Evaluation of the efficacy of retroperitoneoscopic debridement for lumbar tuberculosis: a retrospective study and preliminary results.

ObjectiveTo evaluate the clinical efficacy of oblique lateral interbody fusion (OLIF) combined posterior fixation for single-segment lumbar tuberculosis (TB).MethodsThe medical records of spinal TB patients who were admitted to our department from January 2016 to December 2018 were retrospectively reviewed, and those meeting the inclusion criteria were finally included for analysis. The operative time, operative blood loss, hospital stay, visual analogue scale (VAS) score, Oswestry disability index (ODI), Cobb angle of surgical segment, bone graft fusion rate, erythrocytic sedimentation rate (ESR), C-reactive protein (CRP), neurological function (ASIA grade) and complications of the included patients were all recorded and analyzed.ResultsThirty-nine patients with lumbar TB were finally included. The mean operative time, operative blood loss, and hospital stay were 135.8 ± 19.2 min, 239.4 ± 84.7 ml, and 9.5 ± 2.7 days, respectively. The mean follow-up time was 26.3 ± 7.5 months. During the follow-up, both VAS score and ODI were significantly improved at 1 month, 3 months, 6 months, 1 year postoperative, and the last follow-up, compared with preoperative (P < 0.001). Cobb angle was significantly corrected at 1 month postoperatively (P < 0.001), however, from 3 months postoperative to the last follow-up, Cobb angle was getting lost (P < 0.01). Bone graft fusion rate at 3 months, 6 months, 1 year postoperative, and last follow-up were 66.67%, 87.18%, 94.88%, and 100%, respectively. Compared with preoperative, ESR and CRP were both showed significant decrease at 1 and 6 months postoperative, and the last follow-up (P < 0.001). At the last follow-up, all patients had improvement in ASIA grade compared with preoperative (P < 0.001). Six patients were found with postoperative complications, and all were cured after active treatment.ConclusionsOLIF combined posterior internal fixation is safe and effective in the treatment of single-segment lumbar TB, with satisfactory pain relief, improvement of lumbar and neurological function, and deformity correction.

BackgroundLumbar infectious spondylodiscitis is a severe spinal condition traditionally managed with antibiotics, though some patients require surgical intervention. The heterogeneity in infection sites, causative pathogens, and clinical presentations leads to significant variability in surgical approaches, and optimal surgical strategies remain controversial. This study aims to evaluate the feasibility, safety, and preliminary efficacy of endoscopic retroperitoneal debridement combined with posterior percutaneous pedicle screw fixation for the treatment of lumbar infectious spondylodiscitis.MethodsThis retrospective study analyzed patients diagnosed with lumbar infectious spondylodiscitis and treated with endoscopic retroperitoneal debridement at our institution from June 2023 to June 2024. Baseline patient characteristics, operative time, intraoperative blood loss, postoperative lesion clearance, changes in inflammatory markers (eg, C-reactive protein[CRP] and erythrocyte sedimentation rate[ESR]), complication rates, Visual analog scale (VAS) scores for back pain, Oswestry Disability Index (ODI) scores, kyphotic angle changes at the infected level, and radiological follow-up outcomes were recorded.ResultsOf the 30 patients, 28 (28/30, 93.33%) showed improvement in clinical symptoms. During follow-up, all patients demonstrated significant improvements in VAS scores and ODI scores compared to preoperative values (p<0.05). At the final follow-up, all patients exhibited a kyphotic angle change of less than 8°, and no spinal instability was observed. Computed tomography (CT) at the 12-month follow-up demonstrated intervertebral bone fusion in 27 cases (27/29, 93.10%). Postoperative inflammatory markers showed improved compared with preoperative levels (p<0.001). No infection recurrence or serious surgery-related complications were observed during the postoperative follow-up period.ConclusionEndoscopic retroperitoneal debridement combined with posterior percutaneous pedicle screw fixation appears to be a safe and effective minimally invasive approach for treating lumbar infectious spondylodiscitis. However, long-term efficacy requires further validation through prospective studies with larger sample sizes and extended follow-up periods.

