Posterior Focus Debridement, Bone Grafting, Interbody Fusion And Pedicle Screws Internal Fixation In The Treatment Of Thoracic And Lumbar Spinal Tuberculosis

Objective: To investigate the clinical results of one-stage posterior focus debridement, bone grafting, interbody fusion and pedicle screws internal fixation in the treatment of thoracic and lumbar spinal tuberculosis, and provide evidences for the clinical practice.Methods: From June 2011 to October 2014, 30 patients with thoracic and lumbar spinal tuberculosis were treated with one-stage posterior focus debridement,bone grafting, interbody fusion and pedicle screws internal fixation,including 20 males and 10 females,aged 25 to 75 years old(averaged 45.5 years old).2 cases of T9, 2 cases of T10,2 cases of T11, 5 cases of T12,8 cases of L1, 5 cases of L2, 2 cases of L3, 4 cases of L4. 14 cases were complicated with neurological deficit. According to the Frankel scale system, 1 was in grade B,4 in grade C,6 in grade D,and 3 in grade E. The operation time, neurological function(Frankel grade), kyphosis Cobb angle, Visual Analog Scale, Oswestry Disability Index, Erythrocyte Sedimentation Rate, C reactive protein and tuberculosis recurrence were evaluated. Compared with preoperation, The kyphosis Cobb angle was significantly decreased after operation, and Visual Analog Scale and Oswestry Disability Index was significantly improved(P < 0.05).Results: Only 1 patient got delayed healing of incisions, the others got primary healing of incisions, and all patients showed successful interbody fusion. All the patients were all followed-up, and the duration ranged from 12 to 30 months,with an average of 20.5 months. 14 cases with neurological deficit recovered to different extent. Erythrocyte sedimentation rate and C reactive protein started to decrease at 2 weeks after operation.and to become nearly normal two to four months late. No one case was complicated with tuberculosis recurrence.Conclusion: The curative effect of one-stage posterior focus debridement,bone grafting, interbody fusion and pedicle screws internal fixation in the treatment of thoracic and lumbar spinal tuberculosis is significant. It can correct kyphotic deformity, recover neurological deficit and reconstruct spinal stability. one-stage posterior focus debridement, bone grafting, interbody fusion and pedicle screws internal fixation in treating thoracic and lumbar spinal tuberculosis is a preferable choice of the surgical indications.