Comparison Of Anterior And Posterior Internal Fixation For Spinal Tuberculosis

Purpose : To explore the selection of internal fixation for spinal tuberculosis receiving one stage anterior focus clearance and bone graft fusion.Methods : Sixty-two cases of spinal tuberculosis were retrospectively studied and all the cases were treated by focus clearance, bone graft fusion and internal fixtion from January 2004 to September 2008 . The cases were divided into two groups : 50 cases in Group of anterior internal fixation and 12 cases in Group of posterior internal fixation . The cases in Group of anterior internal fixation underwent anterior focus clearance , bone graft fusion and anterior internal fixation and the case in Group of posterior internal fixation underwent posterior internal fixation , one stage anterior focus clearance and bone graft fusion . There were 9 cases who were older than 70 years , 20 cases with kyphotic deformity and 19 cases with neurological functional lesion in Group of anterior fixation . There were 6 cases with neurological functional lesion , 6 cases with kyphotic deformity and 2 cases with sinus tract in Group of posterior fixation . All the cases received three to four kinds of antitubercle drug preoperative chemotherapy more than 2 weeks.Allthe patients received out of bed activity with the help of brace after 4 to 6 weeks bed rest afteroperation.All the patients continued to receive three to four kinds of antitubercle drug afteroperation chemotherapy for 1 to 1.5 years . The Length of Stay , operation time, blood loss in operation , correction rate, recovery of neurological function , fused time , complication and so on were respectively compared between the two groups .Result : It did not have significant difference between the two groups in the Length of Stay , blood loss in operation , correction rate , recovery of neurological function , fused time and complication . The average operation timesuck was 3.5 hours in the Group of anterior fixation and 5.0 hours in the Group of posterior fixation and it had significant difference in the operation timesuck between the two groups . There were 30 cases in the Group of anterior fixation and 6 cases in the Group of posterior fixation below T11 region , and it did not have significant difference in the complication rate between the two groups in the region , but the complication in the Group of anterior fixation was more serious than the Group of posterior fixation in the region . The 9 cases who were older than 70 years in the Group of anterior fixation were cured after receiving the surgery . There was one recurrence case in the Group of anterior fixation and was cured after receiving the twice operation . There were two cases who had sinus tract preoperative in the Goup of posterior fixation. One was cured after receiving one time operation and the other formed local abscess and were cured after receiving the twice operation .Conclusion : Internal fixation is safe and effective to treat spinal tuberculosis and the way to choose the intenal fixation is based on the patients specific condition , such as the diseased region , combined infection , sinus tract , the severity level of kyphotic deformity , basic body constitution and so on .