Clinical Effect Of Different Surgical Approaches In Surgical Treatment Of Thoracolumbar Spine Tuberculosis

BackgroundIn the recent20years, there had been a significant development about the surgicaltreatment of spinal tuberculosis. diagnostic tools and techniques to improve the earlydiagnosis of tuberculosis of spine. Spinal implant development especially in pediclescrew internal fixation system greatly increased the cure rate of tuberculosis. In manyways of operation treatment of thoracic and lumbar spinal tuberculosis, each method hasits own characteristics and indications. Using the different operation approachs, as longas the indications correctly, can effectively remove the lesion, correction of deformity,to achieve a satisfactory clinical effect.Objectives1. Under the standardization of peri operation period processing, to explore theclinical characteristics of two different operation methods peri operation period of eachindex in the treatment of thoracolumbar spinal tuberculosis.2. To explore the feasibilityof anterior debridement, fusion and internal fixation plus bone and clinical curativeeffect, in order to provide reference for the clinical tuberculosis of lumbar thoracic typeselection.Methods1. Review of85cases with thoracolumbar spine tuberculosis treated by ourhospital from January2003to December2012. Group B included46cases whounderwent anterior radical debridement and instrumentation. Group A included39cases who underwent anterior debridement and bone grafting with posterior instrument. Theoperation time, blood loss, hospitalization days and ASIA grade, ESR, CRP before andafter surgery were observed.2. The (group A) underwent anterior debridement, bonegraft fusion and internal fixation in patients with clinical efficacy,30of which were aperfect follow-up, patients were followed up for9~36months, average18months, noserious complications occurred. Recorded its1) score before surgery, postoperativefollow-up, in March when Cobb angle, ESR, CRP and VAS;2) the recovery ofneurological function and interbody fusion;3) clinical recovery, comparison andanalysis. All the data were analyzed using the SPSS13.0system.Results1. Group(A) of39cases blood loss averaged775.6±129.7ml, the averageoperation time was288.8±79.5min, days of hospitalization for an average of27.1±7.0d, ESR from32.9±18.3mm/h before operation to54.3±25.0mm/h after procedure,CRP from18.1±18.1mg/l before operation to41.1±21.1mg/l after procedure.Group(B) of46cases of bleeding volume was483.7±110.6ml, the average operationtime was215.9±52.4min, days of hospitalization for an average of22.5±6.9d, theESR value from34.2±18.6mm/h before operation to49.4±24.9mm/h after procedure,the value of CRP from30.2±25.6mg/l before operation to38±22.7mg/l afterprocedure. Cobb angle from preoperative35.2±13.2°to postoperative20.6±12.2°.All patients except one have a healing incision.No Significant difference was notedwith respect to the Cobb′s angle, ESR,CRP in two groups(P>0.05).Significantdifference was noted with respect to the operation time, blood loss and hospitalizationtime between two groups(P<0.05). The Cobb′s angle decreased from39.07±12.6°preoperatively to13±7.6°postoperatively. Significant difference was noted with theCobb′s angle between preoperatively and postoperatively (P<0.05). The ESR creasedfrom31.3±19.2mm/h preoperatively to51.7±25.1mm/h postoperatively. The CRPcreased from16.3±16.8mg/l preoperatively to40.1±22.2mg/l postoperatively. The ESR and the CRP were all recovered to normal three months after the operation. The nervedysfunction in group A before operation in36cases, after operation31cases improvedafter treatment. There is dysfunction group B before operation in32cases afteroperation,29cases improved after treatment. In2cases of group A, the preoperativeASIA grade B,1cases improved postoperative grade C,1cases improved to grade D;13cases in grade C,9cases improved to grade D,4cases were improved to grade E;21cases in grade D,16cases improved to grade E. In group B, preoperative ASIAclassification of1cases of grade B, grade D improved after operation;14cases of gradeC,8cases improved to grade D,6cases were improved to grade E;17cases in grade D,14cases improved to grade E. Analysis of two groups of ASIA grade improvement nostatistical difference (P>0.05), no significant differences between the two groups ofCobb angle, ESR, CRP (P>0.05), group A in the operation time, bleeding,hospitalization days were higher than those in group B, operation time, amount ofbleeding between the two groups, hospitalization days difference significant (P<0.05).2,30cases in group A received perfect follow-up, patients were followed up for9~36months, average18months, the value of ESR from31.3±19.2mm/h before operationto51.7±25.1mm/h after procedure, postoperative outpatient follow-up in three monthswas11.4±4mm/h. The value of CRP from16.3±16.8mg/l before operation to40.1±22.2mg/l after procedure, postoperative March outpatient follow-up was8.7±3.9mg/l.Thus it can be seen, after three months outpatient review in CRP, ESR returned tonormal. Among12patients have different degree of kyphosis, Cobb angle decreasedfrom preoperative39.07to postoperative13±12.6°±7.6°, after three monthsoutpatient follow-up was16±8.1°. After analysis, the postoperative Cobb anglecompared with those before operation there was statistically significant difference(P<0.05), there were no statistical differences and at last follow-up (P>0.05). The VASscore from preoperative8.2±2.1to7.3±3.5points after operation, postoperative threemonths outpatient follow-up was2.3+1.6. After compared with the preoperative VAS score had significant difference (P<0.05), after three months outpatients wassignificantly reduced (P<0.01). On the basis of evaluation of effect of modified Macnabcriteria,30patients were excellent in21cases, good in6cases,3cases, the excellentand good rate was90%.Conclusions1.The standardization of peri operation period is important to deal with the twokinds of thoracic and lumbar tuberculosis operation mode can obtain satisfactorycurative effect;2.In the strict indications, anterior debridement, bone graft fusion andposterior internal fixation in the treatment of thoracic and lumbar tuberculosissatisfactory curative effect, especially in the correction of kyphosis, prevent the losspostoperative Cobb angle, has certain advantages on restoration of spinal biomechanicalstability.3.Using different operation approach, as long as the indications correctly, caneffectively remove the lesion, correction of deformity, to achieve a satisfactory clinicaleffect.