The anterior and middle columns instead of the posterior column of spine are usually destroyed by tuberculosis which could aggravate the kyphosis accompanying the growth imbalance of spine in children. The surgical method needs to be selected cautiously for effective treatment. To our knowledge, few studies have evaluated mid-term outcomes of 2 surgeries (posterior-only approach and combined posterior and anterior approaches) with allograft or shaped titanium mesh cages for the treatment of lumbar tuberculosis in children. The study aims to compare the surgical mid-term outcomes of the posterior-only approach and the combined approaches using different bone grafting for the treatment of pediatric lumbar tuberculosis.Between January 2007 and June 2013 at our spine center, 51 consecutive pediatric lumbar tuberculosis with an average age of 7.3 ± 3.93 years treated with combined posterior and anterior approaches (PA, 22 cases) or posterior-only approach (PO, 29 cases) were enrolled. Two types of interbody bone graft were applied in this study: fresh-frozen tricortical iliac-bone allograft (AG, 21 cases) and shaped titanium mesh cages (TM, 30 cases). All medical records and radiographs were retrospectively reviewed. The Japanese Orthopaedic Association (JOA) is applied to evaluate the neurological function. The average visual analogue (VAS) and Oswestry Disability Index (ODI) were used to evaluate the quality of life.The average follow-up was 6.7 ± 1.9 years. The mean operation time, average blood loss, complication rate, and lengths of hospital stay of PO were less than those of the PA. The postoperative VAS (1 day after surgery) of PA was significantly higher than that of PO. The ODI, VAS and JOA scores at the final follow-up had been improved significantly compared with preoperative scores. The ODI, VAS and JOA scores at the final follow-up were similar between PA and PO as well as between AG and TM. There was no statistically significant difference about the fusion times between PO and PA groups. The final follow-up kyphosis correction rate and the correction loss at the final follow-up between the PO and PA groups showed no statistically significant difference. However, the final follow-up correction rate of the AG group was lower than that of TM group. The correction loss of the AG group was higher than that of TM group.The posterior only approach in experienced hands provides satisfying treatment for the children lumbar tuberculosis with less invasive, much safer, and more effective compared with combined posterior and anterior approach. The shaped titanium mesh cages are noted to be a valuable tool in surgical decision making.

Interbody fusion is a common surgical technique for diseases of the lumbar spine. Biportal endoscopic-assisted lumbar interbody fusion (BE-LIF) is a novel minimally invasive technique that has a long learning curve, which can be a barrier for surgeons. Therefore, we analyzed the learning curve in terms of operative time and evaluated the outcomes of BE-LIF. A retrospective study of fifty-seven consecutive patients who underwent BE-LIF for degenerative lumbar disease by a single surgeon from January 2017 to December 2018 was performed. Fifty patients underwent a single-level procedure, and 7 underwent surgery at two levels. The mean follow-up period was 24 months (range, 14–38). Total operative time, postoperative drainage volume, time to ambulation, and complications were analyzed. Clinical outcome was measured using the Oswestry Disability Index (ODI), Visual Analog Scale (VAS) score for back and leg pain, and modified Macnab criteria. The learning curve was evaluated by a nonparametric regression locally weighted scatterplot smoothing curve. Cases before the stable point on the curve were designated as group A, and those after the stable point were designated group B. Operative time decreased as the number of cases increased. A stable point was noticed on the 400th day and the 34th case after the first BE-LIF was performed. All cases showed improved ODI and VAS scores at the final follow-up. Overall mean operative time was 171.74 ± 35.1 min. Mean operative time was significantly lower in group B (139.7 ± 11.6 min) compared to group A (193.4 ± 28.3 min). Time to ambulation was significantly lower in group B compared to group A. VAS and ODI scores did not differ between the two groups. BE-LIF is an effective minimally invasive technique for lumbar degenerative disease. In our case series, this technique required approximately 34 cases to reach an adequate performance level.

