A Clinical Study Of The Treatment Of Lumbar Tuberculosis With Vertebral Debridement And Lavage Drainage By Spinal Endoscopy

Objective: To investigate the efficacy and safety of vertebral debridement and continuous lavage drainage for lumbar tuberculosis by percutaneous spinal endoscopy.Methods: From January 2012 to January 2018,31 patients with lumbar tuberculosis,diagnosed by biopsies or mycobacterium tuberculosis cultures for the pathological tissue from vertebral bodies and underwent failed anti-tuberculosis chemotherapy for 3 months,were retrospectively analyzed.The operations were evaluated by operation time,blood loss,macrovascular,spinal cord and nerve root injury.The recoveries of local tuberculosis were evaluated by erythrocyte sedimentation rate(ESR),C-reactive protein(CRP)and visual analogue scale(VAS)before and after operation.The patients were followed up for 18 to 84 months(mean 46 months).At the last follow-up,the lumbar lordosis(LL),sacral inclination(SI)Japanese Orthopaedic Association(JOA)score and imaging data were used to evaluate the recovery of spinal structure and function after operation.Results: All the 31 patients completed the operation successfully,and there were no complications such as macrovascular,spinal cord and nerve injury.The ESR was(45.94±8.02)at 1-day before surgery,(11.58±2.79)at 3-month,(11.77±4.22)at 6-month,(9.97±3.38)at 12-month after surgery,decreased to normal levels 3 times after surgery.The CRP was(44.72±5.80)at 1-day before surgery,(4.69±0.85)at 3-month,(4.50±0.42)at 6-month,(4.37±0.18)at 12-month after surgery,decreased to normal levels 3 times after surgery.The VAS was(6.42±1.31)at 1-day before surgery,(2.26±1.32)at 3-month,(1.87±0.92)at 6-month,(1.74±0.97)at 12-month after surgery.The preoperative LL was(33.58±1.79),which increased to(42.61±2.81)latest follow-up.The preoperative SI was(30.81±1.87),which increased to(38.16±2.62)latest follow-up.The preoperative JOA was(15.26±1.93),which increased to(26.10±1.54)latest follow-up.The differences in the scores before and after surgery were statistically significant(P<0.05)。The last X-ray showed that there was no obvious collapse of the diseased vertebral bodies and narrowing of the intervertebral space.CT and MRI suggested that the vertebral lesions healed.Conclusion: Vertebral debridement and lavage drainage in the treatment of lumbar tuberculosis under spinal endoscopy has the advantages of short operation time,less intraoperative bleeding,safety and effectiveness,and can provide a new surgical treatment for spinal tuberculosis.