The Relation Of The Height Of The Remnants Of Thoracolumbar Tuberculosis And Selection Of Mode Of Anterior Internal Fixation

Objective:To investigate the relation of the height of the remnants of thoracolumbar vertebral tuberculosis and selection of mode of anterior internal fixation.Methods:A total of 46 cases with one stage anterior debridement, interbody fusion,pedicle screw on the vertebral disease and internal fixation of thoracolumbar tuberculosis were reviewed retrospectively from June 2006 to June 2009, including 18 males and 13 females, with the mean age of 39.4 years(range from 13 to 69 years). Lesion segments:T6-L4(Segment lesions≤3 segments); o cases were A,3cases were B,6 cases were C,4 cases were D and 33 cases were E of the assessment of preoperative Frankel grade.The average Cobb angle of kyphosis was 16±3.1°.ESR:15-140mm/h. CT scan and Two-dimensional reconstruction were done before operation,and the effective height of residual of coronal and front and middle pillar of sagittal of thoracolumbar vertebral in Vertebral tuberculosis were measured before operation, when the minimum effective height was higher than 10mm, combined the intraoperative visual, selected the appropriate internal fixation for anterior debridement and interbody bone grafting. When the minimum effective height was lower than 10mm, the pedicle screw on the diseased vertebral was given up. The clinical efficacy of pedicle screw on the vertebral disease for 46 patients was evaluationed based on the following indicators:(1) Whether it was to be improved aboht TB symptoms and ESR. (2) Compared the Cobb angle of the preoperative, postoperative and the last follow-up.(3) Whether Frankel grade of Preoperative and postoperative was to be improved.(4) Imaging of interbody bone grafting was evaluationed. (5) Functional was evaluationed.Results:(1) 46 cases of patients received followed up from 12 to 24 months, with the mean month of 17 months. All patients'tuberculosis poisoning symptom vanished completely at the last follow-up. ESR:0～15mm/h. No found sinus formation and vertebral tuberculous relapse. (2)4 cases were D and 42 cases were E of the Frankel grade at the last follow-up. (3) The correction of Cobb angle was from 16±3.1°preoperatively to 4.0±2.7°postoperatively,and it was 4.5±1.9°at the last follow-up. (4) The fusion rate after 6 months;excellent:44 cases; good:2cases. Only 1 case of tuberculosis of thoracic 9 and thoracic 10 was fixed with Anterior Thoracolumbar Single Rod System, kyphosis was increased after 3 months,with loosed screw, gypsum bed was lain until the sixth month, interbody bone grafting was fuseded. (5)Function evaluation after 12 months: excellent:45 cases; good:1 cases. Conclusion:As the effective height of residual of coronal and front and middle pillar of sagittal of thoracolumbar vertebral in vertebral tuberculosis was higher than 10mm, achieved reliable stability and treatment efficiency with anterior internal fixation postoperatively. Formulated surgery program from this.can greatly enhance the rate of the pedicle screw on the diseased vertebral, reduced the fixed Segment.