Modified One-stage Posterior Debridement For Thoracolumbar Tuberculosis

Objective: To investigate the feasibility and efficacy of modified one-stage posterior debridement in the treatment of thoracolumbar tuberculosis.Methods: A total of 116 patients with spinal tuberculosis admitted to the Department of Spinal Surgery of Central Hospital from January 2016 to January2021 were retrospectively analyzed,of which 70 met the inclusion criteria.Thirty-four patients underwent modified one-stage posterior debridement(modified group)and 36 patients underwent traditional one-stage posterior debridement(traditional group).The operation time,blood loss,intraoperative(including 7 days after operation)blood transfusion,postoperative supine time,erythrocyte sedimentation rate,C-reactive protein,VAS score,JOA score,ODI score,Cobb angle improvement and fusion time were recorded.The complications and recurrence were recorded.SPSS 19.0 software was applied for statistical analysis of the above data.Results: The patients were followed up for 9-40 months after operation,with an average follow-up time of(13.15 ± 8.26)months.The operation time of34 patients who received modified one-stage posterior debridement was(289.35± 78.28)min,blood loss was(728 ± 122)ml,intraoperative(including 7 days after operation)red blood cell transfusion volume was(1.32 ± 0.39)u,and postoperative supine time was(9.15 ± 3.00)d.Erythrocyte sedimentation rate decreased from(68.12 ± 12.23)mm/h before operation to(46.09 ± 8.66)mm/h and(10.66 ± 2.42)mm/h at 15 days after operation and during follow-up.C-reactive protein decreased from(19.80 ± 11.55)ug/ml preoperatively to(15.07 ± 3.52)ug/ml and(4.66 ± 1.09)ug/ml at 15 days postoperatively and during follow-up,respectively.The preoperative ODI was(43.00 ± 9.16)%,which decreased to(20.15 ± 7.02)% and(6.85 ± 2.48)% at 15 days after operation and follow-up,respectively.The preoperative VAS score was(3.97 ±0.76)points,which decreased to(1.44 ± 0.66)and(0.79 ± 0.48)points at 15 days after operation and follow-up,respectively.The preoperative JOA score was(21.53 ± 4.11),the postoperative 15-day and follow-up were(24.41 ± 3.01)and(26.97 ± 1.77),respectively,and the JOA score improved by(86.00 ±17.03)%.The preoperative Cobb angle was(23.03 ± 7.57)°,which decreased to(2.91 ± 1.19)° and(3.21 ± 0.95)° at 15 days after operation and follow-up,respectively,and the fusion time was(7.35 ± 1.12)mon.There was no significant difference in operation time,ESR,CRP,ODI score,VAS score,JOA score and Cobb angle improvement between the improved group and the traditional group(P > 0.05),but there were significant differences in blood loss,red blood cell transfusion volume,postoperative supine time and fusion time(P< 0.05).Conclusions:1.Both modified one-stage posterior debridement and traditional one-stage posterior debridement have obtained good efficacy in the treatment of thoracolumbar tuberculosis,and the efficacy is similar.2.The modified group had less damage to the posterior column structure,relatively "minimally invasive",less intraoperative blood loss and red blood cell transfusion,and shorter postoperative supine time and fusion time.3.In the modified group,the exposure range is small,the visual field is relatively small,it is difficult to remove the lesion,and the operation time is relatively prolonged.