The aim of this study is to evaluate balloon kyphoplasty as a surgical option for osteoporotic thoracolumbar compression fracture. The study was conducted on 30 patients from January 2014 to December 2017. The anterior vertebral height, kyphotic angle and functional evaluation by Oswestry disability index (ODI) and visual analogue scale (VAS) score were recorded preoperatively, immediate post-operatively at 3, 6, 12 months and yearly then on. All patients showed improvement in mean kyphotic angle from 16.4 ± 3.5 to 5.6 ± 1.7 post-operatively and 8.4 ± 1.6 at final follow-up. There was significant increase in mean anterior vertebral height from 51 ± 7.3% before surgery to 75.5 ± 7.4% at one day after surgery and 71.2 ± 3.2% at the last follow-up. There was significant improvement in mean VAS score from 8.1 ± 0.9 before surgery to 2.2 ± 0.4 at one day, and 2.4 ± 0.3 at final follow-up. The improvement in patients’ ODI score after surgery from 71.4 ± 3.4 to 26.0 ± 4.8 at one day and 21.2 ± 5.5 at final follow-up was noted. The mean operating time was 45.5 ± 15.5 min for each vertebra. Within first day of surgery improvement in pain relief and mobility was experienced by all patients. The orthopedic balloon ruptured in one patient and it was replaced then procedure was continued with no complications. There were no neurological complications in all cases and there was no infections and any occurrence of symptomatic pulmonary embolism. In conclusion, balloon kyphoplasty is a good minimally invasive procedure where along with reduction of pain and disability there is also restoration of sagittal alignment post-operatively.

Objective: To investigate the efficacy of debridement, decompression, interbody fusion and percutaneous screw internal fixation under the unilateral biportal endoscopy (UBE) combined with drug chemotherapy for thoracic and lumbar tuberculosis. Methods: A follow-up study. The clinical data of 9 patients who underwent UBE debridement, decompression, interbody fusion and percutaneous screw internal fixation combined with drug chemotherapy for thoracic and lumbar tuberculosis at the First Affiliated Hospital of Xinjiang Medical University from September 2021 to February 2022 were retrospectively analyzed. There were 4 males and 5 females, aged (52.4±13.5) years (ranged 27-71 years). All patients were given quadruple (isoniazid+rifampicin+pyrazinamide+ethambutol) anti-tuberculosis drugs chemotherapy for 2 to 4 weeks before surgery. The operation time, intraoperative blood loss, postoperative drainage volume, ambulation time, postoperative hospital stay and complications were recorded. The visual analog scale (VAS) of pain, Oswestry disability index (ODI), erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) in the patients were compared before and after the surgery. The degree and improvement of spinal cord injury before and after surgery were assessed according to the American Spinal Injury Association (ASIA) neurological classification; and the Cobb angle was measured before and after surgery to assess kyphotic deformity and correction. X-ray or CT was reviewed at 6 months postoperatively and at the final follow-up, and surgical segmental fusion was evaluated using Bridwell grading criteria. Results: All patients completed the surgery successfully and were followed up for (14.6±1.9) months. The operation time was (182.2±27.5) minutes, the intraoperative blood loss was (222.2±66.7) ml, postoperative drainage volume was (43.3±17.0) ml, the ambulation time was (1.9±0.8) days, postoperative hospital stay was (5.9±1.5) days. Complications occurred in 2 patients (2/9), including 1 case of procedure-related complication. ESR and CRP returned to normal level at the 6-month postoperative follow-up. The VAS score and ODI were significantly improved when compared with those before the operation at each postoperative follow-up time point, and the differences were all statistically significant (all P<0.05). All patients were classified as ASIA grade E at the last follow-up. The postoperative Cobb angle decreased from 14.44°±2.07° to 9.00°±2.29°, and there was no significant loss of angle at the last follow-up. At the 6-month postoperative follow-up, 5 cases (5/9) were classified as Bridwell grade Ⅰ, 2 cases (2/9) as grade Ⅱ, and 1 case (1/9) as grade Ⅲ and Ⅳ, respectively; and all the patients were classified as grade Ⅰ at the last follow-up. Conclusion: Combined with drug chemotherapy, UBE debridement, decompression, interbody fusion and percutaneous screw internal fixation is a safe, feasible and effective therapy for thoracic and lumbar tuberculosis.

ObjectiveThis study was performed to evaluate the surgical indications, clinical efficacy, and preliminary experiences of nonstructural bone grafts for lumbar tuberculosis (TB).MethodsThirty-four patients with lumbar TB who were treated with nonstructural bone grafts were retrospectively assessed. The operative time, operative blood loss, hospital stay, bone graft fusion time, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) concentration, visual analog scale (VAS) score, Oswestry Disability Index (ODI), American Spinal Injury Association (ASIA) impairment grade, and Cobb angle were recorded and analyzed.ResultsThe mean operative time, operative blood loss, hospital stay, Cobb angle correction, and Cobb angle loss were 192.59 ± 42.16 minutes, 385.29 ± 251.82 mL, 14.91 ± 5.06 days, 9.02° ± 3.16°, and 5.54° ± 1.09°, respectively. During the mean follow-up of 27.53 ± 8.90 months, significant improvements were observed in the ESR, CRP concentration, VAS score, ODI, and ASIA grade. The mean bone graft fusion time was 5.15 ± 1.13 months. Three complications occurred, and all were cured after active treatment.ConclusionsNonstructural bone grafts may achieve satisfactory clinical efficacy for appropriately selected patients with lumbar TB.

