Effect of surgical timing on effectiveness of thoracic spinal tuberculosis with myelopathy_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

PENG Qiqi ^1,2 ,  OU Yunsheng ² , ZHU Yong ² , ZHAO Zenghui ² , LUO Wei ² , DU Xing ² , LI Jianxiao ²

1. Department of Orthopedics, Wushan County People’s Hospital, Wushan Chongqing, 404700, P.R.China;
2. Department of Orthopedics, the First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, P.R.China;

Corresponding?author：

OU Yunsheng, Email: ouyunsheng2001@163.com

Keywords：

Surgical timing; thoracic spinal tuberculosis; myelopathy; decompression

DOI：

10.7507/1002-1892.201808071

Video：

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Objective To explore the feasibility of posterior debridement, decompression, bone grafting, and fixation in treatment of thoracic spinal tuberculosis with myelopathy, and investigate the effects of surgical timing on postoperative outcomes.Methods The clinical data of 26 patients with thoracic spinal tuberculosis with myelopathy between August 2012 and October 2015 was retrospectively analyzed. All patients underwent posterior unilateral transpedicular debridement, decompression, bone grafting, and fixation and were divided into two groups according to surgical timing. Group A included 11 patients with neurological dysfunction lasting less than 3 months; group B included 15 patients with neurological dysfunction lasting more than 3 months. No significant difference was found between the two groups in gender, age, involved segments, preoperative erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), Cobb angle of involved segment, and preoperative American Spinal Injury Association (ASIA) classification (P>0.05). The operation time, intraoperative blood loss, hospitalization stay, perioperative complications, and bone fusion time were recorded and compared between the two groups. The change of pre- and post-operative Cobb angle of involved segments was calculated. Neurological function was assessed according to ASIA classification.Results All patients were followed up 25-60 months (mean, 41.6 months). No cerebrospinal fluid leakage occurred intra- and post-operation. The hospitalization stay and perioperative complications in group A were significantly less than those of group B (P<0.05). There was no significant difference in operation time, intraoperative blood loss, and bone fusion time between the two groups (P>0.05). At last follow-up, there was no significant difference in ESR and CRP between groups A and B (P>0.05), but they were all significantly lower than those before operation (P<0.05). In group A, 1 patient with T_{6, 7} tuberculosis developed sinus that healed after dressing; the implants were removed at 20 months with bony union and no recurrence was found after 36 months of follow-up. One patient with T_{4, 5} tuberculosis in group B underwent revision because of recurrence and distal junctional kyphosis of the thoracic spine at 26 months after operation. There was no internal fixation-related complications or tuberculosis recurrence occurred in the remaining patients. At last follow-up, the Cobb angles in the two groups significantly improved compared with those before operation (P<0.05), but there was no significant difference in the Cobb angle and correction degree between the two groups (P>0.05). At last follow-up, the ASIA classification of spinal cord function was grade C in 1 case and grade E in 10 cases in group A, and grade D in 2 cases and grade E in 13 cases in group B; the ASIA classification results in the two groups significantly improved compared with preoperative ones (P<0.05), but no significant difference was found between the two groups (Z=–0.234, P=1.000).Conclusion Posterior unilateral transpedicular debridement, decompression, bone grafting, and fixation is effective in treatment of thoracic spinal tuberculosis with myelopathy. Early surgery can reduce the hospitalization stays and incidence of perioperative complications.

Citation： PENG Qiqi, OU Yunsheng, ZHU Yong, ZHAO Zenghui, LUO Wei, DU Xing, LI Jianxiao. Effect of surgical timing on effectiveness of thoracic spinal tuberculosis with myelopathy. Chinese Journal of Reparative and Reconstructive Surgery, 2019, 33(3): 273-279. doi: 10.7507/1002-1892.201808071 Copy

