| Background and Objective:Tuberculosis has been one of the most serious infectious diseases in developing countries,and the number of tuberculosis patients is large in our country based on the huge population. Bone and joint tuberculosis is the most common extra-pulmonary tuberculosis, and more than half of which is spinal tuberculosis.Spinal tuberculosis mainly invades vertebrae,involving anterior and middle column,and causes instability of spinal,collapse of vertebra and spinal compression,and finally leads to kyphosis deformity.Conventional treatment is anterior partial vertebrectomy and fusion. However,many researches indicated that bone graft often could not provide firm support while osteolysis and remodeling since the focus had destroyed the stability of the spine segment,then resulted in failing to surgery or to correct the kyphosis deformity.So the re-establishment of spinal stabilization is being paid more and more attention to.With the development of spinal surgery and internal fixation,a new treatment of spinal tuberculosis appears recently,which combined conventional debridement,fusion and posterior or anterior internal fixation,trying to provide effective protection for the bone graft and keep the stability of the spine while osteolysis and remodeling,so that the occurrence or development of kyphosis deformity can be prevented.In this study,we investigate the feasibility and therapeutic effect of spinal tuberculosis with one-stage radical debridement,interbody fusion and internal fixation to restore stability of the spine.Methods:①22 patients with spinal tuberculosis were treated by anterior partial vertebrectomy of the diseased vertebrae,iliac grafting and internal fixation from Jan 2002 to Dec 2008 hospitalization in the second affiliated hospital of Dalian medical university.Of the 22 cases, there were 14 males,8 females, from 25 to 74 years old,the average age of them is 39.4. There were 5 cases had the lesionsin in thoracic vertebraa,7 in thoracic-lumbar region and 10 in lumbar vertebra.There were 7 cases paralysis.All the patients were applied anterior partial vertebrectomy,Iliac grafting and internal fixation.The patients need routine 2 to 6 weeks anti-tuberculosis chemotherapy before operation,and continue antitubercu- losis chemotherapy for 9 to 12 months after operation.②Designing various kinds of registration tables about spine tuberculosis , recording the data of clinical,image (X-way,CT and MRI,and so on)and chemical examination (ESR,Liver and renal function,and so on),to perform retrospecttive study and analyses.③To follow-up clinical symptom,knitting rate and the rectification rate of kyphosis deformity.Results:The average follow-up time was 33 months.95% of the patients' ESR recovered to normal.22 cases with kyphosis deformity were corrected from the preoperatively 40.2°to 12.9°postoperatively, but they were found to become 16.0°after 1 year.According to Frankel classification, the preoperative degrees of patients was 1 in Grade B,2 were in Grade C,4 were in Grade D and 15 were in Grade E.7 cases of neural dysfunction to restore to different extents after operation. All the 22 cases were cured in 6 months postoperatively.The later X-ray showed the solid fusion from all the 22patients of iliac grafting in 3-6months(average 4.6months) postopera- tively,at the same time,all the cases resumed their normal daily activities.Conclusion:On the basis of effective chemotherapy,we believe that spinal tuberculosis with one-stage radical debridement,interbody fusion and internal fixation to restore stability of the spine has many advantages, including significantly improved clinical symptoms,thorough focus debride- ment,more rapid fusion of strut grafts,better deformity correction and vertebral column stabilization in patients who have kyphosis related to spinal tuberculosis,and shortening bed rest time as well.Therefore it has reliable value for clinical application.
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