To evaluate the clinical efficacy of oblique lateral interbody fusion combined posterior percutaneous pedicle screw fixation in the treatment of single segment lumbar tuberculosis. Patients who underwent surgical treatment for single segment lumbar tuberculosis from 2015 to 2018 in our department were retrospectively included in this study. The included patients were divided into two groups, namely oblique lateral interbody fusion combined percutaneous pedicle screw fixation (OLIF) group and traditional posterior transforaminal or transpedicular approach debridement and pedicle screws fixation (PTA) group, according to the surgical methods. Outcomes including operative time, operative blood loss, hospital stay, visual analogue scale (VAS) score, Oswestry disability index (ODI), erythrocyte sedimentation rate (ESR), C reactive protein (CRP), Cobb angle correction and loss, bone fusion time, ASIA grade and complications were all recorded and compared. A total of 60 patients were included in this study, involving 23 patients in the OLIF group and 37 patients in the PTA group. The OLIF group had less operative time, blood loss and shorter hospital stay compared with the PTA group (P<0.05). Both the two groups achieved significant improvements in ESR, CRP and ASIA grade at the last follow-up (P<0.05), but no significant differences were found between them (P>0.05). There were no significant differences in Cobb angle correction and loss between the two groups (P>0.05), but the bone graft fusion time of the OLIF group was significantly shorter than the PTA group (P<0.05). The two groups achieved similar improvement in VAS score and ODI at 12 months postoperative and the last follow-up, however, OLIF group had a lower VAS score and ODI at 1 month, 3 months and 6 months postoperative (P<0.05). No significant difference was found in complications between the two groups (P>0.05) and all patients were cured after active treatment. Both OLIF and PTA can achieve satisfactory clinical efficacy in the surgical treatment of single segment lumbar TB, but OLIF has the advantages of less surgical trauma, faster postoperative recovery and shorter bone fusion time.

Osteoporotic vertebral compression fractures (OVCFs) significantly affect the quality of life of elderly patients by causing severe pain and functional loss. Percutaneous kyphoplasty (PKP) and percutaneous vertebroplasty (PVP) are minimally invasive surgical techniques for the treatment of OVCFs. It can be performed unilaterally or bilaterally for prevention of kyphosis without morbidity. This study aims to compare the radiological and clinical outcomes of unilateral versus bilateral approaches in PKP/PVP procedures.This retrospective observational study included 230 unilateral (n = 110) and bilateral (n = 120) patients from three spinal centers who underwent PCP or PVP for OVCF treatment between 2018 and 2024. During the operation, operative time, cement volume, and frequency of fluoroscopy were recorded. The duration of hospital stay was recorded. Visual Analog Scale (VAS) scores and Oswestry Disability Index (ODI) scores were used for clinical evaluation at preoperative, postoperative day 1, and final follow-up. Vertebral height and kyphotic angle were used for radiological evaluation.The unilateral approach had significantly shorter operative times (43.4 ± 9.01 minutes, p &lt; 0.001) compared to the bilateral approach (59.9 ± 11.5 minutes), required less cement (4.44 ± 1.01 mL vs. 7.53 ± 0.911 mL, p &lt; 0.001), and had fewer fluoroscopy (26.2 ± 6.58 vs. 55.6 ± 9.98, p &lt; 0.001). There were no significant differences between the two groups in VAS scores (p = 0.663), ODI scores (p = 0.650), vertebral height restoration (p = 0.720), or kyphotic angle correction (p = 0.129). However, the bilateral group had a higher rate of cement leakage (35 vs. 12%, p = 0.035).These findings suggest that the unilateral approach offers procedural advantages without compromising clinical efficacy, making it a preferable option for elderly patients with OVCFs.

