Therapeutic evaluation of intertransverse bone graft for single segmental thoracic spinal tuberculosis_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

GUIFei , ZHANGYuan , TANGKe , ZHONGWeiyang , HEDanshuang , LUOXiaoji ,  QUANZhengxue

Department of Orthopedics, the First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, P. R. China;

Corresponding author：

QUANZhengxue, Email: quanzx18@126.com

Keywords：

Thoracic tuberculosis; Intertransverse bone graft; Internal fixation; Posterior debridement

DOI：

10.7507/1002-1892.20160172

Video：

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Objective To explore the effectiveness of intertransverse bone graft after debridement and fusion combined with posterior instrumentation in patients with single segmental thoracic tuberculosis. Methods Between March 2014 and May 2015, 17 cases of thoracic tuberculosis were treated by the surgery of intertransverse bone graft after debridement and fusion combined with posterior instrumentation. There were 10 males and 7 females with an average age of 48.5 years (range, 18-70 years), and with a mean disease duration of 4 months (range, 1-9 months). The affected segments included T_{4, 5} in 2 cases, T_{6, 7} in 5 cases, T_{7, 8} in 3 cases, T_{9, 10} in 2 cases, T_{10, 11} in 4 cases, and T_{11, 12} in 1 case. The operation time, intraoperative blood loss, and hospitalization time were recorded. Postoperative plain radiography was taken to assess the decompression and internal fixation, and the fusion effect was evaluated by X-ray or CT examination. The erythrocyte sedimentation rate (ESR), C reactive protein (CRP), visual analogue scale (VAS), Oswestry disability index (ODI), and Kyphosis angle were recorded and compared; the nerve function was evaluated by American Spinal Injury Association (ASIA). Results The mean operation time, intraoperative blood loss, and hospitalization time were 184 minutes (range, 165-220 minutes), 231 mL (range, 150-800 mL), and 18 days (range, 12-26 days) respectively. No complication of hematoma or wound dehiscence was found. All patients were followed up 17.9 months on average (range, 9-22 months). No bone graft failure, internal fixation broken, pleural effusion, cerebrospinal fluid leakage, wound infection, fistula formation, and other complications occurred. Satisfactory intervertebral fusion was obtained in all patients at 3-8 months (mean, 5.3 months) after surgery. The ESR, CRP, VAS score, ODI score, and Kyphosis angle were significantly improved at immediate after operation and last follow-up when compared with preoperative ones (P < 0.05), and the ESR, CRP, VAS score and ODI score at last follow-up were significantly better than those at immediate after operation (P < 0.05). At last follow-up, the nerve function was recovered to ASIA grade E from grade C (1 case) and grade D (6 cases). Conclusion Intertransverse bone graft is a reliable, safe, and effective way of bone graft applied to the single segmental thoracic spinal tuberculosis.

Citation： GUIFei, ZHANGYuan, TANGKe, ZHONGWeiyang, HEDanshuang, LUOXiaoji, QUANZhengxue. Therapeutic evaluation of intertransverse bone graft for single segmental thoracic spinal tuberculosis. Chinese Journal of Reparative and Reconstructive Surgery, 2016, 30(7): 843-848. doi: 10.7507/1002-1892.20160172 Copy

