI, Chung ER, Kim JH, et al.Posterior vertebral column resection for severe scoliosis.Spine (Phila Pa 1976), 2005, 30(14):1682-1687.
10.	Lenke LG, O'Leary PT, Bridwell KH, et al.Posterior vertebral column resection for severe pediatric deformity:minimum two year follow-up of thirty-five consecutive patients.Spine (Phila Pa 1976), 2009, 34(20):2213-2221.
11.	Lenke LG, Sides BA, Koester LA, et al.Vertebral column resection for the treatment of severe spinal deformity.Clin Orthop Relat Res, 2010, 468(3):687-699.
12.	Moon MS.Tuberculosis of the spine.Controversies and a new challenge.Spine (Phila Pa 1976), 1997, 22(15):1791-1797.
13.	秦世炳, 董偉杰, 范俊, 等.脊柱結核合并截癱再手術32例分析.中華外科雜志, 2007, 45(18):1237-1239.
14.	Cheung WY, Luk KD.Clinical and radiological outcomers after conservative treatment of TB spondylitis:is the 15 years' follow-up in the MRC study long enough? Eur Spine J, 2013, 22 Suppl 4:594-602.
15.	歐陽超, 陳志明, 馬華松, 等.后路全脊椎截骨聯合鈦網支撐治療合并神經癥狀的重度脊柱角狀后凸畸形.中國脊柱脊髓雜志, 2013, 23(11):993-997.
16.	呂國華, 王孝賓, 王冰, 等.Ⅰ期后路全脊椎切除治療重度胸腰椎畸形的神經系統并發癥.中華創傷雜志, 2011, 27(6):492-496.
17.	姚子明, 仉建國, 邱貴興, 等.一期后路全脊椎切除治療重度脊柱畸形圍手術期并發癥及其相關危險因素分析.中華骨科雜志, 2013, 33(5):440-446.
18.	Chang KW, Cheng CW, Chen HC, et al.Correction hinge in the compromised cord for severe and rigid angular kyphosis with neurologic deficits.Spine (Phila Pa 1976), 2009, 34(10):1040-1045.
19.	Wang Y, Zhang Y, Zhang X, et al.A single posterior approach for multilevel vertebral column in adults with severe rigid congenital kyphoscoliosis:a retrospective study of 13 cases.Eur Spine J, 2008, 17(3):361-372.

1. 馬遠征, 王自立, 金大地, 等.脊柱結核.北京:人民衛生出版社, 2013:3-185.
2. 胡云洲, 沈懷信, 饒書城, 等.脊柱結核截癱259例治療方法的選擇與療效分析.中華骨科雜志, 1981, 1(4):195-199.
3. 金大地.關于脊柱結核手術入路的選擇--脊柱結核手術入路的合理選擇.中國脊柱脊髓雜志, 2012, 22(9):771.
4. Li M, Du J, Meng H, et al.One-stage surgical management for thoracic tuberculosis by anterior debridement, decompression and autogenous rib grafts, and instrumentation.Spine J, 2011, 11(8):726-733.
5. Jain AK.Treament of tuberculosis of spine with neurologic complications.Clin Orthop Relat Res, 2002, (398):75-84.
6. 李大偉, 馬遠征, 李力韜, 等.脊柱結核伴截癱外科治療的療效分析.中華骨科雜志, 2014, 34(2):156-161.
7. 李晶, 呂國華, 王孝賓, 等.一期前后路手術治療合并嚴重后凸畸形的胸腰椎活動性結核.中華外科雜志, 2010, 48(8):597-600.
8. 盛偉斌, 華強, 曹力, 等.一期后路病灶清除、楔形截骨矯形治療胸腰椎結核并后凸或側后凸畸形.中華外科雜志, 2005, 43(4):205-209.
9. Suk SI, Chung ER, Kim JH, et al.Posterior vertebral column resection for severe scoliosis.Spine (Phila Pa 1976), 2005, 30(14):1682-1687.
10. Lenke LG, O'Leary PT, Bridwell KH, et al.Posterior vertebral column resection for severe pediatric deformity:minimum two year follow-up of thirty-five consecutive patients.Spine (Phila Pa 1976), 2009, 34(20):2213-2221.
11. Lenke LG, Sides BA, Koester LA, et al.Vertebral column resection for the treatment of severe spinal deformity.Clin Orthop Relat Res, 2010, 468(3):687-699.
12. Moon MS.Tuberculosis of the spine.Controversies and a new challenge.Spine (Phila Pa 1976), 1997, 22(15):1791-1797.
13. 秦世炳, 董偉杰, 范俊, 等.脊柱結核合并截癱再手術32例分析.中華外科雜志, 2007, 45(18):1237-1239.
14. Cheung WY, Luk KD.Clinical and radiological outcomers after conservative treatment of TB spondylitis:is the 15 years' follow-up in the MRC study long enough? Eur Spine J, 2013, 22 Suppl 4:594-602.
15. 歐陽超, 陳志明, 馬華松, 等.后路全脊椎截骨聯合鈦網支撐治療合并神經癥狀的重度脊柱角狀后凸畸形.中國脊柱脊髓雜志, 2013, 23(11):993-997.
16. 呂國華, 王孝賓, 王冰, 等.Ⅰ期后路全脊椎切除治療重度胸腰椎畸形的神經系統并發癥.中華創傷雜志, 2011, 27(6):492-496.
17. 姚子明, 仉建國, 邱貴興, 等.一期后路全脊椎切除治療重度脊柱畸形圍手術期并發癥及其相關危險因素分析.中華骨科雜志, 2013, 33(5):440-446.
18. Chang KW, Cheng CW, Chen HC, et al.Correction hinge in the compromised cord for severe and rigid angular kyphosis with neurologic deficits.Spine (Phila Pa 1976), 2009, 34(10):1040-1045.
19. Wang Y, Zhang Y, Zhang X, et al.A single posterior approach for multilevel vertebral column in adults with severe rigid congenital kyphoscoliosis:a retrospective study of 13 cases.Eur Spine J, 2008, 17(3):361-372.

Chinese Journal of Reparative and Reconstructive Surgery

SURGICAL TREATMENT OF THORACIC AND LUMBAR TUBERCULOSIS COMPLICATED WITH SEVERE KYPHOTIC DEFORMITY AND PARAPLEGIA

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