To compare the clinical effects of cortical bone trajectory screws and traditional pedicle screws in posterior lumbar fusion. A retrospective study was conducted to analyze lumbar degeneration patients who underwent surgical treatment at our hospital between January 2016 and January 2019. A total of 123 patients who met the inclusion criteria were enrolled. The subjects were divided into two groups according to their surgical procedures and the members of the two groups were matched by age, sex, and the number of fusion segments. There were 63 patients in the traditional pedicle screws (PS) group and 60 in the cortical bone trajectory screws (CBTS) group. The outcomes of the two groups were compared. The primary outcome measures were perioperative conditions, including operation duration, estimated intraoperative blood loss (EBL), and length-of-stay (LOS), visual analog scale (VAS) score, Oswestry Disability Index (ODI) score, and interbody fusion rate. The secondary outcome measures were the time to postoperative ambulation and the incidence of complications. VAS scores and ODI scores were assessed before operation, 1 week, 1 month, 3 months, and 12 months after operation, and at the final follow-up. The interbody fusion rate was assessed in 1 year and 2 years after the operation and at the final follow-up. The CBTS group showed a reduction in operation duration ([142.8±13.1] min vs. [174.7±15.4] min, P<0.001), LOS ([9.5±1.5] d vs. [12.0±2.0] d, P<0.001), and EBL ([194.2±38.3] mL vs. [377.5±33.1] mL, P<0.001) in comparison with the PS group. The VAS score for back pain in the CBTS group was lower than that in the PS group at 1 week and 1 month after operation and the ODI score in the CBTS group was lower than that in the PS group at 1 month after operation, with the differences being statistically significant (P<0.05). At each postoperative time point, the VAS score for leg pain and the interbody fusion rate did not show significant difference between the two groups. The VAS score for back and leg pain and the ODI score at each time point after operation in both the CBTS group and the PS group were significantly lower than those before operation (P<0.05). No significant difference was found in the time to postoperative ambulation or the overall complication incidence between the two groups. The CBTS technique could significantly shorten the operation duration and LOS, reduce EBL, and achieve the same effect as the PS technique does in terms of intervertebral fusion rate, pain relief, functional improvement, and complication incidence in patients undergoing posterior lumbar fusion.

BACKGROUND: The distribution of bone cement after percutaneous kyphoplasty (PKP) affects its clinical efficacy in patients with osteoporosis. Robotic and traditional treatment of osteoporotic vertebral compression fractures (OVCFs) have both been established as effective, but no studies have compared these 2 modalities in terms of bone cement distribution and clinical outcomes. OBJECTIVE: To compare the bone cement distribution and clinical efficacy of robot-assisted percutaneous kyphoplasty to those of fluoroscopy-assisted percutaneous kyphoplasty for the treatment of OVCFs. SETTING: Department of Orthopedics and Spine Surgery, First Affiliated Hospital of Anhui Medical University, Hefei, China. STUDY DESIGN: A single-center, retrospective observational study. METHODS: Data from 151 patients with OVCFs who underwent PKP between January 2020 and July 2022 were analyzed retrospectively. The patients were divided into 3 groups: robot-assisted unipedicular percutaneous kyphoplasty (RAUPK), fluoroscopy-assisted unipedicular percutaneous kyphoplasty (FAUPK), and fluoroscopy-assisted bipedicular percutaneous kyphoplasty (FABPK). The operation time, intraoperative blood loss, bone cement injection volume, bone cement distribution, and complications (vascular and nerve injury, bone cement leakage, and re-fracture) of each procedure were recorded. The visual analog scale (VAS) score, Oswestry Disability Index (ODI) score, Cobb angle, and anterior height of the injured vertebrae were compared among the 3 groups preoperatively, one day postoperatively, and at the final follow-up. RESULTS: No puncture failures occurred in any of the 3 groups. The mean follow-up period was 20.0 ± 5.2 months. The postoperative VAS scores, ODI, anterior vertebral heights, and Cobb angles of all patients were significantly improved compared to the preoperative values (P &lt; 0.05). There were no significant differences in the VAS score, ODI score, Cobb angle, anterior vertebral height ratio preoperatively or one day postoperatively among the 3 groups (P &gt; 0.05). The groups’ comparative rates of intraoperative blood loss and complications also showed no significant differences (P &gt; 0.05). At the last follow-up, the VAS and ODI scores of the RAUPK group were lower than those of the FAUPK group (P &lt; 0.05), as were the anterior height of the injured vertebra and Cobb angle of the RAUPK group (P &lt; 0.05). The operation time, bone cement injection volume, and bone cement distribution in the RAUPK group were superior to those in the FAUPK group (P &lt; 0.05). Nevertheless, there were no significant differences in the VAS, ODI, Cobb angle, or anterior vertebral height at the last follow-up between the FABPK group and the RAUPK group (P &gt; 0.05). Those 2 groups also showed no significant difference in operation time, intraoperative blood loss, bone cement distribution, or complication rate (P &gt; 0.05). However, the patients in the RAUPK group were injected with a greater volume of bone cement than were those in the FABPK group (P &lt; 0.05). LIMITATIONS: This was a single-center, retrospective, nonrandomized study, which is a major limitation. CONCLUSION: Robot-assisted percutaneous kyphoplasty can establish an optimal path via the unipedicular approach, thereby effectively mitigating the potential risks associated with vascular nerve and cortical bone injuries. Additionally, RAUPK ensures a more favorable distribution of bone cement and provides superior pain relief for patients. Furthermore, RAUPK has greater long-term efficacy than does FAUPK. KEY WORDS: Percutaneous kyphoplasty, TiRobot, unilateral pedicle approach, osteoporotic vertebral compression fractures, optimal path, bone cement distribution

