PHẪU THUẬT KẾT HỢP HAI LỐI TRƯỚC SAU TRONG MỘT THÌ CHO LAO CỘT SỐNG NGỰC VÀ THẮT LƯNG CÓ BIẾN CHỨNG

Abstract

Background: Hong Kong surgery (Hodgson’s anterolateral approach) still remains an effective surgical treatment for spine tuberculosis (Pott’s disease) accompanied by serious complications from 1956 until now. The patient had to be staying in bedrest in post-op for about three months in waiting for the spinal fusion. With modern surgical implants and instruments, combined anterolateral Hong Kong (Hodgson) surgery and posterior correction-fixation allow patients to sit up immediately in post-op for early rehabilitation. The objective of this study is to evaluate the results of the combined anterior decompression Hong Kong (Hodgson) and posterior correctionfixation by whole pedicle screws construct in one stage surgery with patient in lateral position for thoracic and thoracolumbar spinal tuberculosis with complicated. Methods: Retrospective descriptive, a case series study. Anterior approach: Hong Kong (Hodgson) technique for debridement the tuberculous focus, remove the caseum, suppuration, sequestrae, necrotic tissue; spinal cord decompression; and interbody fusion. Posterior approach: kyphotic correction-fixation by pedicle screws construct. Materials: From January 1st, 2010 to December 31st, 2012, 30 patients suffering from spine tuberculosis complicated with neurological damage were surgically treated by a one-stage combined anterior and posterior approach in Ho Chi Minh City Hospital of Trauma and Orthopedic. Mean age: 43 years old (21-74). There were 17 males and 13 females. Lower extremities preoperative paralysis were: paralysis for 14 cases (47%), incomplete paralysis for 13 cases (41%), normal motor function for 3 cases (10%). 10 cases for bladder dysfunction (33%). Preoperative mild pain: 24%, moderate pain: 26%, severe pain: 50%. There were 29 cases for consecutive spinal tuberculosis, and 1 case with two levels of spinal tuberculosis. Results: Average surgical time: 311 minutes (150 – 510 minutes). Mean blood loss: 1106 ml (200 – 2500 ml). Mean intra-op allogenic blood transfusion: 700 ml (375 – 1500ml). Mean postop allogenic blood transfusion: 1332 ml (0 – 1050 ml). Post-op pathologic results: skeletal and soft tissue tuberculosis: 14/30 cases (47%), chronic osteomyelitis (necrosis, caseous): 6 cases (20%), 10/30 (33%) not available. Post-op PCR (intra-op collected pus and caseous sample): TB positive: 17/30 cases, TB negative 2/30 cases, 11/30 cases didn’t tested PCR. Pain recovery: 100%. Neurological improvement: 100% (Frankel B,C,D => E). Bladder function recovery: 100%. Kyphotic angle correction: pre-op: 29.3⁰. post-op: 13⁰ (51.4% correction rate). 3-month follow-up: 15.6⁰ (42.8% correction rate). Final follow-up: 18⁰ (34.7% correction rate). Fusion rate at final follow-up: 100%. Post-op complications- 10%: 1 case with wound infection (3%), 2 cases with implant failure (rod fracture) (7%)- 1 of them fused completely at 9month follow up and 1 fused at 12-month follow up. Conclusion: The one-stage surgery with patient in lateral position in using the combined anterior decompression Hong Kong (Hodgson) technique and posterior correction-fixation by whole pedicle screws construct helps control both surgical fields; and allows the patients to sit up, walk-in post-op and starting very early rehabilitation, improving the outcomes.