Single-stage transpedicular decompression, debridement, posterior instrumentation, and fusion for thoracic tuberculosis with kyphosis and spinal cord compression in aged individuals

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• 作者：Chengke Luo ; MD ; Xiyang Wang ; MD ; PhD ; ^{458843975@qq.com" class="auth_mail" title="E-mail the corresponding author} ; Ping Wu ; MD ; Lei Ge ; MD ; PhD ; Hongqi Zhang ; MD ; PhD ; Jianzhong Hu ; MD ; PhD
• 关键词：Thoracic spinal tuberculosis ; Transpedicular decompression ; Allograft ; Spinal cord compression ; Kyphosis ; The aged
• 刊名：The Spine Journal
• 出版年：2016
• 出版时间：February 2016
• 年：2016
• 卷：16
• 期：2
• 页码：154-162
• 全文大小：1209 K

文摘

The single-stage posterior approach only for spinal tuberculosis (TB) has been reported by some surgeons recently, but few studies have reported single-stage transpedicular decompression, debridement, posterior instrumentation, and fusion in treatment of thoracic TB with kyphosis and spinal cord compression in patients older than 65 years.

Purpose

The purpose of this study was to investigate the effectiveness and feasibility of single-stage transpedicular decompression, debridement, posterior instrumentation, and fusion in the treatment of thoracic TB with kyphosis and spinal cord compression in aged individuals.

Study design

The study used a retrospective review.

Patient sample

Between January 2004 and March 2010, 37 cases of thoracic TB with kyphosis and spinal cord compression in individuals older than 65 were treated with single-stage transpedicular decompression, debridement, posterior instrumentation, and fusion.

Outcome measures

The patients were evaluated based on ASIA (American Spinal Injury Association) classification, kyphotic Cobb angle, fusion status of affected segment via computed tomography scans, and visual analog scale pain score.

Methods

There were 23 men and 14 women with an average age of 72.08±4.49 years (range, 65–81 years). The mean disease duration was 6 months (range, 3 to 21 months). The involved vertebral bodies were T2–T11, including two segments in 29 cases and three segments in 8 cases. The kyphosis Cobb angle was 39.46±4.71° before operation.

Results

The follow-up period ranged from 24 to 61 months (mean 41.43±3.40 months). No mortality occurred. One case of recurrence due to irregular antitubercular treatment was cured by abscess clearing and regular chemotherapy. A solid fusion was achieved in the other 36 cases. According to the ASIA score system, 10 cases were rated as grade D, and 27 cases as grade E at last follow-up. The kyphosis Cobb angle was 22.32±3.41°, showing significant difference when compared with the value before operation (t=17.146, p<.001).

Conclusion

Single-stage transpedicular decompression, debridement, posterior instrumentation, and fusion is an effective and safe method in treatment of thoracic TB with kyphosis and spinal cord compression in aged individuals.