Study Of The Stability Of The Spine On Transpedicular Screw-rod System Internal Fixation In The Surgical Management Of The Treatment Thoracic And Lumbar Tuberculosis

Objective:To study the recovery status of the stability of the spine after the treatment thoracic and lumbar tuberculosis underwent anterior debridement with autograft bone fusion, one-stage posterior internal fixation by transpedicular screw-rod system.Methods:1,Twenty-six patients(10 male 16 female;average,31.1years)with thoracic and lumbar tuberculosis were treated by single-stage anterior debridement, autograft bone fusion and posterior internal fixation by screw-rod from March 2005 to September 2008.Disease region:11 cases of thoracic vertebrae,9 cases of thoracolumbar vertebrae,6 cases of lumbar vertebrae; All patients had varying degrees of spinal kyphosis, Cobb angles were 7.5°to 34°,Neurological deficits were found in 9 patients. Before surgery, patients received standard anti- tuberculosis chemotherapy for 2 to 4 weeks. The tuberculous lesion region was comletely resected, autologousiliac or rib graft was harvested to reconstruct the stability of the affected segments.Anti- tuberculosis chemotherapy was continued for 12~18 months after surgery.All patients had bed-rest after surgery. And they can have exercise functionnel from the bed under effective orthosis protection. Observate the spinal interbody fusion and the improvement of anterior curvature.To study the recovery status of the stability of the spine after the treatment thoracic and lumbar tuberculosis underwent anterior debridement with autograft bone fusion, one-stage posterior internal fixation by transpedicular screw-rod system.2,Group A, the neurological deficits of patients with thoracolumbar spinal tuberculosis, Group B, the patients with thoracolumbar spinal tuberculosis were without neurological deficits. Accurately measure the canales vertebralis diameter before surgery, determinant the types of thoracic and lumbar tuberculosis and the degree of spinal injury intraoperatively.Expand the canales vertebralis diameter to the corresponding level within the normal range. To compare preoperative and postoperative X-rays of the patients, measure the canales vertebralis diameter with vernier caliper and protractor. Ananlye the relation of improving function and the canales vertebralis diameter in the neurological deficits of patients with thoracolumbar spinal tuberculosis after surgery.Results:1,All patients were followed up for 6 to 38 months postperatively, with the average of 24 months. All cases were healed without chronic sinus formation or any recurrence of tuberculosis during the following-up period.No any looseness and fracture of internal fixation was noted in these patients. ESR of these patients redused a months after operation and reached to normal level 6 months later.A solid fusion was achieved from 0 to 19°for an average of 11.5°after surgery. Postoperative follow-up the autogenous bone graft integration can be seen in X-rays 3 months after surgery,none bone displacement, fractures, caving-subsidence, and seudoarthrosis- formation happen during the follow-up. No intraoperative and postoperative complications.2,Before and after surgery in Group A at the value of sagittal diameter of spinal canal area there is visible significant difference(P<0.01), and in Group B there is significant difference too(P<0.05).Of all patients with neurological deficits, 9 patients showed obvious improvement; while one patient with Frankel D lesion remained unchanged, but none of the patients got worse.Conclusion:1,On the premise of strict seize the indication and anti-tuberculosis chemotherapy, single-stange anterior debridement with autografet bone fusion and posterior internal fixation by transpedicular screw-rod system were found to be effective in reconstructing spinal stability, correcting the kyphosis and preventing progression of kyphosis, arresting the disease, until solid spinal fusion. It is one of safe and excellent methods in treating thoracic and lumbar tuberculosis.2,Accurately measure the canales vertebralis diameter of X-rays of the spine before surgery,and expand the canales vertebralis diameter to the corresponding level within the normal range at the time of surgery,the virtual valvue is 6 to 10 mm,in order to provide a good environment and contribute to postoperative improvement in neurological function for restoring nerve function, also it can be to provide a clinical basis for spinal decompression surgery.