Journal of Neurosurgical Sciences 2021 Mar 11

DOI: 10.23736/S0390-5616.21.05225-5

Copyright © 2021 EDIZIONI MINERVA MEDICA

lingua: Inglese

Long-segment versus short-segment fixation through a posterior approach for tuberculous spondylodiscitis of the mid-thoracic spine in adults: a study of mid- to long-term efficacy

Zhenchao XU ^{1, 2}, Xiyang WANG ^{1, 2} ✉, Zhen ZHANG ^{1, 2}

¹ Department of Spine Surgery and Orthopaedics, Xiangya Hospital, Central South University, Changsha, China; ² Hunan Engineering Laboratory of Advanced Artificial Osteo-Materials, Central South University, Changsha, China

BACKGROUND: This retrospective study aimed to perform a comparative evaluation of the mid- to long-term efficacy of long-segment and short-segment fixations via the posterior approach as a treatment for tuberculous spondylodiscitis in the mid-thoracic spine.
METHODS: A total of 95 patients with tuberculous spondylodiscitis in the mid-thoracic spine underwent surgery via the posterior approach including single-stage posterior debridement, interbody fusion, and pedicle screw fixation. Long-segment fixations were performed for 46 patients (group A), while short-segment fixations were performed for the other 49 patients (group B). Clinical and radiological outcomes were assessed during mid- to long-term follow-up.
RESULTS: The average follow-up periods for groups A and B were 75.5±11.8 and 76.8±11.6 months, respectively. The operative time and intraoperative blood loss were lower in group B than in group A (P<0.05). Both management approaches significantly corrected the kyphotic deformity detected either in the early postoperative period or at the final visit after long-term follow-up (P>0.05). Bony fusion was generated after average periods of 10.8±2.1 months and 11.0±2.0 months in groups A and B, respectively. Favorable outcomes were observed on assessment of neurological function and patients’ well-being at the final follow-up.
CONCLUSIONS: No therapeutic differences were observed between long-segment and short-segment fixation as surgical treatment for mid-thoracic Pott’s disease during mid- to long-term follow-up. Kyphotic deformity and neurological impairment were significantly relieved via both posterior fixation approaches, with patients’ well-being reaching a favorable level. Moreover, short-segment fixation led to less blood loss and required a shorter operative time.

KEY WORDS: Long-segment fixation; Short-segment fixation; Posterior approach; Tuberculous spondylodiscitis; Mid-thoracic spine