Treatment Of Thoracic Tuberculosis Research Articles

Treatment of Thoracic Tuberculosis Through Posterior Costal Transverse Joint Window: A Clinical Study

BackgroundThe surgical treatment of thoracic spinal tuberculosis has garnered enormous interest from researchers towards the development of posterior surgical techniques that have contributed to greater use of the one-stage posterior approach. This study aims to demonstrate the initial clinical experience of a modified total posterior approach, in which the one-stage posterior approach preserves the posterior spinal column structure by combining with the endoprosthetic implant fusion for thoracic spinal tuberculosis. MethodsIn this clinical study, we intended to report the initial idea of a modified total posterior approach. In detail, a one-stage posterior approach was applied to preserve the posterior spinal column structure that could be applied to clinical practice. ResultsThe employed practical procedure presented a reduced duration of surgical intervention and intraoperative trauma. Nevertheless, further studies with large samples and multiple centers are required to explore the idea comprehensively. ConclusionsThis approach offered some advantages in terms of intraoperative exposure, blood loss volume, and length of surgery. Further, multi-center studies with large samples are needed to understand the precise effects and implications of the approach.

Multi-modal Neuroelectrophysiological Monitoring in the Treatment of Thoracic Tuberculosis with Debridement and Bone Grafting and Posterior Pedicle Screw Fixation via Costal Transverse Process Approach.

ObjectiveTo explore the value of multi‐mode neuroelectrophysiological monitoring (MIOM) in evaluating spinal cord and nerve root function in the treatment of thoracic tuberculosis via costal transverse process approach.MethodsFrom December 2017 to September 2019, a retrospective study of thoracic tuberculosis patients in our hospital was conducted. This study included 25 patients (14 men and 11 women). The average age of patients at the time of surgery was 63.3 years (range, 20–83 years). All patients (three cases with the destruction of a single vertebral body, 13 cases with the destruction of two vertebral bodies, and nine cases with the destruction of three or more vertebral bodies) underwent costal transverse process approach with debridement and bone grafting and internal fixation combined with intraoperative multimodal neuroelectrophysiological monitoring. During the operation, somatosensory evoked potential (SEP), transcranial electrical stimulation motor evoked potential (TES‐MEP), and spontaneous electromyography (EMG) were used to monitor progress. ESR, visual analogue scale (VAS), Cobb angle, and Oswestry disability index (ODI) were statistically analyzed to evaluate the treatment effects and patient satisfaction.ResultsAll 25 patients were successfully monitored. The follow‐up time ranged from 12 to 21 months, with an average of 15.3 months. SEP waveform abnormalities occurred in five patients during the operation, the incidence rate was 28%. Of these five patients, three patients changed their instruments and postures, and adjusted the flushing water flow in time; one patient received pressure therapy in time; the operation was suspended for 10 min for one patient. There were seven cases with abnormal TES‐MEP waveform, the incidence rate was 28%. Among these seven cases, five cases adjusted the nail path during the operation and adjusted the nail position in time. One case adjusted the inclination angle of the operating table in time; one case completed the contralateral nail stick correction in time; five of them had abnormal TES‐MEP waveforms, and EMG burst potential was also detected, the incidence rate was 20%. After prompt treatment, the abnormal waveforms of all patients returned to normal; no abnormal waveforms, recurrence of tuberculosis, loosening of internal fixation, nerve and spinal cord dysfunction, etc. The VAS score, erythrocyte sedimentation rate (ESR), Cobb angle, and ODI scores of the patients 1 year after operation were significantly improved compared with 1 week after operation (P < 0.05).ConclusionMulti‐mode intraoperative electrophysiological detection combined with costal transverse process approach for the treatment of thoracic tuberculosis could avoid intraoperative nerve and blood vessel damage, reduce surgical risk, improve surgical efficiency, and ensure curative effect.

Efficacy of surgery via the single anterior and single posterior approaches for treatment of thoracic spinal tuberculosis.

