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27 February 2019 : Clinical Research

Percutaneous Pedicle Screw Fixation Alone Versus Debridement and Fusion Surgery for the Treatment of Early Spinal Tuberculosis: A Retrospective Cohort Study

Song Guo12ABCEF, Kai Zhu1ACEF, Shuya Zhang3B, Bin Ma4CD, Mingjie Yang1B, Meijun Yan1F, Xinhua Li1E, Jie Pan1C, Lijun Li1D, Zhigang Wang2AG*, Jun Tan1AG

Med Sci Monit 2019; 25:1549-1557

Abstract

BACKGROUND: Advances in diagnostic imaging techniques make it possible to detect tuberculosis (TB) lesions earlier, when only bone destruction or inflammatory infiltration is demonstrated. These techniques provide doctors with more opportunities to treat TB in the early stages of the disease. Traditional aggressive debridement surgery increases the risk of surgical complications. Therefore, we aimed to determine whether using percutaneous pedicle screw (PPS) fixation alone for the treatment of early spinal TB was a valid and less invasive surgical technique.

MATERIAL AND METHODS: We retrospectively reviewed the clinical and radiographic outcomes in cases with thoracic or lumbar TB treated with PPS surgery or hybrid surgery between January 2010 and January 2017. The operative time, blood loss, length of hospital stay, and hospitalization costs in the 2 groups were recorded and compared. Erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) before and at 18 months after surgery were tested to evaluate TB progress. Back pain was measured using the visual analog scale (VAS) before the operation and at the final follow-up. Radiological outcomes were evaluated at 1, 6, 12, and 18 months after surgery. A paired t-test was used to evaluate preoperative and postoperative clinical outcomes using SPSS 19.0 software. P values less than 0.05 were considered to be significant.

RESULTS: A total of 42 patients were involved in this retrospective study. In both groups, the average preoperative ESR, CRP level, and VAS score for back pain significantly decreased after surgery. In the PPS group, the operative time, blood loss, hospital stay, and hospitalization costs were all significantly lower than those in the hybrid group. X-ray and CT images showed satisfactory bone fusion and good maintenance of spinal alignment in both groups at the final follow-up.

CONCLUSIONS: PPS fixation alone was a valid and less invasive surgery for the treatment of early spinal TB. Furthermore, the recovery process of spinal TB can be facilitated using a “simple” internal fixation procedure, and bone fusion can be achieved without aggressive debridement and bone graft surgery.

Keywords: Antitubercular Agents, Bone Screws, Debridement, Orthopedic Fixation Devices, Tuberculosis, Spinal

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