Clinical research on the treatment of thoracic vertebral tuberculosis by one-stage anterolateral costotransverse extrapleural approach

English Keywords:Thoracic vertebral Tuberculosis  Trapezoid Shape incision  Surgical treatment

English Abstract:

  【Abstract】 Objectives: To evaluate the clinical effect of one-stage posterior instrumentation combined with anterolateral costotransverse extrapleural debridement and bone graft for the treatment of thoracic tuberculosis by means of trapezoid shape incision. Methods: From September 2013 to March 2016, a total of 25 patients with thoracic tuberculosis were admitted to our department. Among the 25 cases, there were 13 males and 12 females. The average age was 42.2±14.8 years(range, 19-67). The levels of lesions were T5-T12. There were 12 cases complicated with kyphosis. The average kyphosis angle was 28.8°±4.8°(range, 23.5°-40.2°). According to Frankel grade of neurological deficit, 3 cases were graded as grade C, 20 cases were grade D and 2 cases were grade E. At the time of admission, ESR was 28.1±21.7mm/h. The preoperative VAS score was 6.4±1.1. All 25 cases underwent trapezoid shape incision and one-stage posterior instrumentation combined with anterolateral costotransverse extrapleural debridement and bone graft. Regular and effective anti-tuberculosis medicine treatment was lasted for 9-24 months on the basis of bacterial culturing and drug sensitive test, with an average of 15.6±5.5 months. The operation time, the amount of bleeding during operation, intraoperative and postoperative blood transfusion, major complications associated with approach were recorded. Visual analogue scale(VAS), ESR, Frankel neural function classification were assessed before and after surgery. The recovery of neurological function was evaluated by Kirkaldy-Willis functional score at 6 months postoperatively. The Cobb angle at preoperation was compared with that at 3 days and 9 months after surgery. Results: All surgeries were successfully completed, the average operation time was 5.2±0.5h(range, 4.3-6.2h). The amount of intraoperative blood loss was 440-650ml, the average was 552.2±62.7ml. 25 patients were followed up from 12 to 34 months, with an average follow-up of 22.1±6.8 months. Preoperative ESR was 9.6±4.3mm/h and ESR at 3 months after operation was 6.8±2.8mm/h. The VAS score was 3.5±1.1 at 3 months after operation． The mean VAS scores and ESR were significantly lower than those before operation(P<0.05). The postoperative Cobb angle for 12 patients with kyphosis was 21.7°±5.6° and 22.4°±5.6° at 9 months after operation. The average angle loss was 0.6°±0.4°. There was significant difference between preoperative and postoperative Cobb angle(P<0.05). The period of interbody fusion was from 6 to 9 months, the average was 7.0±0.9 months. There were no complications during follow-up, such as loosening of internal fixation, spine instability, the aggravation of neurological deficit and so on. Among 3 patients with Frankel grade C, 2 cases recovered to grade D at 3 months after operation, and 1 case recovered to grade E. 20 patients with Frankel grade D recovered to grade E at 3 months after operation, which showed a significant difference when compared with preoperative ones(P<0.05). The Kirkaldy-Willis function score showed that the total fine rate was 96%. Conclusions: Trapezoid shape incision and one-stage posterior instrumentation combined with anterolateral costotransverse extrapleural debridement and bone graft, along with postoperative active chemotherapy is proved to be successful in treating thoracic vertebral tuberculosiscan as it improves the neurological function and kyphosis correct.