ObjectiveThe type of surgical treatment that should be adopted for thoracic tuberculosis (TB) remains controversial. This study was performed to compare the clinical efficacy of surgery via the single anterior and single posterior approaches for treatment of thoracic spinal TB.MethodsSeventy-eight patients with thoracic TB undergoing surgical treatment were divided into two groups on the basis of the surgical methods employed: Group A (single anterior debridement + bone graft fusion and internal fixation) and Group B (single posterior debridement + bone graft fusion and internal fixation). Results of clinical and imaging examinations were analysed and compared between the two groups.ResultsThe surgical duration and mean hospital stay were significantly longer and the perioperative bleeding volume was significantly higher in Group A than B. At the last follow-up, changes in the American Spinal Injury Association grade showed no obvious differences between the two groups. Before and after the surgery and at the last follow-up, no significant differences were detected in the Cobb angle change or correction rate between the two groups.ConclusionSurgery via the single anterior and single posterior approaches achieved good clinical efficacy in the treatment of thoracic spinal TB.

Treatment of Thoracic Spine Tuberculosis by Paraspinal Muscle Gap Approach

Objective: To evaluate the clinical feasibility and efficacy in treatment of thoracic tuberculosis via paraspinal approach. Methods: From June 2011 to August 2016, 24 patients with mono-segmental thoracic spine tuberculosis were treated by transfacet debridement combined with bone grafting and internal fixation through paraspinal approach. There were 11 males and 13 females with age ranging from 21 to 63 years (average, 39.5). There were 3 patients in T4/5, 2 patients in T5/6, 3 patients in T7/8, 3 patients in T8/9, 4 patients in T9/10, 3 patients in T10/11, and 6 patients in T11/12. Patients had different degraded local kyphosis deformity shown on X-ray, and different degraded bone destruction and abscess in thoracic spine shown on CT and MRI before the operation. All of the patients before the regular anti tuberculosis treatment for 2 to 4 weeks, the surgical approach used by paraspinal muscle approach, postoperative regular anti tuberculosis treatment for 9 to 12 weeks. Record the clinical symptoms of patients before and after surgery, preoperative Frankel functional classification of spinal cord injury, the operative time, intraoperative blood loss, postoperative ESR, CRP, complications, VAS score, ODI score and Cobb angle changes, imaging check regularly to evaluate the fusion and follow-up of nerve functional recovery. Results: The average operation time was 198 min. The average blood loss was 436 ml. There were no severe complications during and after operation. All patients were followed up for 1 year to 2 years, average 1.5 years of follow-up, the clinical symptoms improved significantly after operation and last follow-up ESR, CRP, VAS score, ODI score and Cobb angle were significantly improved after operation (P < 0.05), grade I Eck fusion, the fusion rate was 100% and the neurological function were improved. Conclusion: on the basis of strict anti tuberculosis chemotherapy, the use of paraspinal muscle gap approach for the treatment of thoracic tuberculosis is less invasive, less destructive to spinal stability, and can achieve obvious curative effect. It is worthy of clinical application.

The clinical efficacy of pathologic vertebral surgery for thoracic and lumbar tuberculosis

