One-stage posterior retaining part facet joint in laminectomy and debridement combined with short segmental pedicle screw fixation for lumbosacral spinal tuberculosis_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

CHENLin , QINJianpu , AOJun , LIAOWenbo ,  CAIYuqiang

Department of Spinal Surgery, Affiliated Hospital of Zunyi Medical College, Zunyi Guizhou, 563003, P. R. China;

Corresponding?author：

CAIYuqiang, Email: caihuofu@sina.com

Keywords：

Lumbosacral spinal tuberculosis; Facet joint; Posterior operation; Debridement; Internal fixation

DOI：

10.7507/1002-1892.20160173

Video：

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Objective To evaluate the feasibility and effectiveness of one-stage posterior retaining part facet joint in laminectomy, bone graft and debridement combined with short segmental pedicle screw fixation for lumbosacral spinal tuberculosis. Methods Between January 2010 and December 2014, 32 cases of lumbosacral spinal tuberculosis (L₄-S₁) were treated by one-stage posterior retaining part facet joint in laminectomy, bone graft and debridement combined with short segmental pedicle screw fixation. There were 20 males and 12 females, aged 17-62 years (mean, 43 years). The disease duration was 12-48 months (mean, 18 months). The involved segments included L₅, S₁ level in 19 cases and L_{4, 5} level in 13 cases. The effectiveness was evaluated by Oswestry disability index (ODI) and imaging parameters (lumbar-sacral angle correction and Bridwell classification and CT fusion criteria) after operation. Results The operation was successfully completed in all patients; the average operation time was 180 minutes, and the average intraoperative blood loss was 400 mL. All cases were followed up 12 to 67 months (mean, 15.6 months). At last follow-up, common toxic symptom of tuberculosis disappeared, and no internal fixation failure occurred. Neurological function was recovered to normal in 7 patients with neurological symptoms, and American Spinal Injury Association (ASIA) scale was improved to grade E from grade C (2 cases) and grade D (5 cases) before operation. At 1 year and last follow-up, the ODI scores were significantly improved when compared with preoperative score (P < 0.05), but no significant difference was found between at 1 year and last follow-up (P>0.05). The lumbarsacral angle was significantly increased at 7 days, 1 year and last follow-up when compared with preoperative one (P < 0.05), but there was no significant difference between different time points after operation (P>0.05). The bone graft fusion time was 9-24 months (mean, 12 months). At 1 year after operation and last follow-up, X-ray Bridwill bone fusion rates were 87.50% (28/32) and 93.75% (30/32) respectively, and CT fusion rates were 87.50% (28/32) and 90.63% (29/32) respectively; and there was significant difference in interbody fusion between at 1 year and last follow-up (P < 0.05). Drug resistance was observed in 4 cases; Bridwill gradeⅢand gradeⅣfusion was shown in 3 cases and 1 case after adjusting the anti-tuberculosis scheme after 1 year. Conclusion One-stage posterior retaining part facet joint in laminectomy and debridement can effectively clear the tuberculose focus, intervertebral bone graft combined with short segment pedicle screw fixation can maintain postoperative spinal reliable stability and get satisfactory bone fusion rate, so it is an effective method for the treatment of lumbosacral tuberculosis.

Citation： CHENLin, QINJianpu, AOJun, LIAOWenbo, CAIYuqiang. One-stage posterior retaining part facet joint in laminectomy and debridement combined with short segmental pedicle screw fixation for lumbosacral spinal tuberculosis. Chinese Journal of Reparative and Reconstructive Surgery, 2016, 30(7): 849-854. doi: 10.7507/1002-1892.20160173 Copy

