Treatment of Monosegment Spinal Tuberculosis via Posterior Unilateral Vertebral Lamina Fenestration Debridement and Bone Grafting Fusion Combined with Laminar Reconstruction and Internal Fixation: A Retrospective Case-Control Study with a Minimum 5-Year Follow-Up

Zheng Liu; Weiwei Li; Zhengchao Xu; Yilu Zhang; Yunqi Wu; Xiyang Wang; Hao Zeng

doi:10.1016/j.wneu.2019.12.036

Treatment of Monosegment Spinal Tuberculosis via Posterior Unilateral Vertebral Lamina Fenestration Debridement and Bone Grafting Fusion Combined with Laminar Reconstruction and Internal Fixation: A Retrospective Case-Control Study with a Minimum 5-Year Follow-Up

World Neurosurg. 2020 Mar:135:e468-e476. doi: 10.1016/j.wneu.2019.12.036. Epub 2019 Dec 13.

Authors

Zheng Liu¹, Weiwei Li¹, Zhengchao Xu¹, Yilu Zhang², Yunqi Wu², Xiyang Wang³, Hao Zeng⁴

Affiliations

¹ Department of Spine Surgery, Xiangya Hospital, Central South University, Changsha, Hunan, People's Republic of China; Hunan Engineering Laboratory of Advanced Artificial Osteo-Materials, Xiangya Hospital, Central South University, Changsha, Hunan, People's Republic of China.
² Hunan Engineering Laboratory of Advanced Artificial Osteo-Materials, Xiangya Hospital, Central South University, Changsha, Hunan, People's Republic of China.
³ Department of Spine Surgery, Xiangya Hospital, Central South University, Changsha, Hunan, People's Republic of China; Hunan Engineering Laboratory of Advanced Artificial Osteo-Materials, Xiangya Hospital, Central South University, Changsha, Hunan, People's Republic of China. Electronic address: 229061878@qq.com.
⁴ Department of Spinal Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China; Guangxi Key Laboratory of Regenerative Medicine, Nanning, Guangxi, China.

PMID: 31843726
DOI: 10.1016/j.wneu.2019.12.036

Abstract

Objective: To investigate the clinical and imaging outcomes of posterior unilateral vertebral lamina fenestration debridement and bone grafting fusion combined with laminar reconstruction and instrumentation compared with the traditional posterior-only method for treating monosegment spinal tuberculosis.

Methods: Fifty-four patients underwent posterior unilateral vertebral lamina fenestration debridement and bone grafting fusion combined with laminar reconstruction and internal fixation (group A), and 60 patients underwent 1-stage posterior debridement, laminectomy decompression, bone grafting fusion and instrumentation (group B). The clinical and radiographic outcomes of these groups were analyzed and compared.

Results: Group A had less intraoperative blood loss, shorter hospitalization, and a shorter fusion time than did group B (P < 0.05). At 3 months postoperatively, group A had a lower mean Oswestry Disability Index than did group B (P < 0.05). At the final follow-up, group A had a lower mean visual analog scale pain score and a lower mean ODI than did group B (P < 0.05). Group A had a smaller kyphotic angle loss (1.2° ± 0.6°) and loss rate (4.8% ± 2.5%) than did group B (P < 0.05).

Conclusions: The procedure of posterior unilateral vertebral lamina fenestration debridement and bone grafting fusion combined with laminar reconstruction and internal fixation is safe and effective in treating monosegment spinal tuberculosis. Compared with the conventional posterior-only approach, this method maximizes the retention and reconstruction of the posterior column and is minimally invasive, achieving faster postoperative recovery with fewer complications.

Keywords: Laminar reconstruction; Monosegment spinal tuberculosis; Posterior unilateral vertebral lamina fenestration debridement.

MeSH terms

Adult
Bone Transplantation / methods*
Case-Control Studies
Debridement / methods*
Female
Humans
Male
Postoperative Complications / etiology
Retrospective Studies
Spinal Fusion / methods*
Tuberculosis, Spinal / surgery*