One-stage posterior debridement，bone graft and instrumentation for thoracolumbar tuberculosis

English Keywords:Spine tuberculosis  Debridement  Internal fixation  Posterior approach

English Abstract:

  【Abstract】 Objective：To investigate the clinical efficacy and outcome of one-stage posterior debridement，bone graft and instrumentation for thoracolumbar tuberculosis and compare it with combined anterior and posterior approach.Method：A total of 67 cases with thoracolumbar tuberculosis between January 2006 and October 2008 were reviewed retrospectively，of these，39 cases underwent one-stage posterior debridement，bone graft and instrumentation（group A） while another 29 cases experienced anterior debridement and bone graft plus posterior instrumentation（group B）.The operation time，intraoperative blood loss，hospitalization，ESR，ASIA grade and Cobb′s angle before and after surgery between each group were reviewed and compared respectively.Result：In group A，the average operation time was 160.4±20.5min，the average blood loss was 760.7±146.2ml and the average hospitalization was 13.6±3.2d.While in group B，the average operation time was 231.4±27.3min，the average blood loss was 1023.8±197.9ml and the average hospitalization was 18.7±3.6d which showed significant difference between two groups（P＜0.01）.All cases were followed up for 7-34 months（average 16.8 months）.During follow-up，no severe complication was found in both of the two groups.1 case of group A was found tuberculosis of psoas abscess recurrence，and then was cured by the anterior focus clearance.At final follow-up，all cases had evidence of solid bony fusion without any instrument failure.24/25 cases in group A with preoperative neurological deficit improved significantly while 15/18 cases in group B with preoperative neurological deficit improved.The average Cobb′s angle in group A decreased from 32.5°±13.2° preoperatively to 15.3°±8.2° postoperatively and that in group B decreased from 35.2°±14.3° preoperatively to 15.8°±8.7° postoperatively.The value of ESR in group A decreased from 36.2±5.6mm/h preoperatively to 20.5±4.3mm/h postoperatively and that in group B decreased from 38.5±6.1mm/h preoperatively to 19.6±4.1mm/h postoperatively.No significant difference was noted with respect to ASIA grade，Cobb′s angle and ESR between two groups（P>0.05）.Conclusion：Either one-stage posterior debridement，bone graft and instrumentation or combined anterior and posterior surgery can ensure good clinical outcome for thoracolumbar tuberculosis，however，posterior approach have the advantages of less operation time，less blood loss and shortened hospitalization.