Application of computer navigation in the treatment of spinal tuberculosis in the extreme lateral interbody fusion under working channel

English Keywords:Thoracic and lumbar tuberculosis  Tuberculosis focus clearance  Computer navigation  Extreme lateral interbody fusion

English Abstract:

  【Abstract】 Objectives: To investigate computer navigation in the extreme lateral interbody fusion(XLIF) under working channel for thoracolumbar and lumbar tuberculosis. Methods: From June 2013 to October 2014, 46 cases of thoracolumbar or lumbar tuberculosis underwent the XLIF under working channel. Patients were randomly divided into navigation group(16 males, 7 females) and control group(14 males, 9 females), 23 cases in each group. The average age of navigation group was 37.7±16.7 years old, and the average age of control group was 39.2±18.4 years old. 17 cases were complicated with nerve dysfunction(7 cases in navigation group, 10 cases in control group), American Spinal Injury Association(ASIA) grade was used to evaluate neurofunction: in navigation group, there were 5 cases of grade C, 2 cases of grade D, while in control group, there were 6 cases of grade C, 4 cases of grade D. Postoperative outpatient follow-up records included erythrocyte sedimentation rate, bone fusion time, visual analogue score(VAS) score, ASIA grade and Cobb angle lesions. Preoperative general information and ASIA classification, VAS score and Cobb angle of spine comparison between two groups were not statistically significant(P>0.05). Results: The intraoperative bleeding in navigation group was 447±139.6ml, while 627±251.3ml in control group, the difference showed statistical significance(P<0.05). The intraoperative C arm fluoroscopy exposure time was 31±14.2s in navigation group, and 96±44.6s in control group, the difference had statistical significance(P<0.05). Operation time was 158±73.6min in navigation group, and 213±88.2min in control group, the difference had statistical significance(P<0.05). The VAS score, kyphosis angle(Cobb angle), operation time, bone fusion time showed no significant difference between the two groups. 10 cases in control group had preoperative neurological injury, among 6 cases of grade C, 3 cases recovered to grade D after surgery, 3 cases recovered to grade E. 4 grade D patients recovered to grade E. Neurolgical injury was noted in 7 cases in navigation group, after operation, among 5 cases of grade C, 3 cases recovered to grade D, 2 cases recovered to grade E. 2 grade D patients recovered to grade E. 1 cases of incision non-healing occurred in control group, and it cured after suture. 1 case of incision sinus occurred in navigation group, and it cured by dressing treatment after 2 months. Conclusions: Thoracolumbar and lumbar tuberculosis debridement, internal fixation and bone grafting through XLIF under computer navigation can obtain a good surgical effect and shorten the operation time, reduce intraoperative radiation exposure.