1.	Boachie-Adjei O, Papadopoulos EC, Pellisé F, et al. Late treatment of tuberculosis-associated kyphosis: literature review and experience from a SRS-GOP site. Eur Spine J, 2013, 22 Suppl 4: 641-646.
2.	Bakhsh A. Medical management of spinal tuberculosis: an experience from Pakistan. Spine (Phila Pa 1976), 2010, 35(16): E787-791.
3.	张忠民, 付忠泉, 尹刚辉, 等.胸椎结核外科治疗的长期临床随访.脊柱外科杂志, 2012, 10(4): 198-201.
4.	Nene A, Bhojraj S. Results of nonsurgical treatment of thoracic spinal tuberculosis in adults. Spine J, 2005, 5(1): 79-84.
5.	Zhang HQ, Lin MZ, Shen KY. Surgical management for multilevel noncontiguous thoracic spinal tuberculosis by single-stage posterior transforaminal thoracic debridement, limited decompression, interbody fusion, and posterior instrumentation (modified TTIF). Arch Orthop Trauma Surg, 2012, 132(6): 751-757.
6.	Panchmatia JR, Lenke LG, Molloy S, et al. Review article: Surgical approaches for correction of post-tubercular kyphosis. J Orthop Surg, 2015, 23(3): 391-394.
7.	Rajasekaran S. The natural history of post-tubercular kyphosis in children: radiological signs which predict late increase in deformity. J Bone Joint Surg (Br), 2001, 83(7): 954-962.
8.	Moorthy S, Prabhu NK. Spectrum of MR imaging findings in spinal tuberculosis. AJR Am J Roentgenol, 2002, 179(4): 979-983.
9.	Shanmugasundaram TK. Bone and joint tuberculosis-guidelines for management. Indian J Orthop, 2005, 39(3): 195-198.
10.	Li M, DU J, Meng H, et al. One-stage surgical management for thoracic tuberculosis by anterior debridement, decompression and autogenous rib grafts, and instrumentation. Spine J, 2011, 11(8): 723-733.
11.	Dai LY, Jiang LS, Wang W, et al. Single-stage anterior autogenous bone grafting and instrumentation in the surgical management of spinal tuberculosis. Spine (Phila Pa 1976), 2005, 30(20): 2342-2349.
12.	Garg N, Vohra R. Minimally invasive surgical approaches in the managementof tuberculosis of the thoracic and lumbar spine. Clin Orthop Relat Res, 2014, 472(6): 1855-1867.
13.	Zhang P, Shen Y, Ding WY, et al. The role of surgical timingin the treatment of thoracic and lumbar spinal tuberculosis. Arch Orthop Trauma Surg, 2014, 134(2): 167-172.
14.	Wang X, Pang X, Wu P, et al. One-stage anterior debridement, bone grafting and posterior instrumentation vs. single posterior debridement, bone grafting, and instrumentation for the treatment of thoracic and lumbar spinal tuberculosis. Eur Spine J, 2014, 23(4): 830-837.
15.	Zhang H, Zeng K, Yin X, et al. Debridement, internal fixation, and reconstruction using titanium mesh for the surgical treatment of thoracic and lumbar spinal tuberculosis via a posterior-only approach: a 4-year follow-up of 28 patients. J Orthop Surgery Res, 2015, 10(1): 150.
16.	Ma YZ, Cui X, Li HW, et al. Outcomes of anterior and posterior instrumentation under different surgical procedures for treating thoracic and lumbar spinal tuberculosis in adults. Int Orthop, 2012, 36(2): 299-305.
17.	Sahoo MM, Mahapatra SK, Sethi GC, et al. Posterior-only approach surgery for fixation and decompression of thoracolumbar spinal tuberculosis: a retrospective study. J Spinal Disord Tech, 2012, 25(7): E217-223.
18.	Wang XB, Li J, Lü GH, et al. Single-stage posterior instrumentation and anterior debridement for active tuberculosis of the thoracic and lumbar spine with kyphotic deformity. Int Orthop, 2012, 36(2): 373-380.
19.	Liu J, Wan L, Long X, et al. Efficacy and safety of posteriorversus combined posterior and anterior approach for the treatment ofspinal tuberculosis: a meta-analysis. World Neurosurg, 2015, 83(6): 1157-1165.
20.	Canale ST, Beaty JH.坎贝尔骨科手术学.王岩, 译. 12版.北京:人民军医出版社, 2013: 1436.
21.	Nakase H, Park YS, Kimura H, et al. Complications and long-term fol-low-up results in titanium mesh cage recon-struction after cervical corpectomy. J Spinal Disord Tech, 2006, 19(5): 353-357.
22.	Wu J, Luo D, Ye X. Anatomy-related risk factors for the subsidence of titanium mesh cage in cervical reconstruction after one-levelcorpectomy. Int J Clin Exp Med, 2015, 8(5): 7405-7411.
23.	Yilmaz C, Selek HY, Gurkan I, et al. Anterior instrumentation for thetreatment of spinal tuberculosis. J Bone Joint Surg (Am), 1999, 81(9): 1261-1267.
24.	邹沙沙, 陈婷婷, 田汝辉, 等.自体髂骨植骨供骨区并发症的Meta分析.中国组织工程研究, 2013, 17(5): 931-937.
25.	黄江, 杨渊, 林春博, 等.自体髂骨植骨与钢板置入内固定修复胸椎结核.中国组织工程研究, 2014, 18(35): 5606-5610.
26.	崔新刚, 张佐伦, 丁自海.胸腰椎横突形态学对比研究及其临床意义.中国临床解剖学杂志, 2005, 23(5): 474-476.
27.	Panjabi MM, Takata K, Goel V, et al. Thoracic human vertebrae. Quantitative three-dimensional anatomy. Spine (Phila Pa 1976), 1991, 16(8): 888-901.
28.	Fletcher JG, Stringer MD, Briggs CA, et al. CT morphometry of adult thoracic intervertebral discs. Eur Spine J, 2015, 24(10): 2321-2329.
29.	Thanapipatsiri S, Chan DPK. Safety of thoracic transverse process fixation: an anatomic study. Spinal Disorders, 1996, 9(4): 294-298.
30.	Mehta JS, Bhojraj SY. Tuberculosis of the thoracic spine. A classification based on the selection of surgical strategies. J Bone Joint Surg (Br), 2001, 83(6): 859-863.

