Stability Evaluation And The Selection Of Surgical Approach Of A Single Motion Segment Of Thoracic, Lumbar, Sacral Vertebrae Spinal Tuberculosis

Objective: Review of the influence of 45 cases of mono-segmental spinal tuberculosis of thoracic,lumbar and sacral vertebrae spinal on the spinal stability researched in our hospital,To investigate the focus clearance, single segment fixation methods, indications and advantages and disadvantages. Methods:A retrospective analysis of clinical data of 45 cases in our hospital from 2011 June to 2014 August who were treated and followed up the single segment thoracic, lumbar, sacral vertebra tuberculosis was performed, 21 males,24females, age range 17-69 years,mean age 38.5years;medical history 3-36 months,mean medical history 14.5 months. Preoperative quadruple anti-tuberculosis for 2-4 weeks should be performed.According to the kyphotic deformity, vertebral collapse and other potential factors that have influence on the stability of spine and combining with Denis three column theory(the injury of 2 or more columns is spinal instability), divided into 7 cases of group A(stable group), 38 cases in group B(unstable group);The stable group employ the anterior debridement;According to the preoperative degree of vertebral destruction, kyphosis and residual vertebral height measured during the procedure,17 cases(group B1) of unstable groups underwent anterior debridement and bone graft fusion with single segment fixation, 13 cases(group B2) employed anterior debridement and autograft bone fusion and posterior single segment fixation,8 cases(group B3) were treated with posterior debridement, bone graft fusion and single segmental pedicle of vertebral arch internal fixation.The materials of this group were drawn from autogenous bones.Postoperative routine treatment of anti-tuberculosis should be applied for 12-18 months, the follow-up measurement of cobb angle and evaluation of the level of correction、evaluation the condition of bone graft fusion,monitoring the changes of CPR and ESR, comprehensive evaluation combining with the recovery of neurological function(Frankel grade). Results:1.Simple anterior column failure has no obvious impact on the stiffness of spine;The injury of anterior and middle column has obvious damage to the spinal stability;2.In 45 cases,the average correction of kyphotic angle is 17.5 degrees,during the follow-up period, the loss is 3-5 degrees;In group B, bone graft fusion(autogenous rib or iliac) in patients was underwent after 7-9 months, average 8 months; After operation,31 cases complicated with spinal cord dysfunction were improved in different degrees, according to the Frankel classification,the average improvement is about 1 rank. Conclusion:1.Simple anterior column failure has no obvious impact on the stability of the spine;The injury of anterior and middle column is regarded as the spinal unstability;2.Performing the focus clearance,mono-segmental bone fusion and internal fixation can reconstruct the stability of anterior and middle column, which has exact clinical curative and obvious effect on spinal tuberculosis of mono-segment.