{"title":"脊柱结核患者前柱重建的管理指南-一项比较结果分析。","authors":"Pankaj Kandwal, Siddharth Sekhar Sethy, Aman Verma, Parshwanath Bondarde, Aakash Jain, Vibhor Abrol, Kaustubh Ahuja, Bhaskar Sarkar","doi":"10.1097/BRS.0000000000005403","DOIUrl":null,"url":null,"abstract":"<p><strong>Study design: </strong>Retrospective Comparative Study.</p><p><strong>Objective: </strong>A comparative analysis was aimed at evaluating the clinical and radiological outcomes of cases managed with versus without ACR.</p><p><strong>Summary of background data: </strong>Management of spinal tuberculosis (STB) is accomplished with or without anterior column reconstruction (ACR). However, no objective criterion has been defined citing absolute indication.</p><p><strong>Methods: </strong>A retrospective analysis of prospectively collected data of STB was carried out with a minimum follow-up of one year. Along with basic demography, radiological parameters like vertebral body height loss (VHL), column height loss (CHL), segmental kyphosis (SK), adjusted kyphosis (AK) were calculated. A ROC curve analysis was done to identify cut-off values, followed by subgroup analysis for each parameter.</p><p><strong>Results: </strong>In total 103 patients (60 female, 43 male), 55 cases were managed operatively and ACR was done in 39 of those. Change in ODI, VHL, and kyphosis correction were significantly better in ACR (P<0.01). ROC analysis identified cut-off values for VHL 0.55 (Sensitivity 0.87, 1-specificity 0.37), CHL 1.12 (Sensitivity 0.76, 1-specificity 0.25), and AK 15° (Sensitivity 0.74, 1-specificity 0.43). Subgroup analysis was carried out in operated patients segregated above these cutoff values. Though vertebral height gain was better with ACR, no significant differences across the change in ODI and loss of correction were noted between ACR vs N-ACR. However, the instruments to disease vertebrae (I/D) ratio was significantly different across all subgroups (P<0.05).</p><p><strong>Conclusion: </strong>A similar functional outcome, kyphosis correction, and mechanical stability (loss of correction) can be achieved without ACR if index screw purchase with increasing the implant density is feasible. In cases where the index screw deems impossible, the objective criteria of VHL ≥0.55, CHL ≥1.1, and AK ≥150 should be considered for deciding the need for anterior column reconstruction to achieve better outcomes.</p><p><strong>Level of evidence: </strong>III.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":""},"PeriodicalIF":2.6000,"publicationDate":"2025-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Management Guidelines for Anterior Column Reconstruction in Spinal Tuberculosis - A Comparative Outcome Analysis.\",\"authors\":\"Pankaj Kandwal, Siddharth Sekhar Sethy, Aman Verma, Parshwanath Bondarde, Aakash Jain, Vibhor Abrol, Kaustubh Ahuja, Bhaskar Sarkar\",\"doi\":\"10.1097/BRS.0000000000005403\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Study design: </strong>Retrospective Comparative Study.</p><p><strong>Objective: </strong>A comparative analysis was aimed at evaluating the clinical and radiological outcomes of cases managed with versus without ACR.</p><p><strong>Summary of background data: </strong>Management of spinal tuberculosis (STB) is accomplished with or without anterior column reconstruction (ACR). However, no objective criterion has been defined citing absolute indication.</p><p><strong>Methods: </strong>A retrospective analysis of prospectively collected data of STB was carried out with a minimum follow-up of one year. Along with basic demography, radiological parameters like vertebral body height loss (VHL), column height loss (CHL), segmental kyphosis (SK), adjusted kyphosis (AK) were calculated. A ROC curve analysis was done to identify cut-off values, followed by subgroup analysis for each parameter.</p><p><strong>Results: </strong>In total 103 patients (60 female, 43 male), 55 cases were managed operatively and ACR was done in 39 of those. Change in ODI, VHL, and kyphosis correction were significantly better in ACR (P<0.01). ROC analysis identified cut-off values for VHL 0.55 (Sensitivity 0.87, 1-specificity 0.37), CHL 1.12 (Sensitivity 0.76, 1-specificity 0.25), and AK 15° (Sensitivity 0.74, 1-specificity 0.43). Subgroup analysis was carried out in operated patients segregated above these cutoff values. Though vertebral height gain was better with ACR, no significant differences across the change in ODI and loss of correction were noted between ACR vs N-ACR. However, the instruments to disease vertebrae (I/D) ratio was significantly different across all subgroups (P<0.05).