1.	吳在德, 吳肇漢.外科學. 6版.北京:人民衛生出版社, 2005: 898.
2.	趙玉沛, 陳孝平.外科學. 3版.北京:人民衛生出版社, 2015: 991.
3.	蔡和, 湯泳強.脊柱不穩固X線表現及測量方法研究(附73例分析).放射學實踐, 2000, 15(5): 362-364.
4.	Bridwell KH, Lenke LG, McEnery KW, et al. Anterior fresh frozen?structural?allografts?in the thoracic and lumbar?spine. Do they work if combined with posterior fusion and instrumentation in adult patients with kyphosis or anterior column defects? Spine (Phila Pa 1976), 1995, 20(12): 1410-1418.
5.	Nakshima H, Yukawa Y, Ito K, et al. Extension CT scan: its suitability for fusion after posterior lumbar interbody fusion. Eur Spine J, 2011, 20(9): 1496-1502.
6.	Faraj AA. Anterior instrumentation for the treatment of spinal tuberculosis. J Bone Joint Surg (Am), 2001, 83-A(3): 463-464.
7.	Moon M, Moon J, Moon Y, et al. Pott's paraplegia in patient with severely deformed dorsal or dorsolumbar spines: teatement and prognosis. Spinal Cord, 2003, 41(3): 164-171.
8.	Jin D, Qu D, Chen J, et al. One-stage anterior interbody autografting and instrumention in primary surgical management of thoracolumbar spinal tuberculosis. Eur Spine J, 2004, 13(2): 114-121.
9.	Issack PS, Boachie-Adjei O. Surgical correction of kyphotic deformity in spinal tuberculosis. Int Orthop, 2012, 36(2): 353-357.
10.	Sai Kiran NA, Vaishya S, Kale SS, et al. Surgical results in patients with tuberculosis of the spine and severe lower-extremity motor deficits: a retrospective study of 48 patients. J Neurosurg Spine, 2007, 6(4): 320-326.
11.	賀茂林, 肖增明, 李世德, 等.側前方入路一期病灶清除植骨內固定治療腰骶段結核.中國脊柱脊髓雜志, 2009, 19(11): 818-822.
12.	Zhang HQ, Lin MZ, Ge L, et al. Surgical management by one-stage posterior transforaminal lumbar debridement, interbody fusion, and posterior instrumentation for lumbo-sacral tuberculosis in the aged. Arch Orthop Trauma Surg, 2012, 132(12): 1677-1683.
13.	王錫陽, 龐曉陽, 李偉偉, 等.一期后路病灶清除植骨融合內固定治療腰骶段脊柱結核.中國現代醫學雜志, 2011, 21(28): 3527-3531.
14.	阿不都乃比·艾力, 張宏其, 唐明星, 等.單純一期后路手術聯合多枚分網異形鈦網技術治療腰骶段脊柱結核.中南大學學報(醫學版), 2014, 39(12): 1313-1319.
15.	Degreif J, Wenda K, Runkel M, et al. Rotational stability of the tho-racolumbar spine after interlaminar ultrasound window, hemilaminectomy and laminectomy. A comparative experimental study. Unfallchirurg, 1994, 97(5): 250-255.
16.	阮狄克, 呂維加, 費正奇, 等.節段開窗髓核摘除對腰椎穩定性的影響.中華骨科雜志, 1999, 19(5): 269-271.
17.	He D, Wu L, Chi Y, et al. Facet joint plus interspinous process graft fusion to prevent postoperative late correction loss in thoracolumbar fractures with disc damage: finite element analysis and small clinical trials. Clin Biomech (Bristol, Avon), 2011, 26(3): 229-237.
18.	Adams MA, Hutton WC. The mechanical function of the lumbar apophysea joints. Spine (Phila Pa 1976), 1983, 8(3): 327-300.
19.	Vaccaro AR, Lehman RA, Hurlbert RJ, et al. A new classification of thoracolumbar injuries: The importance complex, and neurologic of injury morphology, the integrity of the posterior ligmentous status. Spine (Phila Pa 1976), 2005, 30(20): 2325-2333.
20.	瞿東濱, 金大地.正確認識脊柱結核病灶清除術.中國脊柱脊髓雜志, 2006, 18(8): 565-567.
21.	宋躍明.如何理解脊柱結核病灶徹底清除?中國脊柱脊髓雜志, 2010, 20(10): 798.
22.	王自立.進一步規范脊柱結核的治療.中國脊柱脊髓雜志, 2010, 20(10): 793-794.
23.	羅卓荊.脊柱結核為什么要徹底清除病灶?中國脊柱脊髓雜志, 2010, 20(10): 797-798.
24.	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.中華骨科雜志, 2005, 25(2): 97-101.
25.	張宏其, 陳筱, 郭虎兵, 等.單純后路病灶清除椎體間植骨融合內固定治療脊柱結核的適應證及療效評價.中國矯形外科雜志, 2012, 20(3): 196-199.
26.	No authors listed. Five-year assessments of controlled trials of ambulatory treatment, debridement and anterior spinal fusion in the management of tuberculosis of the spine. Studies in Bulawayo (Rhodesia) and in Hong Kong. Sixth report of the Medical Research Council Working Party on Tuberculosis of the Spine. J Bone Joint Surg (Br), 1978, 60-B(2): 163-177.
27.	No authors listed. A 10-year assessment of controlled trials of inpatient and outpatient treatment and of plaster-of-Paris jackets for tuberculosis of the spine in children on standard chemotherapy. Studies in Mason and Pusan, Korea. Ninth report of the Medical Research Council Working Party on Tuberculosis of the Spine. J Bone Joint Surg (Br), 1985, 67(1): 103-110.
28.	張西峰, 夏志敏, 王巖, 等.微創方法提高病灶內藥物濃度治療脊柱結核的臨床分析.第三軍醫大學學報, 2009, 31(20): 1936-1939.
29.	張西峰.用微創的視角解讀《脊柱結核的手術策略》.中華骨科雜志, 2011, 31(4): 391-393.

