Clinical Efficacy Of The Fixation Technique By Using Cortical Bone Trajectory Screws For Monosegment Lumbar Spinal Tuberculosis

Objective:To evaluate the clinical efficacy of one-stage anterior debridement,bone grafting fusionand posterior cortical bone trajectory(CBT)screw fixation in combination with traditional pedicle screw internal fixation in lumbar single-segment instumentation for the treatment of monosegment 1umbar spinal tuberculosis.Methods:From January 2015 to January 2016,42 patients with monosegment lumbar spinaltuberculosis in the First Affiliated Hospita1 of the Air Force Military Medica1 University of PLA were included in this analysis.All patients were divided into two groups based on the posterior internal fixation technique that was applied according to patient's clinical situation and wish.Internal fixation was performed by CBT screws combined with traditional pedicle screws in 21 patients(A group)and by traditional pedicle screws in 21patients(B group)after anterior debridement and bone grafting fusion.The Cobb angle,the Frankel grade,erythrocyte sedimentation rate(ESR),C-reactive protein(CRP)and visua1 analogue score(VAS)value of al1 patients were analyzed before and after surgery and during the follow-up period.Results:42 cases of patients were recevied followed-up from 18 to 30 months,and average of(24.1±4.5)months.The erythrocyte sedimentation rate(ESR)was(13.5±5.5)mm/1 h in group A and(12.9±4.9)mm/1 h in group B at 3 months after surgery,the difference was not statistically significant(t=0.32,P=0.747).The CRP was(4.7±2.0)mg/L in group A and(5.2±3.2)mg/L in group B at 3 months after operation,without significant statistical difference(t=-0.86,P=0.500).The VAS value was(1.9±0.8)in group A and(2.2±1.0)in group B at 3 months after operation,the difference was not statistically significant(t=-1.02,P=0.312).The average correction of Cobb angle was compared between the 2groups:(11.6±6.3)°in group A,(9.9±5.9)°in group B at the last follow-up,with no significant statistical difference(t=0.96,P=0.343).The correction loss was(1.7±1.2)°in group A and(1.4±1.4)°in group B at the final follow-up,with no significant statistical difference(t=0.94,P=0.355).As to postoperative neurological improvement,1 case with Frankel grade B before operation recovered to grade D;of the 5 cases with grade C before operation,4 cases recovered to grade D and 1 case recovered to grade E;of the 26 cases with grade D before surgery,all recovered to grade E.Conclusion:The technique by using cortical bone trajectory screwing can fix and fuse the diseased segment in lumbar spinal tuberculosis,retain normal movement in the adjacent spinal column,it is indicative to monosegment lumbar spinal tuberculosis.