Minim Invasive Paraspinal Muscle Approach Surgeries In The Treatment Of Thoracic And Lumbar Spinal Tuberculosis

Objective:To explore the feasibility and assess the efficacy of minim invasive paraspinal muscle approach surgeries in the treatment of thoracic and lumbar spinal tuberculosis.Methods:From June2008to October2011,a total of13patients were retrospectively analyzed,include5cases of male,8cases of female, the age ranging from28to53years,with the mean of40.46years.4patients had preoperative kyphosis deformity,cobb angle ranging from18°to24°with the mean of20.67°, one case was complicated with paraplegia with Frankel grade C.All patients underwent minim invasive paraspinal muscle surgeries.Of the total13patients,8underwent one-stage posterior minim invasive paraspinal muscle approach fixation,rectification,debridement and autograft bone fusion,the lesion level include2cases of Ts-9,2cases of T9-10,1case of L1-2,2cases of L2-3,1case of L4-5;5underwent one-stage posterior minim invasive paraspinal muscle approach fixation, rectification combined anterior debridement, autograft bone fusion,the lesion level include1case of T8-9,2cases of T9-10,1case of L2-3,1case of L3-4.All patients underwent normative chemotherapy for2-4weeks before operation. The clinical effects were observed by the time and blood loss in operation, blood loss after operation, the score of VAS one week after operation and the last follow-up,the time ESR drop to normal range after operation,the change of cobb angle,the improvement of the neurological symptom,the situation of the bone fusion.Result:All patients were followed up by6to36months with an average of16.47months,No reoccur, sinus formation or internal fixation failure patients, all patients obstained successful bony fusion,92.31%patients have good results.The cobb angle was10.25°(9°-12°) immediately after operation, and12°(11-14°) at the last follow up.The mean time ESR drop to normal range after operation is2.23months.The thoracic posterior group:average operation time is195min (185-205min),average blood loss in operation is397.5ml (380-420ml) and after operation292.5ml(260-320ml), average VAS score one week after operation is6and the last follow-up is1.75.The lumbar posterior group:average operation time is203.75min(195-215min), average blood loss in operation is475ml(400-550ml) and after operation is330ml(285-400ml), average VAS score one week after operation is5.5and the last follow-up is2.25.The thoracic posterior combined anterior group:average operation time is298.33min(290-305min),average blood loss in operation is750ml(735-760ml) and after operation is463.33ml(450-480ml), average VAS score one week after operation is6.33and the last follow-up is2.33.The lumbar posterior combined anterior group data:average operation time is312.5min(300-325min),average blood loss in operation is900ml(850-950ml) and after operation is657.5ml(635-680ml), average VAS score one week after operation is5.5and the last follow-up is2.Conclusion:The present result show that minim invasive surgeries is feasible and efficitive in the treatment of thoracic and lumbar spinal tuberculosis.It has the dominance of remain spinal posterior structure,reduce operative incision exposture,avoiding implant totally expose in focus of infection,diminish the risk of recurrence.