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Yang P.,Second Affiliated Hospital Of Xian Jiaotong University Medical School | Zang Q.,Second Affiliated Hospital Of Xian Jiaotong University Medical School | Kang J.,Second Affiliated Hospital Of Xian Jiaotong University Medical School | Li H.,Second Affiliated Hospital Of Xian Jiaotong University Medical School | He X.,Second Affiliated Hospital Of Xian Jiaotong University Medical School
European Spine Journal | Year: 2016

Purpose: We aimed to provide evidence for clinical choice of surgical approach in treating spinal tuberculosis, including anterior, posterior and combined approaches (combined anterior and posterior approach). Methods: A literature search up to June 2015 was performed on PubMed, Embase, Cochrane library, CNKI, Wanfang and Weipu database. Weighted mean differences (WMDs) or risk radios (RRs) and their 95 % confidence intervals (CI) were calculated. Results: Total 26 studies with 2345 spinal tuberculosis adults were analyzed. Results showed advantages of posterior approach compared with anterior approach in operation time (WMD = 20.91; 95 % CI: 9.05–32.76), blood loss (WMD = 72.32, 95 % CI: 13.87–130.78), correction of angle (WMD = −2.47; 95 % CI: −4.04 to −0.90) and complications (RR = 1.78; 95 % CI: 1.21–2.60), and compared with combined approach in operation time (WMD = −82.76; 95 % CI: −94.38 to −71.14), blood loss (WMD = −263.63; 95 % CI: −336.85 to −190.41), hospital stay [(WMD = −4.60; 95 % CI: −5.10 to −4.10) and complications (RR = 0.36; 95 % CI: 0.23–0.58]. Meanwhile, significantly larger correction of angle (WMD = −2.25; 95 % CI: −4.35 to −0.14; P = 0.04) and less loss of correction (WMD = 3.97; 95 % CI: 2.22–5.72) were found when compared combined approach with anterior approach. However, combined approach had significantly longer operation time (WMD = −41.92; 95 % CI: −52.45 to −31.38) and more blood loss (WMD = −102.18; 95 % CI: −160.45 to −43.91) than anterior approach. Conclusion: Posterior approach has better clinical outcomes than anterior or combined approach for spinal tuberculosis. However, individual assessment of each case should be considered in the clinical application of these surgical approaches. © 2016 Springer-Verlag Berlin Heidelberg Source


Yang P.,Second Affiliated Hospital Of Xian Jiaotong University Medical School | He X.,Second Affiliated Hospital Of Xian Jiaotong University Medical School | Li H.,Second Affiliated Hospital Of Xian Jiaotong University Medical School | Zang Q.,Second Affiliated Hospital Of Xian Jiaotong University Medical School | Wang G.,Second Affiliated Hospital Of Xian Jiaotong University Medical School
Oncology Letters | Year: 2016

The present study aimed to analyze the indications, feasibility, safety and clinical effects of total spondylectomy and spine reconstruction through posterior or combined anterior-posterior approaches for thoracic lumbar and sacral vertebrae tumors. Between December 2009 and May 2012, 10 patients with thoracic lumbar and sacral vertebrae tumors were retrospectively analyzed. Different surgical indications and approaches were used according to the affected segments, the extent of lesion involvement and the specific pathology results. One-stage posterior or combined anterior-posterior total spondylectomy and reconstruction was used for the treatment of complicated thoracic lumbar and sacral vertebral malignant tumors and invasive benign tumors. The duration of surgery, levels of intraoperative blood loss and transfusions, and the clinical effects were observed. The average surgical duration was 6.8 h (range, 4.8-12 h), with an average blood loss level of 3,200 ml (range, 1,500-10,000 ml) and an average transfusion level of 2,500 ml. During the average 15 months (range, 3-29 months) follow up, two patients succumbed and one patient experienced tumor recurrence. Neither tumor reoccurrence nor metastasis was observed in all other patients. Personalized surgical indications and approaches according to the affected segments, the extent of lesion involvement and the specific pathology results would aid in the reduction of pain, the improvement of nerve function and the reduction of tumor recurrence. © 2016, Spandidos Publications. All rights reserved. Source

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