Simple One-Stage Posterior Surgical For The Treatment Of Thoracolumbar Tuberculosis

Objective:To analyze the clinical efficacy of one-stage posterior debridement,fusion and instrumentation for thoracolumbar tuberculosis and investigate the possible treatment methods for thoracolumbar tuberculosis.Method:The 16 cases of thoracolumbar tuberculosis patients,admitted in Department of Orthopaedics of Qilu Hospital of Shandong University from 2004-2007,underwent one-stage posterior debridement,fusion and instrumentation.The patients include 11 males and 5 females and the average age was 46.5 years,ranging from 26 to 69. All patients were given formal anti-TB therapy and a variety of neurological function improving treatments postoperatively. Then clinical symptoms,lab examinations and x-ray,CT are used to evaluate the TB control and the extent of bone fusion and ASIA score is applied to analyze the nerve function statistically.Results:All patients were followed up regularly postoperatively,ranging from 24 to 48 months,averagely 30.6months.①Symptoms of all patients underwent surgery were significantly improved or disappeared in the last follow-up,and there's no recurrence of tuberculosis.The ESR and other laboratory examinations were normal.②The clinical efficacy were evaluated by modified Macnab methods.The result is excellent in 9 cases,good in 6 cases,fair in 1 case.and the good rate is 93.7%.③The neurological function in patients improved significantly postoperatively according to ASIA classification.The preoperative degrees were 1 in grade B,7 in grade C,8 in grade D,and the postoperative degree were 1 in grade C,6 in grade D,9 in grade E.ASIA score showed sensory and motor function improve clearly than those patients preoperative (P<0.01).The sensory function scores improved from 126.3±15.2 points to postoperative 157.2±15.8 points, motor function scores from 31.5±8.7 points to postoperative 46.9±4.3 points. Nervous function recover within six months after surgery in most patients,and the shorter course of disease,the better of recover.④Postoperative imagings showed all the bone fusion were satisfied.The kyphosis angle decreased from preoperative 26.8°±7.3°to postoperative 9.3°±4.0°, and the angle was lost during follow-up<2°.Conclusion:One-stage posterior debridement,fusion and instrumentation has better clinical efficacy in the treatment of thoracolumbar tuberculosis.It can completely eliminate tuberculosis nidus,achieve adequate decompression,and achieve spinal fusion and reconstruction of spinal stability.Compared with other surgical methods, One-stage posterior debridement,fusion and instrumentation is more feasible, has low risk clinically and has a good clinical significance.