Objective To discuss the clinical efficacy of surgical treatment of pathologic vertebral surgery for thoracic and lumbar tuberculosis. Methods All of 322 cases of thoracic and lumbar spinal tuberculosis patients from December 2003 to June 2014 were retrospectively analyzed in our department. All patients were underwent debridement, fusion and nerve decompression surgery. According to different fixed methods, patients were divided into pathologic vertebral surgery group (fixation completed within lesions invaded motion unit) including 91 males and 100 females, with an average age of 41.53 years, and non-pathologic vertebral surgery group (long segments or short segment fixation) including 61 males and 70 females, with an average age of 42.72 years. We observed the tuberculosis cure rate, degrees of deformity, pain and neurological recovery, operative time, blood loss and complications by follow-up. Results The average follow-up time was 75.52 months in pathologic vertebral surgery group and 76.21 months in non-pathologic vertebral surgery group. The total number of pathologic vertebras in pathologic vertebral surgery group and non-pathologic vertebral surgery group were 277 and 218 respectively, and the average was 1.45 and 1.66. The total number of fixed segments was 277 in pathologic vertebral surgery group and 485 in non-pathologic vertebral surgery group, and the average fixed segments was 1.45 and 3.70. The cure rate was 85.86% in pathologic vertebral surgery group and 85.49% in non-pathologic vertebral surgery group at 6 months postoperatively, and 98.95% and 98.47% at the last follow-up time, with no significant difference between groups. Graft fusion rate was 89.00% in pathologic vertebral surgery group and 89.31% in non-pathologic vertebral surgery group 6 months postoperatively, 98.38% and 98.47% at the last follow-up time, without significant difference. In lumbar spine, the average correction of Cobb's angle was 12.4° in pathologic vertebral surgery group and 13.1° in non-pathologic vertebral surgery group, and the average angle loss was 1.3 and 1.4°, with no significant difference. In thoracolumbar, the average correction of Cobb's angle was 10.9°in pathologic vertebral surgery group and 11.1°in non-pathologic vertebral surgery group, and the average angle loss was 1.7°and 1.5° respectively, without significant difference. However, in thoracic, the average correction of Cobb's angle was 10.2° in pathologic vertebral surgery group and 12.7° in non-pathologic vertebral surgery group, and the average angle loss was 3.6° and 2.5°respectively, with significant difference. The mean operation time was 210.45 min in pathologic vertebral surgery group and 210.45 min in non-pathologic vertebral surgery group, with significant difference. The average blood loss was 726.12 ml in pathologic vertebral surgery group and 726.12 ml in non-pathologic vertebral surgery group, with significant difference. The complication rate was 11.51% in pathologic vertebral surgery group and 11.45% in non-pathologic vertebral surgery group, with no significant difference. Conclusion Pathologic vertebral surgery surgery is a safe, effective and feasible method of operation for treatment of thoracic and lumbar tuberculosis, which can effectively preserve adjacent normal vertebral motion unit features. The thoracic surgery was less satisfactory than the lumbar and thoracolumbar surgery. Key words: Thoracic vertebrae; Lumbar vertebrae; Tuberculosis, spinal; Bone transplantation; Treatment outcome

Treatment of mono-segmental thoracic spine tuberculosis with one-stage posterior focus debridement and internal fixation of inter-centrum non-structural bone grafting

Objective To evaluate the clinical efficacy and feasibility of treatment of mono-segmental thoracic spine tuberculosis with one-stage posterior focus debridement and internal fixation of inter-centrum non-structural bone grafting. Methods Retrospective study of patients with mono-segmental thoracic spine tuberculosis who underwent surgery in our hospital from January 2010 to January 2013 was conducted. 27 patients were involved in the study, including 16 male patients and 11 female patients. The age of patients is from 23 to 69 (average age 40.3). 22 patients suffered from combined spinal cord dysfunction. For the classification of ASIA, 2 cases were of Grade B, 8 cases were of Grade C and 12 cases were of Grade D. All patients had obvious bone destruction in thoracic spine shown on CT and MRI before the operation. All patients were given anti-tuberculosis drugs (Isoniazid, Rifampicin, Ethambutol, Streptomycin) for 2-3 weeks, preoperatively. And all patients underwent one-stage posterior focus debridement, and bone particles gained from partial decompression and spina iliaca posterior superior bone particles were planted among the centrum. Pedicle screw fixation was conducted internally. Thoracic vertebra X-ray film and CT were rechecked per 3 months after the operation. Bone grafting fusion and physiological curvature change of thoracic vertebra were evaluated. Results All patients were followed up for 12-24 months with the average time of 21.7±2.3 months. The operating time was 110-190 min (average time 167±35 min) and the bleeding amount during the surgery was 350-700 ml (490±160 ml on the average). The bone grafted in centrum achieved bone fusion with the average fusion time of 6.5±2.4 months. The neurological function was improved for all patients, including 19 cases (Grade 1 improvement) and 3 cases (Grade 2 improvement). The preoperative and postoperative Cobb angles of thoracic vertebra were 47°±11° and 41°±9°, respectively. And it was 43°±10° at the final followup period. Conclusion Based on the standardized treatment of antituberculosis drugs and strong fixation with pedicle screw and rod, one-stage posterior focus debridement and internal fixation of inter-centrum non-structural bone grafting are effective and feasible to treat mono-segmental thoracic spine tuberculosis. Key words: Thoracic vertebrae; Tuberculosis; Internal fixators

Treatment of thoracic and lumbar spinal tuberculosis via posterior paraspinal muscle gap approach

