Comparison Of Clinical Outcomes Between Lesion Surgery And Non-lesion Vertebral Surgery For Thoracic And Lumbar Tuberculosis

Objective To investigate the clinical effectiveness of lesion surgery for treating thoracic and lumbar tuberculosis. Methods From December 2003 to June 2014, patients with thoracic and lumbar spinal tuberculosis receiving surgical treatment were divided into two groups according to different instrumental methods. Patients in lesion surgery group(experimental group) accepted the radical foci debridement, graft implantation and internal fixation surgery completely located in infected spinal motion segments. There were 191 cases in experimental group including 91 males and 100 females, with an average age of 41.53 years. Those in non-lesion surgery group(control group) adopted the long segmental or short segmental fixation method。There were 131 cases including 61 males and 70 females, with an average age of 42.72 years. All patients used quadruple anti-tuberculosis chemotherapy. Results The average follow-up time was 75.52 months in experimental group and 76.21 months in control group. The total number of diseased segments in experimental group and control group were 277 and 218 respective, and the average diseased segments number of them was 1.45 and 1.66.The total number of fixed segments were 277 in experimental group and 485 in control group, and the average fixed segments were 1.45 in experimental group and 3.70 in control group. The cure rate were 85.86% in experimental group and 85.49% in control group at 6 months postoperatively, 98.95% and 98.47% respectively at the time of the follow-up, with no significant difference between groups. Graft fusion rate was 89.00% in experimental group and 89.31% in control group postoperative 6 months, 98.38% and 98.47% respectively at the time of the follow-up, without significant difference. In lumbar spine, the average corrective Cobb’s angle was 12.4°in experimental group and 13.1°in control group, and the average loss angle was 1.3 and 1.4°, with no significant difference. In thoracolumbar, the average corrective Cobb’s angle was 10.9°in experimental group and 11.1°in control group, and the average loss angle was 1.7°and 1.5° respectively, without significant difference. However, in thoracic, the average corrective Cobb’s angle were 10.2°in experimental group and 12.7°in control group, and the average loss angle was 3.6° and 2.5°respectively, with significant difference. The mean operation time was 210.45 min in experimental group and 210.45 min in control group, with significant difference. The average blood loss was 726.12 ml in experimental group and 726.12 ml in experimental group, with significant difference. The complication rate was 27.74% in experimental group and 29.00% in experimental group, with no significant difference. At the end time of the follow-up, ESR and CRP switched back, nervous function of Frankel grade improved and the mean score of VAS was 1 in two groups. Conclusion Lesion surgery including the radical foci debridement, graft implantation and internal fixation, which located in infected segments, is safer and more effective for treatment of thoracic and lumbar tuberculosis, charactering as slight trauma 、 less bleeding, and preserving motion.