The Clinical Study Of Anterior Minimally Invasive Combined Posterior Lesions Cleared、bone Graft And Internal Fixation For Treatment Of Severe Lumbar Spinal Tuberculosis With Huge Psoas Abscess

Objective: To analyse the clinical efficacy of anterior minimally invasivecombined posterior lesions cleared、bone graft and internal fixation for treatment ofsevere lumbar spinal tuberculosis with huge psoas abscess,to discuss the surgicalmethod in treating with severe lumbar spinal tuberculosis with huge psoas abscesses.Methods: From December2010to December2011,30patients of severelumbar spinal tuberculosis with huge psoas abscesses were treated by the way ofsurgical method mentioned above in Affiliated Hospital of Qinghai University SpinalSurgery.There were17males and13females,with an average age36.7years (rangedfrom21-67years). The diseased levels included L1-L2in8patients, L2-L3in7patients, L3-L4in4patients, L4-L5in3patients, L5-S1in2patients, L3-L5in3patients, L2-L5in1patients and L4-S1in2patients. There are bilateral psoas abscessin12cases and unilateral in18cases. All the patients had different degree of lumbago,lumbar kyphosis and neurological dysfunction. Preoperative VAS score was5.5-10.0score(average8.1±1.4). Preoperative sagittal Cobb’s angle was5.5-10.0score(average38.7°±5.3°). Accoding to Frankel scale, there were B grade3cases, Cgrade17cases, D grade10cases. The standard chemotherapy including isoniazid,rifampicin, ethambutol and pyrazinamide was administrated for2weeks beforeoperation and continued for10-12months. The clinical manifestations were observed,erythrocyte sedimentation rate、C-reactive protein、liver function and kidney functionwere received at regular intervals and lumbar vertebra X-ray was received after3months,6months and12months postoperatively, observing the low back painimprovement, the change of Cobb angle and neural symptom recovery.Result: All the operations were sucessfully completed. There were no severecomplications.The mean operation time was175minutes (145-210minutes), and themean intraoperative blood loss was330ml(210-450ml). All the patients werefollowed up for15-25（average17.5） months. Postoperative lumbago alleviated inall cases,VAS score of last follow-up was1.0-3.0score(average2.0±1.1), the mean improvement of VAS score was6.1. Frankel grade of last follow-up:3cases of gradeB recovered to grade C,17cases of grade C recovered to grade D14cases, E grade2cases and no recovery in1cases,10cases of grade D recovered to grade E. At finalfollow-up, the mean sagittal angle was6.0°-9.0°,with the mean correction of6.9°±1.4°. There were significantly different about the Cobb angle of kyphosis andVAS score between preoperative and last follow-up(P<0.05).Bony fusion wasobtained at final follow-up.Conclusions: The operating method of anteriorminimally invasive combined posterior lesions cleared、bone graft and internalfixation can achieve thorough cleaning of tuberculosis lesions, decompression ofspinal cord, correction of kyphosis deformity and improvement of bone graft fusion,it is an ideal surgery to treat the severe lumbar spinal tuberculosis with huge psoasabscesses.