| BackgroundsTuberculosis is an old disease, Mycobacterium bovis DNA in human remains from the Iron Age displays that TB has been a threat to the human health in the Iron Age. Spinal TB is the most common and serious form of TB in the skeleton. Close attention had been paid on it because of its high incidence, high rate of disability and other serious consequences. MRI was generally applied in the diagnosis of spinal TB because it can reveal the exact extent of the disease and the anatomic structure. The MRI also has the characters of high resolution of soft tissue, the visualization of multilayer and multi-parameter, and has no impair on the human body. Lots of the literatures have introduced its application in the diagnosis. However, the application of MRI in surgical treatment, still need to be further explored. With the progress of chemotherapy, spinal surgery technology mature, the application of internal fixation devices, spinal TB cure rate has increased significantly and the rate of disability had decreased obviously. However, there is still some controversy in the indication of conservative treatment and surgical treatment, surgical approach and election of surgical procedures, long-term efficacy, the causes and strategies of complications.Partâ… A new MRI classification of spinal TB (SH classification)Objectives1.To establish a new MRI classification of spinal TB by analyzing the MRI of 230 cases retrospectively;2. To evaluate the SH classification at the early diagnosis of spinal TB, in order to provide an early conservative treatment to patients, prevent the misdiagnosis and severe complications through a timely treatment;3. To explore the value of the SH classification in the surgical indication and election of surgical procedures;4. The changes of MRI signal at the TB focus could provide the evidence of removed area, so as to preserve subnormal bone and part of sclerotic bone to reduce the bone defect;5. We can remove the lesions of the TB during the operation and retain subnormal bone on the basis of preoperative imaging that can show the the scope of the subnormal bone.Methods1. Collection dataWe had consulted the medical records form April 1, 2007 to March 31,1997, and 230 cases had been found, gains their imaging data and other information by The ID and MRI number.2. Imaging analysis and classificationWe invited 2 senior imaging physicians and 3 spinal surgeons to analyze the MRI with double-blind approach from the focus signal change and the whole characters of the lesions. The whole characters of the lesions included disc cataplasia, abnormal signal of vertebral body, abscess formation, vertebral body tumbling, posterior process, sagittal plane index, instability, pressed cord, vertebral canales occupied and nerve symptom. It was divided into five types to analyze with the diagnosis, surgical indication, the election of surgical procedures.3. Following-upWe had obtained the present imaging data and another information by the follow-up of out-patient clinic, telephone contact and home visits. Results1. SH classificationIt was classified into five types according including signal change type (typeâ… ) with 33 cases, abscess forming type (typeâ…¡) with 39 cases, spine destroyed type (typeâ…¢) with 83 cases, canal occupied type (typeâ…£) with 46 cases, and posterior process type (typeâ…¤) with 29 cases.2. Follow-up resultsOf the 230 cases, 33 were lost, 188 had been cured, 9 with recurrence had also been cured through adjustment of chemotherapy or by operation. All of the patients had got a good treatment effect with conservative treatment, or removing the lesions and the sub-normal bone retaining.Conclusions1. We have established a new MRI classification system of spinal TB (SH classification) by analyzing the MRI of 230 cases retrospectively, signal change type (typeâ… ),abscess forming type (typeâ…¡),spine destroyed type (typeâ…¢), canal occupied type (typeâ…£),posterior process type (type V), respectively;2. The MRI is the gold standard in the diagnosis of spinal TB, especially in the earlier periods, patients ofâ… type could usually be treated by conservative treatment;3. In the SH classification, typeâ…¡to typeâ…¤have the indication of surgery;4. We can elect different surgical procedures on the basis of SH classification, segment and extent of spinal TB.Partâ…¡Long-term efficacy of spinal TB survey (The follow-up of 197 cases)Objectives1. To analyze the causes and strategies of recurring of spinal TB and the complication of internal fixation devices by a 1 to 10-year follow-up with 230 cases from April 1, 2007 to March 31,1997;2. To discuss the removed area of spinal TB, the operative approach and the re-establishment of stability on the basis of the following-up.Methods1. Collection data keep up with the same2. Imaging analysis and classificationWe classified and analyzed the imaging data of the MRI According to SH classification that have established in the partâ… .3. Following-upWe had obtained the present imaging data and another data by the follow-up of out-patient clinic, telephone contact and home visits.4. Statistical analysisThe data of the four-frame and RxC table were analyzed by X2 test in SPSS13.0 software, testing the standard of 0.05.Results1. Follow-up resultsOf the 230 cases, 33 were lost,188 had been cured, 9 with recurrence had also been cured through adjustment of chemotherapy or by operation. All of the patients had got a good treatment effect with the conservative treatment, or the operation with the removing lesions and the sub-normal bone retaining.2. The follow-up results of SH classification33 cases of type I , 39 cases of typeâ…¡,83 cases of typeâ…¢,46 cases of typeâ…£, and 29 of cases typeâ…¤all had gained a good treatment effects with the different treatment. 3. Fixation-related complicationsThe internal fixation devices were used in140 cases, including 83 anterior approachs and 57 posterior approachs. The screw broken had happened in 2 cases, the screws of 5 cases had loosed and prolapsed, one spinal body was incided in another case.4. Recovery of neurological functionsThere were 4 cases whose ASIA scale is A, 2 of which backed to B, 1 recovered to C, 1 lost; there were 9 cases of B, 3 of which returned to C, the other recovered to D; C and D of ASIS scale,13,19 respectively, had all recovered to E.5. Statistical resultsFollow-up rate, cure rate and recurrence rate of various types all used X2-text, p values >0.05, it can not be considered to exist to statistical difference between various types. Therefore, the follow-up and cure rate have not statistical differences.â… type included expectant treatment and surgical treatment, P value >0.05, we can not deem to exist to the difference between two treatment method.6. The recovery of signalThe subnormal bone recovered to normal completely between 6 mouths and 1 year after the operation, it was obviously that the standard anti-tuberculous therapy could make it turn into normal bone. The abscess and focus of spinal TB disappear completely.Conclusions1. We can elect different surgical procedures on the basis of SH classification, segment and extent of spinal TB;2. By the folio wing-up of 223 cases, we have analyzed the causes and strategies of the recurrence and fixation-related complications;3. We have analyzed the hot-spot issues in the surgical treatment, such us removing extent to lesions, operative approach and the reconstruction of stability, and we have put forward our unique view.
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