Efficacy of posterior debridement, bone graft fusion and internal fixation in the treatment of noncontiguous spinal tuberculosis

English Keywords:Spinal tuberculosis  Noncontiguous  Individualized treatment  Bone graft fusion and internal fixation  Surgical outcomes

English Abstract:

  【Abstract】 Objectives: To investigate the clinical characteristics of noncontiguous spinal tuberculosis and the efficacy and prognosis of one-stage posterior debridement, bone graft fusion and internal fixation for the treatment of noncontiguous spinal tuberculosis. Methods: The clinical data of 31 patients with noncontiguous spinal tuberculosis treated in our hospital between July 2016 and May 2022 were retrospectively analyzed, including 18 males and 13 females, aged 49.5±27.5 years. There were 24 cases with 2 lesions and 7 cases with 3 lesions. Responsible vertebrae were clarified, and surgical lesions, fusion segments, and internal fixation methods were determined for each patient, so as to develop individualized surgical plans. The patients were followed up for 29.7±14.7 months(15-85 months). The operative time, intraoperative blood loss, and intraoperative and postoperative complications were recorded. Erythrocyte sedimentation rate(ESR) and C-reactive protein(CRP) were examined and recorded before operation, at 1 month, 3 months, and 1 year after operation, and at the last follow-up. Visual analogue scale(VAS) was used to evaluate the pain before operation, at 1 week, 1 month, 3 months, 1 year after operation and at the last follow-up. Cobb angle was measured before operation, at 1 week after operation, and at the last follow-up. The American Spinal Injury Association(ASIA) classification was recorded before operation and at the last follow-up. Bridwell bone healing criteria were used to evaluate postoperative tuberculosis activity, symptom improvement, deformity correction, and bone healing at the last follow-up. Results: Among the 31 patients, 20 (65.4%) had only one lesion (65.4%), 23 (74.2%) were admitted to the hospital with pain as the main complaint, 15 (48.4%) had only pain symptoms during the course of the disease, 11 cases (35.5%) had only one lesion with pain symptoms, and 18 (58.1%) patients had at least one lesion missed at the initial diagnosis. All the patients were successfully operated. The operative time was 280.0±52.2min(165-330min), and blood loss was 567.7±332.0mL(150-1000mL). There were 4 cases of cerebrospinal fluid leakage and 3 cases of incision infection after operation, which were cured after symptomatic treatment. All foci of tuberculosis were cured without recurrence or retransmission. At pre-operation, 1 month, 3 months, 1 year after surgery, and at the last follow-up, ESR was 41.5±26.3mm/h, 16.3±13.4mm/h, 12.5±6.3mm/h, 11.4±5.2mm/h, and 9.2±3.1mm/h, and the levels of CRP were 32.8±23.2mg/L, 7.3±5.6mg/L, 6.2±4.1mg/L, 5.1±3.7mg/L, 2.8±2.3mg/L, which were both significantly lower after operation than those before operation(P<0.05). The VAS score was 6.4±2.4, 2.4±1.7, 2.3±1.3, 1.6±0.9, 0.9±0.7, and 0.4±0.3 before operation, at 1 week, 1 month, 3 months, 1 year after operation, and at the last follow-up, which was significantly improved after operation when compared with that before operation(P<0.05). The Cobb angle was 25.7°±4.9° before operation, 15.4°±2.1° at 1 week after operation, and 17.1°±2.3° at the last follow-up, and there were significant differences between the postoperative angles and preoperative angles(P<0.05). Among the 10 patients with preoperative neurological impairment, 1 patient with preoperative grade A recovered to grade C at the last follow-up. Among the 4 patients with preoperative grade B, 1 patient recovered to grade C and 3 to grade D. Of the 5 patients with preoperative grade C, 2 recovered to grade D and 3 to grade E. All 42 bone graft lesions achieved bone fusion at 6-12 months after operation. At the last follow-up, 34 lesions healed in Bridwell grade Ⅰ and 8 in Bridwell grade Ⅱ. Conclusions: For patients with noncontiguous spinal tuberculosis, one-stage posterior debridement, bone graft fusion and internal fixation is safe and efficient after determining responsible vertebrae and lesion features, which can obtain satisfactory results.