1. 吳在德, 吳肇漢.外科學. 6版.北京:人民衛生出版社, 2005: 898.
2. 趙玉沛, 陳孝平.外科學. 3版.北京:人民衛生出版社, 2015: 991.
3. 蔡和, 湯泳強.脊柱不穩固X線表現及測量方法研究(附73例分析).放射學實踐, 2000, 15(5): 362-364.
4. Bridwell KH, Lenke LG, McEnery KW, et al. Anterior fresh frozen?structural?allografts?in the thoracic and lumbar?spine. Do they work if combined with posterior fusion and instrumentation in adult patients with kyphosis or anterior column defects? Spine (Phila Pa 1976), 1995, 20(12): 1410-1418.
5. Nakshima H, Yukawa Y, Ito K, et al. Extension CT scan: its suitability for fusion after posterior lumbar interbody fusion. Eur Spine J, 2011, 20(9): 1496-1502.
6. Faraj AA. Anterior instrumentation for the treatment of spinal tuberculosis. J Bone Joint Surg (Am), 2001, 83-A(3): 463-464.
7. Moon M, Moon J, Moon Y, et al. Pott's paraplegia in patient with severely deformed dorsal or dorsolumbar spines: teatement and prognosis. Spinal Cord, 2003, 41(3): 164-171.
8. Jin D, Qu D, Chen J, et al. One-stage anterior interbody autografting and instrumention in primary surgical management of thoracolumbar spinal tuberculosis. Eur Spine J, 2004, 13(2): 114-121.
9. Issack PS, Boachie-Adjei O. Surgical correction of kyphotic deformity in spinal tuberculosis. Int Orthop, 2012, 36(2): 353-357.
10. Sai Kiran NA, Vaishya S, Kale SS, et al. Surgical results in patients with tuberculosis of the spine and severe lower-extremity motor deficits: a retrospective study of 48 patients. J Neurosurg Spine, 2007, 6(4): 320-326.
11. 賀茂林, 肖增明, 李世德, 等.側前方入路一期病灶清除植骨內固定治療腰骶段結核.中國脊柱脊髓雜志, 2009, 19(11): 818-822.
12. Zhang HQ, Lin MZ, Ge L, et al. Surgical management by one-stage posterior transforaminal lumbar debridement, interbody fusion, and posterior instrumentation for lumbo-sacral tuberculosis in the aged. Arch Orthop Trauma Surg, 2012, 132(12): 1677-1683.
13. 王錫陽, 龐曉陽, 李偉偉, 等.一期后路病灶清除植骨融合內固定治療腰骶段脊柱結核.中國現代醫學雜志, 2011, 21(28): 3527-3531.
14. 阿不都乃比·艾力, 張宏其, 唐明星, 等.單純一期后路手術聯合多枚分網異形鈦網技術治療腰骶段脊柱結核.中南大學學報(醫學版), 2014, 39(12): 1313-1319.
15. Degreif J, Wenda K, Runkel M, et al. Rotational stability of the tho-racolumbar spine after interlaminar ultrasound window, hemilaminectomy and laminectomy. A comparative experimental study. Unfallchirurg, 1994, 97(5): 250-255.
