Clinical effects of posterior debridement combined with biomimetic bone graft and internal fixation for thoracic and lumbar spinal tuberculosis

English Keywords:Thoracic and lumbar  Tuberculosis  Posterior approach  Biomimetic bone  Internal fixation

English Abstract:

  【Abstract】 Objectives: To explore the clinical effects of one stage single posterior approach for thoracic and lumbar spinal tuberculosis． Methods: A total of 17 patients with thoracic and lumbar spinal tuberculosis in our hospital from January 2011 to May 2015 were selected． There were 11 males and 6 females, aged from 25 to 71 years(average, 41.2±5.6 years); 9 cases with thoracic spinal tuberculosis(T4-T10), 7 cases with thoracic lumbar spinal tuberculosis(T11-L2), 1 case with lower lumbar spinal tuberculosis(L3-L5). There were 12 cases in single segment and 5 cases in two segments. According to American Spinal Injury Association(ASIA) grading system, 1 case was in grade B, 4 cases in grade C, 6 cases in grade D and 6 cases in grade E. All patients underwent one stage simple posterior debridement, interbody fusion and internal fixation. Antituberculosis drugs were used from 2 weeks before operation to 18 months after operation． The clinical effects were evaluated according to pain visual analogue scale(VAS), Cobb angle correction, recovery of neurological function which was classified based on the ASIA grading system, and bone graft fusion rate． Results: All surgeries were successfully performed, and the average operation time and blood loss during operation were 294±88min(264-366min) and 731±78ml(457-1350ml) respectively． All those patients were followed up, and the average follow-up time was 23±6 months(18-27 months)． No patients were noted complications such as incision infection and recurrence of tuberculosis． One patient who suffered from pleura rupture during surgery recovered after repairement of pleura and closed drainage. The 6-month and 12-month bone graft fusion rate was 88.2% and 100% respectively. VAS score of preoperation, 2 weeks postoperation and final follow-up was 8.1±0.6, 2.1±0.3 and 1.1±0.2 respectively; Cobb angle was 28.3°±9.8°, 8.1°±1.5° and 9.1°±3.5° respectively. At final follow-up, the final correct rate was 65.3%; ASIA grade was grade D in 4, grade E in 13. The VAS score, Cobb angle and ASIA grade were statistically significant before and after surgery(P＜0.05). Conclusions: One stage posterior debridement, interbody fusion and internal fixation is a good choice for short segment and circumscribed thoracic and lumbar tuberculosis．