ABSTRACT
Objective To explore the effectiveness of short segmental screw fixation and bone graft fusion on the decayed vertebral of thoracolumbar tuberculosis.Methods A total of 46 cases undergone one stage anterior debridement,interbody fusion,screw fixation on the decayed vertebral of thoracolumbar tuberculosis were retrospectively analyzed from June 2009 to November 2013.Including 25 males and 21 females,with the mean age of 39.6 years (range,13-69 years).Lesion segments:T6-L4 (segment lesions ≤ 3 segments); 3 B gradecases,6 C grade cases,4 D grade cases and 33 E grade cases assessmed by Frankel grade.The average Cobb angle of kyphosis was 16.34°±3.19° and ESR:19-81 mm/1 h preopration.CT scan and Two-dimensional reconstruction were done before operation,and the effective height of front and middle pillar of residual thoracolumbar vertebral in coronal and sagittal position were measured before operation,when the minimum effective height was higher than 10 mm,combined the intraoperative visual,the appropriate internal fixation for anterior debridement and interbody bone grafting were choosed.The cobb angle,the Frankel grade,the ESR and VAS value were compared with preoperative and postoperative.The stability and bone graft fusion were also observed.Results Fourty-six cases of patients were received followed up from 12 to 48 months,an average of 26 months.All patients with tuberculosis poisoning symptoms disappeared.The ESR:0-15 mm/1 h.Frankel rating at the end of postoperative follow-up:2 D-class cases,44 E-class cases.The VAS score (6.85± 1.22,4.49±0.95 vs.2.06±0.93) and vertebral Cobb angle (16.34°±3.19°,4.16°±2.71° vs.4.52°±1.29°) at post-operation 7 d and the last follow-up were significant lower than those at pre-operation,while the ESR (41.25±1.61 mm/1 h,17.36±6.82 mm/1 h vs.10.67±0.72 mm/1 h) was reduced to normal levelthan that of pre-operation.The comparative difference was statistically significant between pre-operative and post-operative.The fusion rate at the end of post-operative follow-up:44 excellent cases,2 good cases.Conclusion When the effective height of front and middle pillar of residual thoracolumbar vertebral in coronal and sagittal position in vertebral tuberculosis was higherthan 10mm,reliable stability and treatment efficiency were achieved with anteriorinternal fixation.