A retrospective study investigated the results of the lamina with spinous process (LSP) as a bone graft in one-level thoracic or lumbar spinal tuberculosis with the one-stage posterior approach of debridement, fusion and internal instrumentation. Data from 35 patients from January 2013 to December 2015 were analysed. Surgery time, blood loss, hospitalization time, drainage volume, and follow-up (FU) duration were recorded. The visual analogue scale (VAS), Oswestry Disability Index (ODI), erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), American Spinal Injury Association (ASIA) grade, segmental angle, and bone fusion were compared between preoperative and final FU. All of the patients were followed up for a mean 43.90 ± 10.39 months. The mean age, surgery time, blood loss, hospitalization time, hospital cost and drainage volume were 33.65 ± 11.06 years, 182.40 ± 23.82 min, 280.80 ± 76.82 mL, 14.05 ± 3.58 days, 74,382.00 ± 11,938.00 yuan, and 340.00 ± 167.20 mL, respectively. VAS and ODI were significantly improved at the final FU. The ESR and CRP recovered to normal. The mean angle of 24.35 ± 5.74°preoperatively showed a significant difference between 1 week, postoperatively and final FU. Although there were the loss of angle at final FU comparing with the 1 week postoperatively, it still maintain the good alignment and the segmental stability. All patients achieved bony fusion with a mean time of 12.90 ± 3.91 months. In conclusion, the LSP as a structural bone graft is reliable, safe and effective for segmental stability reconstruction, which could be one choice for surgical management of thoracic or lumbar spinal TB.

To evaluate the outcome of computed tomography (CT)-guided percutaneous puncture and local chemotherapy for tuberculosis (TB) of the lumbar or lumbosacral spine. From January 2002 to August 2006, 49 patients with lumbar or lumbosacral spinal TB in whom conservative treatment had failed were treated by minimally invasive surgery. There were 21 female and 28 male patients. The mean age of the patients was 47 ± 18 years (range from 12 to 78 years). There were 40 cases with lumbar TB, and 9 with lumbosacral TB. From L(1) to S(1), the involved vertebral numbers were 8, 26, 19, 19, 21 and 10, respectively. In 3 patients the spinal TB involved a single vertebra, in 39 patients two, in 6 patients three and in only one case four vertebrae. According to the Frankel scale, three patients had grade E incomplete paralysis preoperatively. The outcome, after treatment by CT-guided percutaneous puncture and local chemotherapy, was retrospectively analyzed according to the preoperative and postoperative kyphotic angles and the Oswestry disability index (ODI). Forty-nine patients were followed up for from one year to 5 years and 8 months (average 35 months). All cases recovered, and there was no recurrence. Preoperatively, the kyphotic angle was 16.47°± 8.74°, and it had decreased to 13.35°± 8.02° by the final follow-up (t= 5.79, P < 0.001). The average ODI score had improved from 70.12 ± 22.24 to 12.72 ± 8.62 (t= 21.42, P < 0.001). The majority of cases of lumbar and lumbosacral spinal TB can achieve satisfactory results with minimally invasive surgery. Its clinical application is therefore strongly recommended.