Objective To explore the feasibility and assess the efficacy of posterior paraspinal muscle gap approach in the treatment of thoracic and lumbar spinal tuberculosis.Methods From June 2009 to June 2013,a total of 29 patients were analyzed retrospectively.There were 2 patients of tuberculosis T8,9,6 of T9,10,8 of L1,2,10 of L2,3,and 3 of L4,5.The patients included 12cases of male,17 cases of female; the age ranged from 28 to 53 years,with a mean of 40.78 years.Nine patients had preoperative kyphosis deformity,and Cobb angle ranged from 19° to 39° (mean,29.67°).Two patients complained with paraplegia with Frankel grade C.All patients had preoperative standardized oral isoniazid,rifampicin,pyrazinamide border,ethambutol,glucuronolactone for 2-4 weeks.All patients underwent one-stage posterior paraspinal muscle gap approach fixation,rectification,debridement and autograft bone fusion.The clinical effects were observed by the time and blood loss in operation,blood loss after operation; the score of visual analogue scale (VAS) one week after operation and the last follow-up,the time erythrocyte sedimentation rate (ESR) drop to normal after operation,the change of cobb angle,the improvement of the neurological symptom,the situation of the bone fusion.Results Operation time was 3-4 h,with an average of 3.3 h; operative blood loss was 300-600 ml,with an average of 434 ml.Drainage volumn was 250-450 ml after surgery with an average of 340 ml.All patients were followed up for 6 to 36 months with an average of 16.56 months.There was no recurrence,sinus formation or internal fixation failure,and all patients obtained successful bony fusion.The mean time ESR drop to normal range after operation was 4.22 months.One patient of the two with Frankel grade C pre-operation turn to grade D,the other grade E.The Cobb angle was 10.33° (9°-12°) immediately after operation,and 12.22° (11°-14°) at the final follow-up.Conclusion Posterior paraspinal muscle gap approach surgeries is feasible and effective in the treatment of thoracic and lumbar spinal tuberculosis. Key words: Thoracic vertebrae; Lumbar vertebrae; Tuberculosis, Spinal

Debridement combined with local anti-TB drugs delivery for thoracic and lumbar spine tuberculosis

Objective To investigate a therapeutic method which could provide sustained-release delivery and local longlasting anti-TB treatment after debridement of thoracic and lumbar spine tuberculosis.Methods Data of 18 patients (including 2 revised cases),who were diagnosed of thoracic and lumbar tuberculosis and required surgery treatment from October 2008 to January 2011 were retrospectively analyzed.There were 12 males and 6 females,with an average age of 48.7± 13.3 years (range,22 to 67 years).Affected spinal segments in these patients spanned from T8 to S1.fourteen patients were treated with posterior surgical procedure alone while the other 4 were treated with one-stage combined anterior-posterior surgery.Combined with autogenous bone,OSTEOSET RBK drug carrier-type artificial bone mixed with isoniazid and streptomycin was used after debridement.Chlinical parameters including clinical symptoms,laboratory results,and imaging data were evaluated during follow-up.Results Incisions of all patients achieved primary healing.The duration of patient follow-up ranged from 29 to 56 months (average,39.5months).No liver and kidney function abnormalities,ototoxicity,or local nerve irritations were found perioperatively.Improvements in clinical symptoms were observed in all patients.One patient with L2a tuberculosis recurred 18 months after the initial surgery.At 6-month follow-up,intervertebral body fusion was achieved without complications of internal fixation or significant angle loss of kyphosis correction.Conclusion OSTEOSET RBK dmg carrier-type artificial bone mixed with isoniazid,streptomycin for treatment of thoracic and lumbar spine tuberculosis is a safe and effective way to control local infection and recurrence.Combined with autologous bone could contribute to bone fusion. Key words: Thoracic vertebrae; Lumbar vertebrae; Tuberculosis, Spinal; Bone substitutes

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

Background contextThe 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. PurposeThe 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 designThe study used a retrospective review. Patient sampleBetween 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 measuresThe 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. MethodsThere 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. ResultsThe 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). ConclusionSingle-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.