1. Boachie-Adjei O, Papadopoulos EC, Pellisé F, et al. Late treatment of tuberculosis-associated kyphosis: literature review and experience from a SRS-GOP site. Eur Spine J, 2013, 22 Suppl 4: 641-646.
2. Bakhsh A. Medical management of spinal tuberculosis: an experience from Pakistan. Spine (Phila Pa 1976), 2010, 35(16): E787-791.
3. 张忠民, 付忠泉, 尹刚辉, 等.胸椎结核外科治疗的长期临床随访.脊柱外科杂志, 2012, 10(4): 198-201.
4. Nene A, Bhojraj S. Results of nonsurgical treatment of thoracic spinal tuberculosis in adults. Spine J, 2005, 5(1): 79-84.
5. Zhang HQ, Lin MZ, Shen KY. Surgical management for multilevel noncontiguous thoracic spinal tuberculosis by single-stage posterior transforaminal thoracic debridement, limited decompression, interbody fusion, and posterior instrumentation (modified TTIF). Arch Orthop Trauma Surg, 2012, 132(6): 751-757.
6. Panchmatia JR, Lenke LG, Molloy S, et al. Review article: Surgical approaches for correction of post-tubercular kyphosis. J Orthop Surg, 2015, 23(3): 391-394.
7. Rajasekaran S. The natural history of post-tubercular kyphosis in children: radiological signs which predict late increase in deformity. J Bone Joint Surg (Br), 2001, 83(7): 954-962.
8. Moorthy S, Prabhu NK. Spectrum of MR imaging findings in spinal tuberculosis. AJR Am J Roentgenol, 2002, 179(4): 979-983.
9. Shanmugasundaram TK. Bone and joint tuberculosis-guidelines for management. Indian J Orthop, 2005, 39(3): 195-198.
10. Li M, DU J, Meng H, et al. One-stage surgical management for thoracic tuberculosis by anterior debridement, decompression and autogenous rib grafts, and instrumentation. Spine J, 2011, 11(8): 723-733.
11. Dai LY, Jiang LS, Wang W, et al. Single-stage anterior autogenous bone grafting and instrumentation in the surgical management of spinal tuberculosis. Spine (Phila Pa 1976), 2005, 30(20): 2342-2349.
12. Garg N, Vohra R. Minimally invasive surgical approaches in the managementof tuberculosis of the thoracic and lumbar spine. Clin Orthop Relat Res, 2014, 472(6): 1855-1867.
13. Zhang P, Shen Y, Ding WY, et al. The role of surgical timingin the treatment of thoracic and lumbar spinal tuberculosis. Arch Orthop Trauma Surg, 2014, 134(2): 167-172.
14. Wang X, Pang X, Wu P, et al. One-stage anterior debridement, bone grafting and posterior instrumentation vs. single posterior debridement, bone grafting, and instrumentation for the treatment of thoracic and lumbar spinal tuberculosis. Eur Spine J, 2014, 23(4): 830-837.
15. Zhang H, Zeng K, Yin X, et al. Debridement, internal fixation, and reconstruction using titanium mesh for the surgical treatment of thoracic and lumbar spinal tuberculosis via a posterior-only approach: a 4-year follow-up of 28 patients. J Orthop Surgery Res, 2015, 10(1): 150.