To explore the efficacy of secondary balloon kyphoplasty (BKP) for new vertebral compression fracture (NVCF) of previously non-fractured, non-treated vertebrae after previous BKP and to compare the therapeutic effect between patients with single-level adjacent NVCF and remote NVCF. We retrospectively studied patients with single-level NVCF after initial BKP in our hospital from January 2007 to August 2014. The mean follow-up time from secondary BKP was 13.78±3.18 (12-24) months. Visual analog scale (VAS) and Oswestry disability index (ODI) scores were assessed prior to the initial BKP, one day after initial BKP, prior to the secondary BKP, one day after the secondary BKP, and at last follow-up. Kyphotic angle and vertebral heights were also compared for secondary BKP. Data were compared between patients with adjacent NVCF and remote NVCF. 36 patients were investigated. Compared with pre-operative value of initial and secondary BKP, patients in both groups gained statistical significant improvements for VAS and ODI after initial and secondary BKP, respectively (P<0.05), and this improvement maintained at final follow-up. No statistical difference in VAS was found between the 2 groups after initial BKP and prior to the secondary BKP (P>0.05), but patients in remote NVCF group achieved better VAS score than patients in adjacent NVCF group after the secondary BKP and at the final follow-up (P<0.05). No statistical differences were detected in ODI between the 2 groups prior to the initial BKP, one day after initial BKP, prior to the secondary BKP and 1day after the secondary BKP (P>0.05), but the ODI scores were higher in adjacent NVCF group than in remote NVCF at last follow-up (P<0.05). Kyphotic angle and vertebral heights were significantly restored and maintained after secondary BKP within groups, respectively. Secondary BKP is an effective procedure for treating NVCF after initial BKP. Patients with new fracture in remote level gain slightly better pain relief than those in the adjacent level.

The standard recommended and common reconstruction method for spinal tuberculosis is titanium mesh bone graft and autogenous iliac crest. However, these methods have their own disadvantages. To evaluate the clinical efficacy of one-stage posterior debridement with iliac bone graft, titanium mesh bone graft, or nanohydroxyapatite/polyamide-66 cage in thoracic and lumbar tuberculosis. Between January 2013 and December 2018, 57 patients with thoracic or lumbar tuberculosis were treated by interbody bone graft combined with posterior internal fixation after debridement. Thirteen patients were treated with iliac bone graft to construct the stability of the vertebral body, 26 patients were treated with titanium mesh bone graft, and 18 patients were treated with nanohydroxyapatite/polyamide-66 cage bone graft. The main clinical results were evaluated by intervertebral height, cage subsidence, operation time, operative blood loss, postoperative hospitalization, postoperative complications, visual analog scale (VAS) score, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), American Spinal Injury Association (ASIA) grade, and bone graft fusion time. All the outcomes were recorded and analyzed by statistical methods. The mean follow-up time was 24.5 months. Neurologic function was improved in most patients at the last follow-up. There were significant differences in ESR, CRP, and VAS score between preoperative and postoperative values; however, there were no significant differences in ESR, CRP, and VAS score among the three groups. There were no significant differences in operation time, blood loss, postoperative hospitalization, and postoperative complications among the three groups at discharge. There was no significant difference in ASIA grade among the three groups at the last follow-up. Nanohydroxyapatite/polyamide-66 cage group had a lower cage subsidence (P = 0.013). The bone graft fusion time of the nanohydroxyapatite/polyamide-66 cage group was significantly shorter than the iliac bone graft group and the titanium mesh bone graft (P < 0.05). The follow-up outcomes showed that the method involving one-stage posterior debridement and internal fixation, interbody graft, and fusion is an effective and safe surgical method for patients with thoracic and lumbar tuberculosis. The incidence rate of cage subsidence was less and the bone graft fusion time was shorter with nanohydroxyap atite/polyamide 66 cage when compared with iliac bone graft and titanium mesh bone graft in the surgical treatment of thoracic and lumbar tuberculosis. Nanohydroxyapatite/polyamide-66 cage has a promising application prospect to be a new bone graft material.