Abstract
BackgroundThe objective of this study was to compare the outcomes of one-stage posterior surgery involving debridement, bone grafting, and instrumentation with and without local continuous chemotherapy and postural drainage for the treatment of lumbar spinal tuberculosis.MethodsFrom January 2009 to January 2013, 109 patients with lumbar spinal tuberculosis were treated in our center using a posterior surgical approach. Patients underwent one-stage posterior debridement, bone grafting, and instrumentation, without (group A) and with (group B) local continuous chemotherapy and postural drainage. Clinical and radiographic results for the two groups were analyzed and compared. Clinical efficacy was evaluated based on surgery duration and blood loss. The Frankel scale was used to evaluate neurological function. A visual analog scale was used to assess low back pain. Bone graft fusion and instrumentation failure were monitored by radiography, and tuberculosis activity was monitored by erythrocyte sedimentation rate (ESR) and C-reactive protein testing.ResultsGroups A and B contained 52 and 57 patients, respectively. Patients were followed for 18–36 (mean, 26.64 ± 4.2) months. All bone grafts ultimately fused, but the fusion rate was significantly more rapid in group B [6.4 ± 0.5 (range, 5–10) months] than in group A [8.9 ± 0.6 (range, 6–12) months; P < 0.05]. At 6 weeks postoperatively, ESR levels differed significantly between groups A and B (24.6 ± 1.5 vs. 16.3 ± 1.1 mm/h; P < 0.05). ESR levels normalized in both groups at 16 weeks.ConclusionsLocal continuous chemotherapy and postural drainage effectively eliminated infection foci caused by abscess remnants and accelerated interbody bone fusion in patients with lumbar spinal tuberculosis undergoing one-stage posterior surgery involving debridement, bone grafting, and instrumentation.
Highlights
The objective of this study was to compare the outcomes of one-stage posterior surgery involving debridement, bone grafting, and instrumentation with and without local continuous chemotherapy and postural drainage for the treatment of lumbar spinal tuberculosis
We examined the effects of local continuous chemotherapy and postural drainage on posterior debridement, bone grafting, and instrumentation in this treatment approach
Tuberculosis was confirmed by bacterial culture or pathology in all patients; cultures from 70 patients were positive for Mycobacterium tuberculosis
Summary
The objective of this study was to compare the outcomes of one-stage posterior surgery involving debridement, bone grafting, and instrumentation with and without local continuous chemotherapy and postural drainage for the treatment of lumbar spinal tuberculosis. Spinal tuberculosis can be treated surgically, with the goals of achieving adequate decompression and debridement, reinforcing spinal stability, and correcting and preventing deformity. Approaches to this surgical treatment include anterior spinal fusion, anterior spinal fusion with posterior spinal fusion, posterior spinal fusion alone, and posterior spinal fusion followed by anterior spinal fusion [2, 3]; the best surgical approach, remains a matter of debate. The disadvantages of the anterior-only approach include insufficient kyphosis correction and the potential for major loss of correction postoperatively This approach may involve division of the diaphragm, and is associated with a low rate of fusion and a high rate of vascular complications [4, 5]. Some surgeons have reported the performance of this one-stage surgery via the posterior approach alone [6,7,8,9]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
