Clinical study on treatment of thoracolumbar spinal tuberculosis through one-stage anterolateral-posterior approach / 西安交通大学学报(医学版)

ABSTRACT

Objective To explore the clinical efficacy of one-stage anterolateral-posterior approach debridement,bone graft and internal fixation in treatment of thoracolumbar spinal tuberculosis.Methods From January 2010 to December 2014,56 cases of thoracolumbar spinal tuberculosis were retrospectively analyzed, including 31 males and 25 females,aged 18 -72 years (mean 43.1 years).All patients were managed by standard courses of chemotherapy with quadruple anti-TB drugs for 2 - 4 weeks.Patients were treated by anterolateral debridement,autologous iliac bone graft fixed by absorbable screw fixation,and posterior pedicle screw fixation via multi-split muscle gap (Wiltse approach).We recorded the operation time,the amount of bleeding,bone graft fusion,postoperative erythrocyte sedimentation rate (ESR),Cobb angle,VAS score,and American Spinal Injury Association (ASIA)score to evaluate the surgical results.Results The average operation time was 175-290 min, with an average of (248±42)min.The bleeding volume was 300 -900 mL with an average of (420 ±68)mL.The average follow-up time was (24 ± 5.2 )months,bone fusion rate was 100%,and fusion time was (4.7 ± 0.5 ) months.At the last follow-up,the average Cobb angle was (8.2±3.1)°,VAS was (2.1±0.8),and ESR was (17± 4.2)mm/h.The ASIA neurological functions were all classified as Grade E except for 3 cases of Grade D.All these were significantly different from the preoperative ones.Six patients had complications of different degree but without serious complications.Conclusion One-stage anterolateral debridement,autologous iliac bone graft fixedby absorbable screw fixation,and posterior pedicle screw fixation via multi-split muscle gap (Wiltse approach)can completely remove the tuberculosis lesions and achieve ideal kyphosis correction,high bone graft fusion,and satisfactory neurological function recovery.Absorbable screws can be safely applied to the bone graft site after debridement.