Clinical Efficacy Analysis Of Modified Anterior-posterior Surgery Through Wiltse Approach Combined With Affected-vertebrae Pedicle Screw Placement In The Treatment Of Thoracolumbar Spinal Tuberculosis With Kyphosis

Objective: A comparative study between modified anterior and posterior approach through the first-stage Wiltse approach combined with affected-vertebrae pedicle screw placement internal fixation system plus anterior lesion clearance and to support bone graft with traditional anterior and posterior approach,discuss the clinical efficacy and advantage of modified anterior-posterior surgery in the treatment of thoracolumbar spinal tuberculosis with kyphosis.Methods:Retrospective study of 66 cases of thoracolumbar spinal tuberculosis treated in the orthopedic spine group of the second affiliated hospital of Nanchang University from February 2016 to June 2019,including 34 cases(A group)with modified anterior and posterior approach through the first-stage Wiltse approach combined with affected-vertebrae pedicle screw placement internal fixation system plus anterior lesion clearance and to support bone graft,and 32 cases(B group)with traditional anterior-posterior surgery(Rear middle approach no affected-vertebrae pedicle screw placement internal fixation system plus anterior lesion clearance and to support bone graft).Both groups were operated by the same surgeon.A、B groups were compared with length of hospital stay,operation time,bone graft fusion time,postoperative drug chemotherapy time,intraoperative blood loss,postoperative drainage volume,preoperative and postoperative and last follow-up c-reactive protein and erythrocyte sedimentation rate.Classification of ASIA function before and after operation,Cobb angle and its correction rate and loss rate during preoperative,immediate and final follow-up,VAS score before and after 3 months,JOA scores,JOA improvement rates and ODI scores before and after 1,3,6 and 12 months respectively.The complications and recurrence of the two groups were recorded and the above data were analyzed by statistical method.Results: All 66 patients completed complete postoperative follow-up records,the follow-up time is 12-36 months,average(16.75±5.80)months.At the last follow-up,tuberculosis was cured and no TB recurrence was found.There A、B nosignificant statistical differences in length of hospital stay,operation time,bone graft fusion time,postoperative chemotherapy time,preoperative,postoperative and final follow-up ESR and CRP,preoperative and postoperative ASIA grade,preoperative and postoperative 3 months VAS score,postoperative related complications and tuberculosis recurrence(P > 0.05).A group was less than B group in terms of intraoperative bleeding and postoperative drainage(P>0.05).The correction and loss of Cobb angles were A group better than B group(P<0.05).There was no significant difference between the two groups in JOA、ODI score and JOA improvement rate at 1month postoperatively(P>0.05).A group had better improvement JOA、ODI score and JOA improvement rate at 3,6 and 12 months after operation(P<0.05).Conclusion: both the modified anterior-posterior surgery through first-stage Wiltse approach combined with affected-vertebrae pedicle screw placement internal fixation system plus anterior lesion clearance and to support bone graft and traditional anterior and posterior approach,discuss can have Satisfactory results in the treatment of thoracolumbar spinal tuberculosis with kyphosis.However,the modified anterior-posterior surgery was effective in the correction of thoracolumbar spinal tuberculosis kyphosis,and was better than the control group in reducing intraoperative bleeding,postoperative drainage and persistent back after operation.