[Effect of surgical treatment for thoracolumbar spinal tuberculosis by anterior radical debridement with bone graft fusion and posterior pedicle screw-rods system fixation]

Abstract

Objective: To study the clinical effects of one stage surgical treatment of thoracolumbar spinal tuberculosis by anterior radical debridement with bone graft fusion and posterior pedicle screw-rods system fixation.

Methods: From February 2002 to March 2007, 21 patients who were 45.3 years old on average with thoracolumbar spinal tuberculosis, including 13 males and 8 females were underwent surgical treatment of posterior pedicle screw-rods system fixation, correction of deformities, anterior radical debridement, bone graft fusion. Among them, 3 patients had 2 involved vertebras, 17 patients had 3 involved vertebras, and 1 patient had 4 involved vertebras. The patients were all complicated with kyphosis deformity with an average Cobb angle of (28.0+/-9.7) degrees. According to the Frankel neurological function grade system, 3 cases in grade B, 5 in grade C, 1 in grade D, 12 in grade E. All the patients received antiphthisic treatment with isonicotinylhydrazide (INH), rifampicin (RFP), Ethambutol (EMB), pyrazinamide (PZA), and support therapy in preoperation. The chemotherapy was continued 9 to 12 months after operation. Neurological functions of all cases were investigated, and radiography was analyzed pre-operation and post-operation to determine the state of bony fusion and the correction of spinal kyphosis. Statistical analysis was made according to the preoperative and post-operative Cobb angle.

Results: The follow-up period ranged from 1 to 6 years with 2.5 years on average. All the patients had primary healing of the incisions. The Cobb angle was (9.8+/3.3) degrees in post-operation. The kyphosis deformity was corrected 17.2 degrees in thoracolumbar on average (t=-13.48, P<0.01). According to the Frankel neurological functional grade system, 1 case was in grade C, 3 in grade D, and 17 in grade E.

Conclusion: It is effective for patients with thoracolumbar spinal tuberculosis in correction of spinal kyphosis, reconstruction of the spinal stability and bony fusion by anterior radical debridement with bone graft fusion and posterior pedicle screw-rods system fixation.