Treatment Of Lumbosacral Tuberculosis By Posterior Internal Fixation And Anterior Radical Eradication, Bone Graft Fusion At One-stage

Objective To investigate the feasibility,therapeutic efficacy and clinical indication of one-stage posterior internal fixation,anterior radical eradication,bone graft fusion in treatment of the lumbosacral tuberculosis.Methods Twenty-three cases with tuberculosis of the lumbosacral spine were treated by one-stage posterior internal fixation,anterior radical eradication,bone graft fusion.All patients included 14 males and 9 females, and the average age was 41.3 years(range 19～68 years).The affection segment of L₅ was five,L₄/L₅ was six and L₅/S₁ was twelve.On the basic of the ASIA in preoperative,the level C was seven,level D was thirteen and level E was three.The average ESR(erythrocyte sedimentation rate) of the preoperative was 40.8 mm/h(range 28～65 mm/h).The average CRP(C-reactive protein) of the preoperative was 16.2 mg/L(range 9.6～22.5 mg/L).The average lumbosacral angle of the preoperative was 18.8°(range 10.5～26.6°).The average interverterbral space altitude of the preoperative was 7.9mm(range 6.8～9.2mm).Results The average operation time was 200 min(range 180～240 min).The average blood was loss during the operation was 543 ml(range 400～1100 ml).There were not the main vessal and nerve injury and serious complications in the operation.On the basic of the ASIA,6 of the level C recovered to level D,the other one recovered to level E,all of the level D recovered to level E after the operation.The ESR and the CRP were all recovered to normal three months after the operation.The average lumbosacral angle of the postoperative was 27.1°(range 20.6-34.5°),The average lumbosacral angle was 25.9°(range 18.5-33.5°) at the late follow-up and the loss angle smaller under 2°. The average interverterbral space altitude of the postoperative was 10.4 mm(range 8.9～11.3mm).The average interverterbral space altitude was 9.9mm(range 8.5～10.8mm) at the late follow-up and the loss height smaller under 1.0 mm.We found that it had the statistical significance between preoperative and postoperative as well as late follow-up(P＜0.05).Conclusions one-stage posterior internal fixation,anterior radical eradication,bone graft fusion can significantly improved clinical symptoms,rebuilded and protected the stability pf the spine,fasted bone graft,obviated or rected postconvex malformation,degraded the Mutilation rate and shortened bed rest time as well.It is the utility method to the treatment of the lumbosacral tuberculosis.