Journal of Jilin University(Medicine Edition) ›› 2021, Vol. 47 ›› Issue (2): 489-496.doi: 10.13481/j.1671-587X.20210231

• Clinical medicine • Previous Articles     Next Articles

Posterior 360° debridement combined with double titanium mesh bone graft fusion in treatment of thoracolumbar tuberculosis with lateral displacement: A case report and literature review

Xinhe LI1,Bing CHEN2,Qingsan ZHU1,Lili SONG3,Yuntao WU1,Shuangwei LUAN1,Haochuan LIU1()   

  1. 1.Department of Orthopedics,China-Japan Union Hospital,Jilin University,Changchun 130033,China
    2.Department of Anesthesiology,China-Japan Union Hospital,Jilin University,Changchun 130033,China
    3.Department of Hand Surgery,China-Japan Union Hospital,Jilin University,Changchun 130033,China
  • Received:2020-04-07 Online:2021-03-28 Published:2021-03-25
  • Contact: Haochuan LIU E-mail:liuhaochuan@jlu.edu.cn

Abstract: Objective

To discuss the feasibility of treating thoracolumbar tuberculosis with lateral displacement using the combination of posterior 360° debridement and double titanium mesh bone graft fusion.

Methods

The clinical data of a patient of thoracolumbar tuberculosis with lateral displacement were collected and the surgical treatments and clinical efficacy of the patient were analyzed and the relative literatures were reviewed.

Results

The 41-year-old woman patient was admitted to the hospital due to backache for half a year and aggravation with numbness and weakness of both lower limbs for half a month. The physical examination showed a bulge on the lower back, obvious percussion pain and the hypoesthesia at the level of bilateral groin. The muscle strength of each muscle group of both lower limbs was grade Ⅱand the muscle tension was normal. The physiological and pathological reflexes were not elicited. The laboratory examination results showed T cells spot test of tuberculosis infection(T-SPOT)(+),erythrocyte sedimentation rate(ESR) 76 mmHg and C-reactive protein(CRP)55.19 mg·L-1. The imaging results indicated the pathological fracture of L1 vertebral body, damage of T12/L1 vertebral body and intervertebral space, thoracolumbar kyphosis with lateral displacement and abscess in bilateral psoas major, spinal canal and paravertebral parts. The diagnosis was thoracolumbar spinal tuberculosis (T12, L1), lateral kyphosis of thoracolumbar, incomplete paralysis of both lower limbs and abscess in psoas major and paravertebral parts. The intervertebral and paravertebral focus were fully removed and the spinal stability was reconstructed during the operation. The operation was successful, the patient’s symptoms were obviously relieved, the physiological curvature of the thoracolumbar was recovered, and the bone graft fusion was good. One year after the operation, the Frankel Classification returned to E from preoperative B, the visual analogue score (VAS) was decreased from 7 points before the operation to 1 point, and the oswestry disability index (ODI) score was decreased from preoperative 78% to 16%. No recurrence, and the prognosis was good.

Conclusion

The combination of posterior 360° debridement and double titanium mesh supporting combined structural bone graft and granular bone graft can bring better effect of intervertebral support and fusion to the treatment of thoracolumbar tuberculosis with lateral displacement and fully remove the intervertebral and paravertebral focus. It can be used as a surgical method for the treatment of such diseases.

Key words: thoracolumbar tuberculosis, lateral displacement, 360° debridement, double titanium mesh, bone graft fusion

CLC Number: 

  • R639