Clinical Research Of Affected-vertebrae Pedicle Screw Placement For The Treatment Of Multi-Level Thoracolumbar Tuberculosis

Objective: To observe clinical effects of affected vertebrae short pedicle screw placement, focus clearance and bone graft fusion internal fixation for the treatment of multi-level thoracolumbar tuberculosis, and to seek improvement and therapeutic efficacy of the surgery for multi-level thoracolumbar tuberculosis.Method: 40 patients with multi-level thoracolumbar tuberculosis(and with spinal tuberculosis diagnosis after surgeries) who were treated in the Affiliated Hospital of Qinghai University from February 2012 to February 2014 are enrolled. For the patients, 15 cases are female and 25 are male; the age range is 26 to 63 years with an average of 43.4±2.3 years; the disease courses are from 6months to 2 years with an average of 12 months. 14 patients are with a focus on thoracic vertebra, 5 are with tuberculosis of lumbar spinal, while 21 were diagnosis with tuberculosis of both. All patients were diagnosed with CT, X rays and MRI to meet the diagnosis criteria of multilevel thoracolumbar tuberculosis. All patients complain sever pain, limited activities, spinal kyphosis deformity, neural dysfunction and others. For Frankel classification, 6 patients were divided into A Grade, 10 were B Grade, as well as 12 and 12 patients were C Grade and D Grade respectively. Neural functional improvement of before and after surgeries is evaluated according to Frankel classification standards. For pre-operation, the average of Cobb angle and the average of anterior affected vertebral height(%) that were measure from imaging results were 35.6±3.7 and 40.5%±6.3. Conventional antituberculous chemotherapy lasted for at least 14 days. Surgeries were performed after patients had developed surgery tolerance. Oral antibuberculous medication lasted for 10 to 12 months after surgeries. Liver function, kidney function, ESR and C-reactive proteins were reviewed regularly. X rays were performed for thoracolumbar spines at 3-mo, 6-mo and 12-mo during the follow-up. Improvement of symptoms and recovery of neural functions as well as bone graft fusion and kyphosis correction were observed during the follow-up.Result: All patients received surgeries successfully without severe complications during and after surgeries. The follow-up for all patients were completed with a period of 12 to 36 months(average 18 months). After antituberculosis drugs discontinuation at 10 th to 12 th month postoperatively, all patients showed disappearance of thetuberculosis symptoms, no lower back pains and no relapse. For the last follow-up visit, the Frankel classifications of the patients were as follows: 1was A Grade, 1 was B Grade, 8 were C Grade, as well as 10 and 20 patients were D and E Grades respectively. The corrections of kyphosis were favorable while the improvement of kyphotic angles was significant. For the last visit, the average of Cobb angle and the average of anterior affected vertebral height(%) was 6.8°±2.9 and 92.4±5.7. The comparisons between all observation indicators of last-visit and before operations were significant statistically(P<0.05). Favorable bone graft fusions were showed with ESR of below 20mm/h during the last visits.Conclusion: Affected-vertebrae short pedicle screw placement for multi-level thoracolumbar tuberculosis will achieve prompt correction and favorable restoration of kyphosis and dislocation. With this method, fixed segments are reduced while full load sharing balance will be achieved as well as less post-operative angle loss will be. Besides, graft dislodgement, collapse and nonunion would be prevented which pose positive impact upon the functional recovery of both spine and spinal cord. This method lays basis for the biomechanical stability reconstruction of spine, improves recovery rate of bone fusion, prevents and corrects spine malformations, reduces tuberculosis relapse, avoids second surgeries effectively and decreases patient injuries and burden. So far, affected-vertebrae short pedicle screw placement with significant clinical effects and high safety and reliability which is worth of being generalized will become a clinical trend and ideal therapy.