The operative option and therapeutic effect in the treatment of multiple-level contiguous thoracic spinal tuberculosis

Objective To investigate operative approach,immobilization manner,and surgical effect of multiple-level contiguous thoracic spinal tuberculosis.Methods Between January 2001 and December 2010,112 patients with thoracic spinal tuberculosis were treated with 5 different surgical procedures.Among them,81 adults with multiple-level contiguous thoracic spinal tuberculosis were followed up for 17 to 75 months (average,39 months).Twenty three patients suffered from spinal cord dysfunction; according to the Frankel classification,there were 3 cases of type A,4 cases of type B,7 cases of type C,and 9 cases of type D.The double vertebral bodies were commonly affected areas,especially T10 and T11-Results Local symptoms of all patients were relieved significantly 1 to 3 weeks postoperatively.Erythrocyte sedimentation rates (ESR) returned to normal level in all patients 8 to 12 weeks postoperatively.Three sinuses were found 0.5 month,1 month and 1.5 months postoperatively,respectively,which were cured by changing dressing for 1 to 2 months.The average correction of kyphotic deformity was 10.2°±2.1° in anterior fixation group,while 12.6°±2.7° in posterior fixation group.At final follow-up,the average loss of correction was 6.9°±1.9° in anterior fixation group,while 5.8°±1.4° in posterior fixation group.At least one Frankel grade improvement was observed in 23 patients.Conclusion The surgical methods should be chosen according to the location and degree of the lesion.Correct surgical procedures can obtain good results in correction and maintenance of the deformity,clearance of the foci,decompression of the spinal cord and pain relief for thoracic spinal tuberculosis.The posterior fixation is better than the anterior fixation with regard to correction and maintenance of the kyphotic deformity. Key words: Thoracic vertebrae; Tuberculosis, spinal; Spinal fusion

Posterior transpedicular debridement, decompression and instrumentation for thoracic tuberculosis in patients over the age of 60

Our aim was to evaluate the feasibility and efficiency of the application of posterior transpedicular debridement with instrumentation and fusion to the treatment of over 60-year-old patients with thoracic tuberculosis. Fifteen over 60-year-old patients with thoracic tuberculosis treated by posterior transpedicular debridement with instrumentation and fusion between August 2006 and November 2010, seven males and eight females in this study were reviewed, retrospectively. Their age ranged from 61 to 75 (mean age 63.4). The follow-up period ranged from 12 to 51 months (mean 30 months). The patients were evaluated based on vertebral body loss, kyphotic angle, fusion status of affected segment, visual analog scale (VAS) pain score, and Frankel's classification. A solid fusion was achieved in all 15 cases. No postoperative complications, chronic infection, sinus formation or significant loss of deformity correction was noted in these patients. Moreover, VAS score was reduced and Frankel's grade was recovered in all patients and there was no recurrence of the tuberculous infection. Posterior transpedicular debridement with instrumentation and fusion is a feasible and effective procedure in the treatment for thoracic tuberculosis in patients over the age of 60.

Anterior radical debridement and reconstruction using titanium mesh cage for the surgical treatment of thoracic and thoracolumbar spinal tuberculosis: minimium five-year follow-up.

To evaluate the long-term outcomes for the surgical treatment of thoracic and thoracolumbar spinal tuberculosis with anterior radical debridement and reconstruction with titanium mesh cages (TMCs). 69 patients with thoracic and thoracolumbar spinal tuberculosis were retrospectively analyzed. Outcomes data included VAS back pain, subjective clinical results, and radiographic data. All patients had resolution of their infections, obtained solid bony fusions without failure of fixation, experienced improvement of neurological function, and improved in their VAS back pain scores at final long-term follow-up. In the thoracic spine group, 92.3% of patients had good or excellent subjective clinical results. The loss of kyphotic angle correction and intervertebral height was 9.6% and 3.8%, respectively. In the thoracolumbar spine group, 93.3% of patients had good or excellent subjective clinical results. The loss of kyphotic angle correction and intervertebral height was 12.8% and 4.2%, respectively. Anterior radical debridement and reconstruction using TMCs for the treatment of thoracic and thoracolumbar spinal tuberculosis is an acceptable treatment option. Solid bony fusion, good clinical outcomes as well as improvement of neurological function can be achieved although TMCs subsidence can occur.