Treatment Of Thoracic And Lumbar Tuberculosis By Posterior Approach Focus Clearance, Bone Graft Fusion And Internal Fixation At One-stage

Objective To find the feasibility and efficacy of one stage surgery in thoracic and lumbar tuberculosis by retrospective investigation,which accomplished the posterior approach focus clearance,bone graft fusion and internal fixation.Then evaluate the superiority by compare with the traditional surgery.Method Seventy-nine cases of thoracic and lumbar tuberculosis were treated from January 2006 to October 2008 and Sixty-seven cases were retrospectively studied which included 42 males and 25 females,and the average age were 39 years(range 11 to 70 years).All the cases were divided into two groups:38 cases in new operation group underwent one stage posterior approach focus clearance,bone graft fusion and internal fixation,and 27 cases in traditional operation group underwent posterior internal fixation,anterior focus clearance and bone graft fusion.Nutrition support,standard chemotherapy at least 12 to 18 months and liver-renal function test were carried out in all patients after surgery.All patients were followed up 3 months later.Clinical status,roentgenogram,ESR and were to recheck.Patients were followed by immobilization in a brace to exercise and followed up regularity.The evaluation criterion includes the ASIA,cobb angle,ESR,hospital day,operation time and blood loss.Results A mean of 9 months' follow-up(range:7-34 months) was achieved in 67 patients.All the diagnosis were confirmed by pathological results.All new operation group's patients were recover from tuberculosis prosperously,apart from one case had subcutaneous effusion and obtain rehabilitation after bed rest and standard chemotherapy,one case as the psoas major abscess to underwent the focus clearance again.The traditional operation group had superficial wound infections with two cases,and were healed after anti-inflammatory.The neurological function recovery of new operation group:one case from A to B,one A case and B case recovered to C,one B case and three C cases recovered to D,one C case and sixteen-six cases recovered to E. All the other cases(ASIA scale were E) had not any change.The ASIA change between preoperative and postoperative was conspicuous,and had the statistical significance.The new operation group had definitive fusion.The average thoracic cobb angle of the preoperative was 32.5±13.2°(range 15.9°～64.3°),and the cobb angle of the postoperative was 17.3±6.5°(range 7.9°～21.9°),and the cobb angle was 18.5±6.6°(range9.4°～32.1°) three months after surgery.The average lumbar cobb angle of the preoperative was 26.4±5.6°(range 18.6°～40.2°),and the cobb angle of the postoperative was14.4±3.9°(range 7.9°～21.9°),and the cobb angle was 15.6±3.7°(range 9.7°～22.8°) three months after surgery.The cobb angle had a conspicuous change between preoperative and postoperative,which had the statistical significance.The average thoracic tuberculosis ESR of the preoperative was 41.8±23.6mm/h(range 16～83mm/h),and the ESR was 19.2±5.0mm/h (range 9～26mm/h) three months after surgery.The average lumbar tuberculosis ESR of the preoperative was 37.2±15.8mm/h(range 19～75mm/h),and the ESR was 17.5±4.8mm/h(range 6～22mm/h) three months after surgery.The ESR had a conspicuous change between preoperative and postoperative,which had the statistical significance.The average operation time of the new operation group was 160.4±20.5min,compared with the 231.4±27.3min of the traditional group.The operation time of the new operation group was obviously less than those of traditional group.The average blood loss of the new operation group was 760.7±146.2ml,which compared with the 1023.8±197.9ml of the traditional group.The blood loss of the new operation group was obviously less than those of traditional group.The average hospital day of the new operation group was 23.4±4.2 day,compared with the 26.0±3.7 day of the traditional group.The hospital day of the new operation group was obviously less than those of traditional group.Conclusion According to evaluate the ASIA,cobb angle,ESR, hospital day,operation time and blood loss,Treatment of Thoracic and Lumbar Tuberculosis by posterior approach focus clearance,bone graft fusion and internal fixation at one-stage is a feasible and effective procedure in the spine tuberculosis treatment.