1.	Restrepo CS, Katre R, Mumbower A. Imaging manifestations of thoracic tuberculosis. Radiol Clin North Am, 2016, 54(3): 453-473.
2.	Yao Y, Zhang H, Liu M, et al. Prognostic factors for recovery of patients after surgery for thoracic spinal tuberculosis. World Neurosurg, 2017, 105: 327-331.
3.	Fisahn C, Alonso F, Hasan GA, et al. Trends in spinal surgery for Pott’s disease (2000-2016): an overview and bibliometric study. Global Spine J, 2017, 7(8): 821-828.
4.	Shen X, Liu H, Wang G, et al. Single-stage posterior-only approach treating single-segment thoracic tubercular spondylitis. Int J Clin Exp Pathol, 2015, 8(9): 11051-11059.
5.	Basu S, Kondety SKC. Transpedicular decompression/debridement and posterior spinal fusion with instrumentation for single-level thoracic spinal tuberculosis with myelopathy-is anterior column reconstruction necessary? Spine Deform, 2018, 6(3): 282-289.
6.	Jain AK, Kumar J. Tuberculosis of spine: neurological deficit. Eur Spine J, 2013, 22 Suppl 4: 624-633.
7.	Wang H, Yang X, Shi Y, et al. Early predictive factors for lower-extremity motor or sensory deficits and surgical results of patients with spinal tuberculosis: A retrospective study of 329 patients. Medicine (Baltimore), 2016, 95(34): e4523.
8.	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.
9.	Yin XH, Zhou ZH, Yu HG, et al. Comparison between the antero-posterior and posterior only approaches for treating thoracolumbar tuberculosis (T10-L2) with kyphosis in children: a minimum 3-year follow-up. Childs Nerv Sits, 2016, 32(1): 127-133.
10.	Nene A, Bhojraj S. Results of nonsurgical treatment of thoracic spinal tuberculosis in adults. Spine J, 2005, 5(1): 79-84.
11.	Patil SS, Mohite S, Varma R, et al. Non-surgical management of cord compression in tuberculosis: a series of surprises. Asian Spine J, 2014, 8(3): 315-321.
12.	Luo C, Wang X, Wu P, et al. Single-stage transpedicular decompression, debridement, posterior instrumentation, and fusion for thoracic tuberculosis with kyphosis and spinal cord compression in aged individuals. Spine J, 2016, 16(2): 154-162.
13.	Jain AK, Jain S. Instrumented stabilization in spinal tuberculosis. Int Orthop, 2012, 36(2): 285-292.
14.	吳鵬, 歐云生, 劉德龍, 等. 后路經單側椎弓根病灶清除植骨內固定治療胸腰椎結核的療效分析. 中國修復重建外科雜志, 2015, 29(10): 1259-1264.
15.	趙增輝, 朱勇, 羅偉, 等. 一期后路經單側入路病灶清除植骨內固定治療多節段胸腰椎結核. 中國修復重建外科雜志, 2017, 31(9): 1073-1079.
16.	Xie J, Li T, Wang Y, et al. Change in Cobb angle of each segment of the major curve after posterior vertebral column resection (PVCR): a preliminary discussion of correction mechanisms of PVCR. Eur Spine J, 2012, 21(4): 705-710.
17.	Chandler K, Cappello R. Laminectomy membrane formation in dogs: is the answer still elusive? Vet J, 2006, 172(1): 1-2.
18.	羅一, 鄧展生, 陳靜, 等. 有限減壓及椎板重建在單節段胸椎結核手術治療中的應用. 中國修復重建外科雜志, 2012, 26(12): 1409-1414.
19.	Mori T, Leung CC. Tuberculosis in the global aging population. Infect Dis Clin North Am, 2010, 24(3): 751-768.
20.	Kamara E, Mehta S, Brust JC, et al. Effect of delayed diagnosis on severity of Pott’s disease. Int Orthop, 2012, 36(2): 245-254.
21.	Liu Z, Wang X, Xu Z, et al. Two approaches for treating upper thoracic spinal tuberculosis with neurological deficits in the elderly: A retrospective case-control study. Clin Neurol Neurosurg, 2016, 141: 111-116.
22.	Jain AK. Treatment of tuberculosis of the spine with neurologic complications. Clin Orthop Relat Res, 2002, (398): 75-84.
23.	Dunn R, Zondagh I, Candy S. Spinal tuberculosis: magnetic resonance imaging and neurological impairment. Spine (Phila Pa 1976), 2011, 36(6): 469-473.

