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Surgical Strategy and Management Outcomes for Adjacent Multisegmental Spinal Tuberculosis: A Retrospective Study of Forty-eight Patients

Li, Litao, PhD*,†; Xu, Jianzhong, MD*; Ma, Yuanzheng, MD; Tang, Daidi, MD; Chen, Yonglin, MD; Luo, Fei, MD*; Li, Dawei, MD; Hou, Tianyong, PhD*; Zhou, Qiang, MD*; Dai, Fei, MD*; He, Qingyi, MD*; Zhang, Zehua, MD*

doi: 10.1097/BRS.0000000000000053
Surgery
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Study Design. Retrospective study.

Objective. To evaluate the clinical outcomes of 4 different procedures for the treatment of adjacent multisegmental spinal tuberculosis (AMSST) and to investigate the selection strategy of the optimal procedure with respect to focal characteristics.

Summary of Background Data. Because of the lack of support of the anterior columns of multiple segments, AMSST is thought to confer high risks for the development of kyphosis and paraplegia. However, there are few reports regarding the clinical outcomes of the surgical treatment for AMSST have been investigated.

Methods. From August 1999 to June 2010, 48 patients with AMSST were enrolled in this study. Seven patients (A group) underwent a single-stage anterior operation. Eighteen patients (AP group) underwent a single-stage posterior and anterior combined operation. Eighteen patients (P group) underwent a single-stage posterior operation. Five patients (DP group) underwent computed tomography-guided drainage and local chemotherapy combined with a 2-stage posterior operation. The patients were followed up clinically and radiologically for an average of 29.6 months.

Results. The cohort consisted of 29 males and 19 females, aged 4 to 54 years. The patients exhibited significant improvements in deformity and neurological deficits. Graft union was achieved in all patients 5 to 12 months postoperatively. Surgery-related complications were noted in 1 and 2 patients in the AP and P groups, respectively. Postoperative recurrence occurred in 1 and 2 patients in the AP and P groups, respectively. All 48 patients had been cured at the final follow-up.

Conclusion. This study demonstrated that the 4 procedures can safely and effectively achieve nerve decompression, graft fusion, and kyphosis correction. Individualized procedures should be chosen according to the patient's general condition, focal characteristic, type of complication, and surgeon's experience.

Level of Evidence: 3

Patients with adjacent multisegmental spinal tuberculosis involve the destruction of anterior or middle column of multiple adjacent levels and have increased risks of kyphosis and paraplegia. Procedures described in this study can achieve satisfactory outcomes. Individualized surgical modalities should be considered according to different focus characteristics, patients' general conditions, and surgeons' experience.

*Department of Orthopaedics, Southwest Hospital, Third Military Medical University, Chongqing, China

Department of Orthopaedics, The 309th Hospital of the PLA, Beijing, China; and

Department of Radiology, Southwest Hospital, Third Military Medical University, Chongqing, China.

Address correspondence and reprint requests to Zehua Zhang, MD, or Jianzhong Xu, MD, Department of Orthopaedics, Southwest Hospital, Third Military Medical University, Chongqing, People's Republic of China; E-mail: zhangzehuatmmu@yahoo.com.cn or xjzslw@163.com

Acknowledgment date: May 10, 2013. First revision date: August 21, 2013. Acceptance date: September 21, 2013.

The device(s)/drug(s) is/are FDA-approved or approved by corresponding national agency for this indication.

No funds were received in support of this work.

No relevant financial activities outside the submitted work.

© 2014 by Lippincott Williams & Wilkins