16. Ma YZ, Cui X, Li HW, et al. Outcomes of anterior and posterior instrumentation under different surgical procedures for treating thoracic and lumbar spinal tuberculosis in adults. Int Orthop, 2012, 36(2): 299-305.
17. Sahoo MM, Mahapatra SK, Sethi GC, et al. Posterior-only approach surgery for fixation and decompression of thoracolumbar spinal tuberculosis: a retrospective study. J Spinal Disord Tech, 2012, 25(7): E217-223.
18. Wang XB, Li J, Lü GH, et al. Single-stage posterior instrumentation and anterior debridement for active tuberculosis of the thoracic and lumbar spine with kyphotic deformity. Int Orthop, 2012, 36(2): 373-380.
19. Liu J, Wan L, Long X, et al. Efficacy and safety of posteriorversus combined posterior and anterior approach for the treatment ofspinal tuberculosis: a meta-analysis. World Neurosurg, 2015, 83(6): 1157-1165.
20. Canale ST, Beaty JH.坎贝尔骨科手术学.王岩, 译. 12版.北京:人民军医出版社, 2013: 1436.
21. Nakase H, Park YS, Kimura H, et al. Complications and long-term fol-low-up results in titanium mesh cage recon-struction after cervical corpectomy. J Spinal Disord Tech, 2006, 19(5): 353-357.
22. Wu J, Luo D, Ye X. Anatomy-related risk factors for the subsidence of titanium mesh cage in cervical reconstruction after one-levelcorpectomy. Int J Clin Exp Med, 2015, 8(5): 7405-7411.
23. Yilmaz C, Selek HY, Gurkan I, et al. Anterior instrumentation for thetreatment of spinal tuberculosis. J Bone Joint Surg (Am), 1999, 81(9): 1261-1267.
24. 邹沙沙, 陈婷婷, 田汝辉, 等.自体髂骨植骨供骨区并发症的Meta分析.中国组织工程研究, 2013, 17(5): 931-937.
25. 黄江, 杨渊, 林春博, 等.自体髂骨植骨与钢板置入内固定修复胸椎结核.中国组织工程研究, 2014, 18(35): 5606-5610.
26. 崔新刚, 张佐伦, 丁自海.胸腰椎横突形态学对比研究及其临床意义.中国临床解剖学杂志, 2005, 23(5): 474-476.
27. Panjabi MM, Takata K, Goel V, et al. Thoracic human vertebrae. Quantitative three-dimensional anatomy. Spine (Phila Pa 1976), 1991, 16(8): 888-901.
28. Fletcher JG, Stringer MD, Briggs CA, et al. CT morphometry of adult thoracic intervertebral discs. Eur Spine J, 2015, 24(10): 2321-2329.
29. Thanapipatsiri S, Chan DPK. Safety of thoracic transverse process fixation: an anatomic study. Spinal Disorders, 1996, 9(4): 294-298.
30. Mehta JS, Bhojraj SY. Tuberculosis of the thoracic spine. A classification based on the selection of surgical strategies. J Bone Joint Surg (Br), 2001, 83(6): 859-863.

Chinese Journal of Reparative and Reconstructive Surgery

Therapeutic evaluation of intertransverse bone graft for single segmental thoracic spinal tuberculosis

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