A Clinical Study On Surgical Treatment Of Spinal Tuberculosis And Risk Factors Of Related Complications

Objective:1.Till now,there is still a great controversy about the selection of surgical methods for spinal tuberculosis.This study was to compare the clinical effects of combined anterior and posterior approach and posterior approach alone in the treatment of spinal tuberculosis with focal debridement,bone graft fusion and internal fixation.2.In this study,we investigated the postoperative complications of spinal tuberculosis patients in our hospital and discussed the risk factors of postoperative bone graft nonfusion.Methods:1.295 in-patients with spinal tuberculosis,from December 2015 to December 2020 who was admitted in our hospital,were analyzed retrospectively.The patients were treated by combined anterior and posterior debridement or anterior debridement of spinal tuberculosis.The patients were divided into 3 groups according to the segment of lesion,which were divided into thoracic segment group(127 cases),thoracolumbar segment group(33 cases)and lumbar segment group(135 cases).The general data,operative data and postoperative follow-up data of all patients were collected to compare the clinical efficacy and prognosis of two surgical approaches in the treatment of spinal tuberculosis.2.The clinical data of 131 patients who underwent spinal tuberculosis debridement,bone graft fusion and internal fixation in our hospital from March 2018 to March 2020 were retrospectively analyzed,postoperative complications were analyzed in all patients.The patients were divided into two groups according to bone fusion after the operation;there were37 patients in the nonfusion group and 94 in the fusion group.The general data,preoperative data,intraoperative and follow-up data were collected,and the risk factors of postoperative nonfusion were evaluated by Logistic regression analysis.Results:1.There were significant differences in the operative time and the amount of blood loss in the patients with thoracic and lumbar lesions between the groups of different operative approaches.The operation time and the amount of intraoperative bleeding in the combined approach group were significantly higher than those in the posterior approach group(P<0.05).The JOA score and VAS score of the three groups were improved after operation and the last follow-up(P<0.05).The JOA score in the combined approach group was higher than that in the posterior approach group at the last follow-up,and the difference was statistically significant(P<0.05).ESR and CRP of three groups were significantly lower than that of before operation(P<0.05).ESR and CRP in combined approach group were lower than those in posterior approach group(P<0.05).The local kyphosis angle of the three groups decreased significantly after different surgical approaches(P<0.05),in thoracic group the final follow-up value of posterior approach group was lower than that of combined approach group(P<0.05),but the final follow-up value of thoracolumbar and lumbar approach group was lower than that of posterior approach group(P<0.05).At one year after operation,the rate of bone graft fusion in thoracic posterior approach group was better than that in combined approach group,while that in the lumbar combined approach group was better than that in the posterior approach group(P<0.05).2.In the patients included,there were 37 patients had postoperative bone graft nonfusion,2 patients had postoperative recurrence,and 1 patient had postoperative internal fixation loosening,1 patient developed delayed paraplegia after operation.About the short-term postoperative complications,2 patients had sinus formation,3 patients had nonunion or delayed healing of incision,and 7 patients had gastrointestinal reactions,2 patients developed pleura/ peritoneum injury.We divided the patients into two groups according to whether the bone was fused or not after operation.The osteoporosis degree of the unfused group was higher than that of the fused group(P<0.05).There were statistically significant differences between the two groups in terms of continuous multisegment status,disease duration,intraoperative surgical methods and whether patients received standardized drug treatment for1 year after surgery(P<0.05).After single-factor analysis,we selected multiple-factor regression analysis based on different indexes and clinical experience.Multivariate logistic regression analysis showed that long disease duration,posterior approach,and degree of osteoporosis were risk factors for postoperative bone graft nonfusion(OR>1,P<0.05),while standard drug treatment for 1 year after surgery was a protective factor(OR<1,P<0.05).Conclusion:1.The operation of debridement,fusion and internal fixation of spinal tuberculosis by combined approach has the characteristics of long operation time and large trauma,the combined approach can provide better spinal stability and higher fusion rate,while the posterior approach is more suitable for patients with thoracic spinal tuberculosis,it can provide better deformity correction and bone graft fusion while reducing surgical trauma and risk.2.Our research shows that spinal tuberculosis patients who had a long disease course,who underwent simple posterior debridement,or who had severe osteoporosis had a higher risk of bone graft nonfusion after surgery.Tuberculosis treatment is beneficial for the osseous fusion of the postoperative bone graft area.