16. 阮狄克, 呂維加, 費正奇, 等.節段開窗髓核摘除對腰椎穩定性的影響.中華骨科雜志, 1999, 19(5): 269-271.
17. He D, Wu L, Chi Y, et al. Facet joint plus interspinous process graft fusion to prevent postoperative late correction loss in thoracolumbar fractures with disc damage: finite element analysis and small clinical trials. Clin Biomech (Bristol, Avon), 2011, 26(3): 229-237.
18. Adams MA, Hutton WC. The mechanical function of the lumbar apophysea joints. Spine (Phila Pa 1976), 1983, 8(3): 327-300.
19. Vaccaro AR, Lehman RA, Hurlbert RJ, et al. A new classification of thoracolumbar injuries: The importance complex, and neurologic of injury morphology, the integrity of the posterior ligmentous status. Spine (Phila Pa 1976), 2005, 30(20): 2325-2333.
20. 瞿東濱, 金大地.正確認識脊柱結核病灶清除術.中國脊柱脊髓雜志, 2006, 18(8): 565-567.
21. 宋躍明.如何理解脊柱結核病灶徹底清除?中國脊柱脊髓雜志, 2010, 20(10): 798.
22. 王自立.進一步規范脊柱結核的治療.中國脊柱脊髓雜志, 2010, 20(10): 793-794.
23. 羅卓荊.脊柱結核為什么要徹底清除病灶?中國脊柱脊髓雜志, 2010, 20(10): 797-798.
24. 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.中華骨科雜志, 2005, 25(2): 97-101.
25. 張宏其, 陳筱, 郭虎兵, 等.單純后路病灶清除椎體間植骨融合內固定治療脊柱結核的適應證及療效評價.中國矯形外科雜志, 2012, 20(3): 196-199.
26. No authors listed. Five-year assessments of controlled trials of ambulatory treatment, debridement and anterior spinal fusion in the management of tuberculosis of the spine. Studies in Bulawayo (Rhodesia) and in Hong Kong. Sixth report of the Medical Research Council Working Party on Tuberculosis of the Spine. J Bone Joint Surg (Br), 1978, 60-B(2): 163-177.
27. No authors listed. A 10-year assessment of controlled trials of inpatient and outpatient treatment and of plaster-of-Paris jackets for tuberculosis of the spine in children on standard chemotherapy. Studies in Mason and Pusan, Korea. Ninth report of the Medical Research Council Working Party on Tuberculosis of the Spine. J Bone Joint Surg (Br), 1985, 67(1): 103-110.
28. 張西峰, 夏志敏, 王巖, 等.微創方法提高病灶內藥物濃度治療脊柱結核的臨床分析.第三軍醫大學學報, 2009, 31(20): 1936-1939.
29. 張西峰.用微創的視角解讀《脊柱結核的手術策略》.中華骨科雜志, 2011, 31(4): 391-393.

Chinese Journal of Reparative and Reconstructive Surgery

One-stage posterior retaining part facet joint in laminectomy and debridement combined with short segmental pedicle screw fixation for lumbosacral spinal tuberculosis

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