| Objective1. To explore the clinical outcomes of posterior lumbar debridement, fusion and instrumentation combined with percutaneous catheter drainage (P-PCD) for the treatment of lumbar tuberculosis with psoas abscess (PA) via comparing with one-stage combined anterior and posterior approach (APP).2. To evaluate the clinical outcomes of selective debridement, fusion and instrumentation via posterior approach for the treatment of spinal tuberculosis with extensive paravertebral abscess(STEPA).Methods1. From January 2008 to June 2012,74 patients diagnosed as lumbar tuberculosis with psoas abscess were enrolled.43 patients underwent P-PCD (group A), including 25 males and 18 females aging from 20 to 63 years old with an average of 38.5±8.7.31 patients underwent one-stage of APP (group B), including 17 males and 14 females aging from 22 to 61 years old with an average of 39.9±9.5. The operative time, loss of blood, length of hospital stay, clinical cure rate and other clinical results for the two groups were analyzed and compared.2. From August 2010 to June 2013,15 patients with spinal tuberculosis with extensive paravertebral abscess were enrolled in this study. All patients underwent posterior operation.The destructive segments were selected for debridement,fusion and reconstruction. Other segments eroded by the extensive paravertebral abscess were not eradicated via either one-stage anterior or posterior approach. Neurologic recovery was assessed according to the American Spinal Injury Association (ASIA). Kyphosis angle was measured on the basis of the method described by Konstan and graft union assessed according to the CT-scan.Results1. All patients in both groups were cured at the final follow-up. The patients with neurological dysfunction improved after surgery. All cases achieved bone fusion in both groups(P>0.05). The correction of kyphosis deformity and the loss of correction angle between both groups had no statistic differences respectively (P>0.05). The loss of blood, operative time and the length of hospital stay in group A were less than which in group B (P<0.01). Both groups achieved favorable one-stage cure rate (P>0.05). The complications between both groups had no statistic differences (P>0.05), but the complication rate of APP (4.7%) is lower than that of P-PCD (12.9%).2.The patients were followed up for an average of 27.6±6.7 months. All patients were cured via posterior approach alone. Displacement of intervertebral bone graft was found in 1 case according to CT-scans one month after surgery, however it achieved fusion at the final follow-up. All cases achieved fusion ultimately with average fusion time of 8.1±2.3 months. The average surgical time and loss of blood was 175±41.1 min and 650±154.7 ml respectively. The average preoperative kyphosis angle was 24.7±9.2°, the average postoperative kyphosis angle was 16.1±4.4°,there were significant statistic differences between preoperative and postoperative kyphosis angle (P<0.01);the loss of the correction angle ranged from 0° to 6° at the final follow-up,there were significant statistic differences between preoperative and the final follow-up kyphosis angle (P<0.01).All patients achieved complete recovery at the final follow-up.ConclusionThoracic and lumbar tuberculosis with extensive abscess is not necessarily the indication of combined anterior and posterior approach. Under the effective anti-TB drugs, P-PCD can achieve the same clinical efficacy in the treatment of lumbar tuberculosis with PA; selective debridement, fusion and instrumentation via posterior approach can achieve satisfactory outcomes in the treatment of STEPA, and these individual treatment methods can reduce the surgical trauma and lower the risk of complications. |
PDF Full Text Request