Research On A New Classification Of Spinal Tuberculosis And Its Treatment By Posterior Approach

Objective:By reviewing the clinical data of patients with spinal tuberculosis and analyzing the pathological and imaging characteristics of patients with different diseases.to put forward a new classification method of spinal tuberculosis,which provides a theoretical basis for describing the different pathological stages of spinal tuberculosis more scientifically and conveniently in clinical practice,for selecting a reasonable approach and method of hand operation,and for summarizing the feasibility and indications of posterior operation for spinal tuberculosisMethod:A new classification method of spinal tuberculosis established,which based on the retrospective analysis of clinical data of 117 cases of spinal tuberculosis from January 2014 to January 2019,and on screening out the characteristic indexes of clinical,pathological and imaging changes closely related to the pathological process of spinal tuberculosis by analyzing the clinical and imaging features of the patients.The clinical data of the patients before operation,after operation and follow-up were evaluated by visual analogue score(VSA),spinal nerve dysfunction score(Asia),laboratory data,X-ray,CT,MRI and other imaging examinations.All data were processed by statistical method.Result:1.In the 117 patients,69 were male and 48 were female,average age of which was 40 years old(5-77years old).The course of disease was the shortest 2 months and the longest 5 years,the average of which was(12±3.6)months.All patients were followed up for 12 to 60 months,with an average of 24 months.There were 5 cases of tuberculosis accumulating in cervical vertebrae,43 cases in thoracic vertebrae,38 cases in lumbar vertebrae,28 cases in thoracolumbar vertebrae and 3 cases in lumbosacral vertebrae.There were 1 case of single vertebral body involved,72 cases of two vertebral bodies involved and 44 cases of more than two vertebral bodies involved.There were 4 cases of spinal jumping tuberculosis,3 cases of osteopathic cured tuberculosis,1 case of spinal accessory tuberculosis,22 cases of preoperative Cobb angle ?30°,18 cases of preoperative Cobb angle?30° and 2 cases of preoperative Cobb angle?90°.Among the 117 cases,except 9 cases of conservative treatment and 5 cases of cervical tuberculosis,the remaining 103 cases of thoracolumbar and sacral tuberculosis were treated by posterior operation.Among the 103 cases of surgical treatment,80 patients had no spinal nerve dysfunction,the remaining 23 patients had spinal nerve dysfunction.According to the Asia classification,there were 1 case in Grade A,4 cases in Grade B,6 cases in Grade C,9 cases in grade D and 83 cases in grade E.Among 103 patients,59 had no kyphosis and 44 had kyphosis.The operation time was 90-540 minutes,with an average of 276 minutes.The intraoperative bleeding volume was 80-2500 ml,with an average of 827 ml.The range of Cobb angle was 10-62° in patients before operation,29.91 ± 12.62 °in average.The range of Cobb angle was 0-36 ° in patients after operation,12.56±7.60°in average.The range of Cobb angle was 4-40° in patients at the last follow-up,15.61± 8.44 ° in average.The difference was statistically significant(P<0.05).The ESR was 31(12,50)mm/h before operation and 25(17,42)mm/h 4 weeks after operation.There was no significant difference between this two groups(P>0.05).The C-reactive protein was 17.77(8.54,37.81)mg/L in patients before operation and 14.60(6.51,26.50)mg/L in patients 4 weeks after operation.The C-reactive protein was lower than that before operation,the difference between the two was statistically significant(P<0.05).The VSA score of the patients before operation was 4(3,6),and the VSA score of 4 weeks after operation was 1(1,2).The VSA score of 4 weeks after operation was significantly lower than that before operation,and the difference between the two groups was statistically significant(P<0.05).2.By Spearman rank correlation analysis,we found that the degree of kyphosis(Cobb angle)had significant correlation with the course of disease,location,segment,whether there were neurological symptoms,and ASIA grade(P<0.05),but not with the cold abscess of tuberculosis,dead bone.So,for patients with spinal tuberculosis,the different stages of the pathological process of tuberculosis activity can be used as the main classification basis for the classification of spinal tuberculosis,and other relevant characteristic indications should also be used as auxiliary reference indicators for classification.3.According to the correlation analysis,the new analysis used the course of disease and the special involvement site of patients with spinal tuberculosis as the main indicators of the new classification spinal tuberculosis can be divided into three types:type ?(simplex spinal tuberculosis),type ?(progressive spinal tuberculosis),type ?(jumping spinal tuberculosis),type ?(spinal accessory tuberculosis),type ?(Osteopathic cure type spinal tuberculosis).Other important indicators used,such as involved segments,the severity of kyphosis and the presence or absence of spinal nerve symptoms,can be used as an auxiliary reference index for classification of spinal tuberculosis,that is,according to the cumulative location and segment of the tuberculosis can be divided in to lesion C(cervical vertebra),T(thoracic vertebra),L(lumbar vertebra),S(sacral vertebra),and according to the cumulative segment count of tuberculosis focus.According to the severity of kyphosis,it can be divided into mild(Cobb angl?30°),moderate(30°<Cobb angle?60°),severe(60°<Cobb angle ?90°),extremely severe(Cobb angle>91°).According to whether the patient has spinal nerve dysfunction,it can be divided into two categories:with spinal nerve dysfunction(N0)and without spinal nerve dysfunction(N1).A new classification system was formed based on the course of disease,segment,degree of kyphosis and the presence or absence of spinal nerve disorders.Note:IIT2K2N1 indicates that progressive spinal tuberculosis with 2 segments of thoracic spine is associated with severe kyphosis and has no neurological symptoms.4.In this study,a new type was used to analyze the patients in reverse,and the reliability and repeatability of the indexes were analyzed.Conclusion:1.The degree of kyphosis associated with the course of disease,location,segment,presence or absence of neurological symptoms and Asia grade.The course of spinal tuberculosis can be regarded as the main index of tuberculosis classification,and the location and segment of the focus involved,the degree of kyphosis and spinal cord injury should also be included in the classification index system?so as to accurately and comprehensively reflect the status of spinal tuberculosis and guide the treatment.The new classification method is comprehensive,reasonable,convenient for communication and application,and has certain clinical guiding significance for the treatment of spinal tuberculosis?2.Posterior surgery can effectively remove the tuberculosis focus,facilitate the reconstruction of the stability of the spine sequence reconstruction and posterior rigid internal fixation,and avoid the lack of anterior surgery,which is feasible and practical.