Treatment of thoracic and lumbar spinal tuberculosis via posterior paraspinal muscle gap approach / 中华骨科杂志

ABSTRACT

Objective To explore the feasibility and assess the efficacy of posterior paraspinal muscle gap approach in the treatment of thoracic and lumbar spinal tuberculosis.Methods From June 2009 to June 2013,a total of 29 patients were analyzed retrospectively.There were 2 patients of tuberculosis T8,9,6 of T9,10,8 of L1,2,10 of L2,3,and 3 of L4,5.The patients included 12cases of male,17 cases of female; the age ranged from 28 to 53 years,with a mean of 40.78 years.Nine patients had preoperative kyphosis deformity,and Cobb angle ranged from 19° to 39° (mean,29.67°).Two patients complained with paraplegia with Frankel grade C.All patients had preoperative standardized oral isoniazid,rifampicin,pyrazinamide border,ethambutol,glucuronolactone for 2-4 weeks.All patients underwent one-stage posterior paraspinal muscle gap approach fixation,rectification,debridement and autograft bone fusion.The clinical effects were observed by the time and blood loss in operation,blood loss after operation; the score of visual analogue scale (VAS) one week after operation and the last follow-up,the time erythrocyte sedimentation rate (ESR) drop to normal after operation,the change of cobb angle,the improvement of the neurological symptom,the situation of the bone fusion.Results Operation time was 3-4 h,with an average of 3.3 h; operative blood loss was 300-600 ml,with an average of 434 ml.Drainage volumn was 250-450 ml after surgery with an average of 340 ml.All patients were followed up for 6 to 36 months with an average of 16.56 months.There was no recurrence,sinus formation or internal fixation failure,and all patients obtained successful bony fusion.The mean time ESR drop to normal range after operation was 4.22 months.One patient of the two with Frankel grade C pre-operation turn to grade D,the other grade E.The Cobb angle was 10.33° (9°-12°) immediately after operation,and 12.22° (11°-14°) at the final follow-up.Conclusion Posterior paraspinal muscle gap approach surgeries is feasible and effective in the treatment of thoracic and lumbar spinal tuberculosis.