1. Restrepo CS, Katre R, Mumbower A. Imaging manifestations of thoracic tuberculosis. Radiol Clin North Am, 2016, 54(3): 453-473.
2. Yao Y, Zhang H, Liu M, et al. Prognostic factors for recovery of patients after surgery for thoracic spinal tuberculosis. World Neurosurg, 2017, 105: 327-331.
3. Fisahn C, Alonso F, Hasan GA, et al. Trends in spinal surgery for Pott’s disease (2000-2016): an overview and bibliometric study. Global Spine J, 2017, 7(8): 821-828.
4. Shen X, Liu H, Wang G, et al. Single-stage posterior-only approach treating single-segment thoracic tubercular spondylitis. Int J Clin Exp Pathol, 2015, 8(9): 11051-11059.
5. Basu S, Kondety SKC. Transpedicular decompression/debridement and posterior spinal fusion with instrumentation for single-level thoracic spinal tuberculosis with myelopathy-is anterior column reconstruction necessary? Spine Deform, 2018, 6(3): 282-289.
6. Jain AK, Kumar J. Tuberculosis of spine: neurological deficit. Eur Spine J, 2013, 22 Suppl 4: 624-633.
7. Wang H, Yang X, Shi Y, et al. Early predictive factors for lower-extremity motor or sensory deficits and surgical results of patients with spinal tuberculosis: A retrospective study of 329 patients. Medicine (Baltimore), 2016, 95(34): e4523.
8. 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.
9. Yin XH, Zhou ZH, Yu HG, et al. Comparison between the antero-posterior and posterior only approaches for treating thoracolumbar tuberculosis (T10-L2) with kyphosis in children: a minimum 3-year follow-up. Childs Nerv Sits, 2016, 32(1): 127-133.
10. Nene A, Bhojraj S. Results of nonsurgical treatment of thoracic spinal tuberculosis in adults. Spine J, 2005, 5(1): 79-84.
11. Patil SS, Mohite S, Varma R, et al. Non-surgical management of cord compression in tuberculosis: a series of surprises. Asian Spine J, 2014, 8(3): 315-321.
12. Luo C, Wang X, Wu P, et al. Single-stage transpedicular decompression, debridement, posterior instrumentation, and fusion for thoracic tuberculosis with kyphosis and spinal cord compression in aged individuals. Spine J, 2016, 16(2): 154-162.
13. Jain AK, Jain S. Instrumented stabilization in spinal tuberculosis. Int Orthop, 2012, 36(2): 285-292.
14. 吳鵬, 歐云生, 劉德龍, 等. 后路經單側椎弓根病灶清除植骨內固定治療胸腰椎結核的療效分析. 中國修復重建外科雜志, 2015, 29(10): 1259-1264.
15. 趙增輝, 朱勇, 羅偉, 等. 一期后路經單側入路病灶清除植骨內固定治療多節段胸腰椎結核. 中國修復重建外科雜志, 2017, 31(9): 1073-1079.
16. Xie J, Li T, Wang Y, et al. Change in Cobb angle of each segment of the major curve after posterior vertebral column resection (PVCR): a preliminary discussion of correction mechanisms of PVCR. Eur Spine J, 2012, 21(4): 705-710.
17. Chandler K, Cappello R. Laminectomy membrane formation in dogs: is the answer still elusive? Vet J, 2006, 172(1): 1-2.
18. 羅一, 鄧展生, 陳靜, 等. 有限減壓及椎板重建在單節段胸椎結核手術治療中的應用. 中國修復重建外科雜志, 2012, 26(12): 1409-1414.
19. Mori T, Leung CC. Tuberculosis in the global aging population. Infect Dis Clin North Am, 2010, 24(3): 751-768.
20. Kamara E, Mehta S, Brust JC, et al. Effect of delayed diagnosis on severity of Pott’s disease. Int Orthop, 2012, 36(2): 245-254.
21. Liu Z, Wang X, Xu Z, et al. Two approaches for treating upper thoracic spinal tuberculosis with neurological deficits in the elderly: A retrospective case-control study. Clin Neurol Neurosurg, 2016, 141: 111-116.
22. Jain AK. Treatment of tuberculosis of the spine with neurologic complications. Clin Orthop Relat Res, 2002, (398): 75-84.
23. Dunn R, Zondagh I, Candy S. Spinal tuberculosis: magnetic resonance imaging and neurological impairment. Spine (Phila Pa 1976), 2011, 36(6): 469-473.

Chinese Journal of Reparative and Reconstructive Surgery

Effect of surgical timing on effectiveness of thoracic spinal tuberculosis with myelopathy

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