Clinical Studies Treatment Of Lumbosacral Spinal Tuberculosis And Upper Cervical Tuberculosis With CT-guided Minimally Invasion Surgery

Objective:To evaluate the outcomes of CT-guided percutaneous puncture and local chemotherapy for lumbosacral spinal tuberculosis and upper cervical tuberculosis.Methods:Clinical date of 11 patients(male 8,female 3)diagnosed as upper cervical tuberculosis from January 2002 to March 2013 were reviewed retrospectively. The average age of these patients was 33.3 years(range, 2-68). Among them, 9 were involved in the adjacent two levels(C1-2 8 cases,C2-3 1 case), 2 involved in the adjacent three levels(C1-3,2 cases),3 cases were involved in other organ tuberculosis.145 patients with lumbosacral spinal tuberculosis who were failed with conservative treatment were treated by minimal invasion surgery, male 84 cases, female 61 cases. 2 cases lost follow-up,the other 143 cases obtains follow-up.The average age was 42.6 years old,the youngest of the 2 years 7months,maximum 81 years old; There are 6 cases recurrence with internal fixation fusion,and 8 cases recurrence with no internal fixation fusion.There are 32 cases of patients with paraspinal abscess, 1 patient underwent fenestration operation. By CT-guided percutaneous puncture and local chemotherapy. Comparison of patients with before treatment and follow-up ESR and lumbar lordosis angle(Lumbar lordosis,LL).Results:Mean follow-up duration of was 60 months(range, 28-108 months). It was found that clinical symptoms completely disappeared and the results of blood sedimentation were normal. At last follow-up, the mean VAS score was 2.55(range, 0-4). 2 cases were treated with change catheter for 1 case occurred catheter fall off and 1 case occurred catheter blockage. No tuberculose recurrence, sinus tract occurred and pseudoarticulation formation.This group of patients without implementation anterior approach open surgery.The patients of lumbosacral spinal tuberculosis were followed up 21 months and 149 months(average67 months). 73 patients were followed up for more than five years. All patients reached clinical healing. Lumbar lordosis, comparison of before 36.32°and after 33.35° a group there is a statistically significant difference(P=0.000).Conclusions:Regularity anti-TB treatment is the most basic treatment for upper cervical tuberculosis and lumbosacral spinal tuberculosis. Most of the upper cervical tuberculosis can only local chemotherapy for cure.Conservative treatment fails and the degree of spinal deformity and neurological symptoms within the acceptable range of lumbosacral spinal tuberculosis, choose to continue chemotherapy plus local chemotherapy treatment can achieve good therapeutic effect.For cases with atlantoaxial instability or dislocation,anterior approach minimally invasive treatment and open internal fixation and bone grafting can obtain good clinical curative effect.