Clinical Effectiveness By Moving Window Method In Posterior-anterior Surgery To Treat Lumbosacral Spinal Tuberculosis

Objective To evaluate the clinical efficacy of anterior "moving window" exposure in the treatment of lumbosacral spinal tuberculosis during posterior and anterior surgery.Methods A retrospective analysis was made on the clinical data of 30 patients with lumbosacral spinal tuberculosis treated between January 2010 and January 2018.All patients were treated with one-stage or two-stage posterior internal fixation,malformation correction and the anterior was used to perform lesion,debridement 、nerve decompression and bone graft through the “moving window method”.The average age was 41.8±13.9years old,14 males and 16 females;here were 9 patients with L4~S1 lesions,3 patients with L4~S2,3patients with L3~S1,2 patients with L3~S2,8 patients with L5~S1,5 patients with L5~S2.15 cases of nerve compression symptoms,2 cases have ponytail compression symptoms.All the patients were treated by antituberculous chemotherapy and nutrition support preopera-tively and postoperatively.and regular follow-up(1,4,6,12 months after surgery,every year thereafter).The bleeding volume,The operation duration,analogue scale(VAS)score,lumbosacral angle,nerve function recovery,related complications were observed and The control of tuberculosis was assessed erythrocyte sedimentation rate(ESR)and C-reactive protein(CRP)during different follow-up periods.Bone graft fusion,tuberculosis activity,malformation correction was assessed by X-ray,three-dimensional CT and Magnetic resonance imaging or enhancement.Results All patients were followed up and The average follow-up time was 50.8±23.8(6-90)months.The average operation time was 270-540(425.0±78.0)min and the averageamount of bleeding was 300-1800(943.3±391.9)ml.There was no recurrence and no complications such as tuberculous peritonitis,erectile dysfunction,and retrograde ejaculation occurred.All included patients,the VAS scores at the preoperative levels,4 months after surgery and final follow-up were 7.3±1.2 points,0.8±0.7 points and 0.6±0.5 points.Compared with pre-operation,there were significant differences in 4 months after operation and the last follow-up(both P<0.05).There was no significant difference between 4 months after operation and the last follow-up.lumbosacral angle were 22.1°±2.1°,30.9°±1.9° and 30.8°±1.8°;ESR and CRP were 28.9±15.2mm/h/26.5±15.1mg/L 、 8.0±2.3mm/h/1.0±0.5mg/L and7.6±2.5mm/h/0.9±0.3mg/L.Compared with preoperative values,the lumbosacral angle,ESR and CRP of patients in groups were statistically significantly improved at the 4 months after surgery and final follow-up(P<0.05).There was no significant difference between the 4months after surgery and the final follow-up(P>0.05).Conclusion Through the posterior-anterior approach,the anterior approach uses the“moving window method” to treat lumbosacral spinal tuberculosis that has the advantages of sufficient exposure,safety,convenient operation and less complications.It is a good choice for surgical treatment of lumbosacral spinal tuberculosis.