Debridement Via Facet Joint Approach And Ilium Grafting With Internal Fixation In The Treatment Of Thoracic Spinal Tuberculosis

Objective:To evaluate the clinical efficacy and feasibility of debridement via facet joint approach and ilium grafting with internal fixation in the treatment of thoracic spinal tuberculosis.Methods:Retrospective analysis was conducted on 20 patients with thoracic spinal tuberculosis(including 10 males,10 females with the average age of(60.4±15.2))who were treated with debridement via facet joint approach and ilium grafting with internal fixation in our hospital from January,2014 to October,2018,of which 8 had a history of tuberculosis at other sites,1 had a fluid abscess and 1 had an exposed sinus tract.The Frankel Spinal Cord Injury Scale and Visual Analogue Scale of Pain(VAS)were applied to evaluate the neurological function and the severity of back pain.And indexes,such as operation time,intraoperative blood loss,postoperative drainage time and drainage volume,C-reaction protein,erythrocyte sedimentation rate,kyphotic angle and postoperative fusion time were adopted to evaluate the surgical efficacy.Results:All patients were followed up for 26-60 months with an average of 48.9±9.9 months.The operation time was 48.9±9.9min with an average of(188.8±65.8)min.The intraoperative blood loss was 100-1500 ml with an average of 100-1500 ml.The average kyphosis angle was(21.5±7.1)° preoperatively,which were recovered to(13.3±6.3)° immediately after operation with(14.9±7.3)° at the last follow-up(F=37.883,P<0.001).The kyphosis angle after immediate surgery was 8.25°(95%CI=6.063-10.440,P<0.001)lower than that before surgery,and the kyphosis angle at the last follow-up was 6.65°(95%CI=3.652-9.641,P<0.001)lower than that before surgery.The postoperative back pain was also relieved,and the VAS score was(0.9±0.9)at the last follow-up that was significantly reduced compared with that before surgery,whose difference was of obvious statistical significance(P<0.001,Z=-4.026).All patients obtained bony fusion at the final follow-up,and the fusion time ranged ffrom 6 to 10 months with an average of(7.8±1.2)months.Both CRP and ESR were roughly recovered to normal values.Only one patient experienced postoperative superficial wound infection,and no serious complications were occurred.The recurrence of tuberculosis was not found,and the neurological function of all patients was improved to varying degrees.Conclusion:The treatment of thoracic spinal tuberculosis with debridement via facet joint approach and ilium grafting with internal fixation is feasible.