</p><p><strong>Conclusion: </strong>A similar functional outcome, kyphosis correction, and mechanical stability (loss of correction) can be achieved without ACR if index screw purchase with increasing the implant density is feasible. In cases where the index screw deems impossible, the objective criteria of VHL ≥0.55, CHL ≥1.1, and AK ≥150 should be considered for deciding the need for anterior column reconstruction to achieve better outcomes.</p><p><strong>Level of evidence: </strong>III.</p>\",\"PeriodicalId\":22193,\"journal\":{\"name\":\"Spine\",\"volume\":\" \",\"pages\":\"\"},\"PeriodicalIF\":2.6000,\"publicationDate\":\"2025-05-27\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Spine\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1097/BRS.0000000000005403\",\"RegionNum\":2,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q2\",\"JCRName\":\"CLINICAL NEUROLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Spine","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1097/BRS.0000000000005403","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"CLINICAL NEUROLOGY","Score":null,"Total":0}
Management Guidelines for Anterior Column Reconstruction in Spinal Tuberculosis - A Comparative Outcome Analysis.
Study design: Retrospective Comparative Study.
Objective: A comparative analysis was aimed at evaluating the clinical and radiological outcomes of cases managed with versus without ACR.
Summary of background data: Management of spinal tuberculosis (STB) is accomplished with or without anterior column reconstruction (ACR). However, no objective criterion has been defined citing absolute indication.
Methods: A retrospective analysis of prospectively collected data of STB was carried out with a minimum follow-up of one year. Along with basic demography, radiological parameters like vertebral body height loss (VHL), column height loss (CHL), segmental kyphosis (SK), adjusted kyphosis (AK) were calculated. A ROC curve analysis was done to identify cut-off values, followed by subgroup analysis for each parameter.
Results: In total 103 patients (60 female, 43 male), 55 cases were managed operatively and ACR was done in 39 of those. Change in ODI, VHL, and kyphosis correction were significantly better in ACR (P<0.01). ROC analysis identified cut-off values for VHL 0.55 (Sensitivity 0.87, 1-specificity 0.37), CHL 1.12 (Sensitivity 0.76, 1-specificity 0.25), and AK 15° (Sensitivity 0.74, 1-specificity 0.43). Subgroup analysis was carried out in operated patients segregated above these cutoff values. Though vertebral height gain was better with ACR, no significant differences across the change in ODI and loss of correction were noted between ACR vs N-ACR. However, the instruments to disease vertebrae (I/D) ratio was significantly different across all subgroups (P<0.05).
Conclusion: A similar functional outcome, kyphosis correction, and mechanical stability (loss of correction) can be achieved without ACR if index screw purchase with increasing the implant density is feasible. In cases where the index screw deems impossible, the objective criteria of VHL ≥0.55, CHL ≥1.1, and AK ≥150 should be considered for deciding the need for anterior column reconstruction to achieve better outcomes.
期刊介绍：
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Recognized internationally as the leading journal in its field, Spine is an international, peer-reviewed, bi-weekly periodical that considers for publication original articles in the field of Spine. It is the leading subspecialty journal for the treatment of spinal disorders. Only original papers are considered for publication with the understanding that they are contributed solely to Spine. The Journal does not publish articles reporting material that has been reported at length elsewhere.
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