Selection Of Surgical Approach For Lower Lumbar Spinal Tuberculosis

Objective:Retrospective study of the selection of surgical approach for lower lumbar tuberculosis.Methods: From December 2014 to December 2016,57 cases of GATA III-type lower lumbar tuberculosis admitted to our hospital orthopedic department,including 29 males and 28 females,aged 18-61 years,a verage 40.4 ± 18.5 years old,involving a vertebra In 3 cases,46 cases in 2vertebrae,8 cases in 3 vertebra and above.57 patients had varying degrees of lumbar pain and/or lower extremity radiating pain before operation.There were 8 cases with neurological dysfunction.The preoperative ASIA grade C grade3 cases,D grade 5 cases.Thirty-six patients in group A(posterior lesion clearance,bone graft fusion and internal fixation)and 21 in group B(anterior lesion clearance,bone fusion and internal fixation)were grouped according to different surgical procedures.The operation time,blood loss,hospitalization time,erythrocyte sedimentation rate and C-reactive protein in the two groups were compared and analyzed.The postoperative complications,tuberculosis recurrence,imaging and the improvement of lower back pain(VAS score)were compared.Results: In group A,the average operation time was 181.18 ± 60.92 min,the av erage amount of blood loss during operation was 365 ± 321.3ml and the length of hospitalization was 15.5 ± 5.9 days.The erythrocyte sedimentation rate de creasedfrom 46.25 ± 17.36 mm /hpreoperatively to 22.23 ± 13.09 mm / h.The change of C-reactive protein decreased from 24.68 ± 22.37 mg / L preoperatively to 8.67 ± 7.6mg / L at the last follow-up.In group B,the average operation time was 211.85 ± 90.09 min and the average amount of bleeding during operation was 394.23 ± 306.7ml.The erythrocyte sedimentation rate decreased fro m 47.58 ± 14 mm / h preoperatively to 15.85 ± 4.6mm / h at final follow-up.C-reactive protein Changes from preoperative 33.23 ± 28.42 mg / L dropped to the last follow-up was 10.54 ± 10.16 mg / L.No serious complications occurre d during operation in both groups.After 8 to 12 weeks erythrocyte sedimentation rate returned to normal.Eight patients with preoperative neurological impair ment recovered to grade E at the last follow-up.One case in group A and group B,respectively,after half a month,one month incision to form the sinus,dressing treatment 1 to 2 months after the cure.No recurrence of tuberculosis at the last follow-up.Conclusion: Lower back tuberculosis(GATA III type)by the posterior and anterior approach should be considered the choice of lesion,abscess area,kyphosis angle,the correct choice of surgical indications,intraope rative practices,can be satisfied with the curative effect,effectively relieve the suffering of patients.