Minimally Invasive Approach Next To The Erector Spinae For Treatment Of Thoracolumbar Spinal Tuberculosis

Background and Objective: TB is an ancient disease,it was common disease in Less developed countries. Is due to the emergence of resistant strains, the increase of floating population, can not effectively control Source of infection and AIDS pandemic concurrent increase in TB infections and other reasons, The incidence of TB has significantly increased, the incidence of pulmonary tuberculosis also increased. Spine is a common part of extrapulmonary TB parts, it is primacy in bone and joint tuberculosis cidence rate ,about 40 ~ 50%. Over the last decade, The treatment and the concept of spinal tuberculosis are constantly updated, Treatment effect is greatly increased, Surgical treatment of spinal tuberculosis has become a hot field of orthopedics. Most traditional surgical treatment of spinal tuberculosis is by anterior approach,it is cause severe trauma and more bleeding. Therefore, in recent years,many orthopedic surgeons used posterior incision for debridement, and achieved good results. But there are still stripping the muscles too much, the muscles were pull on the heavy in surgical field, it can cause postoperative multifidus muscle atrophy, lower back pain and other sequelae. This topic design minimally invasive approach next to the erector spinae for treatment of thoracolumbar spinal tuberculosis, and discuss it's application in spinal tuberculosis surgery.Method: we selected the patients in our department during December 2009 to December 2010 who had clinical diagnosis of thoracolumbar spinal tuberculosis, a total of 17 cases. The patients were randomly divided into 2 groups. M group(Group M, Minimally invasive surgery group) used minimally invasive approach next to the erector spinaeto fordebridement and internal fixation, a total of 7 cases.C group(Group C,Conventional surgery group) used posterior incision for debridement and internal fixation, a total of 10 cases. We use arterial pressure measurement devices of ECG to measure the pressure in Erector spinae, multifidus and other deep spinal muscles. Patient's creatine kinase levels were measured before and after operation. Record operation time, blood loss, analgesic use and hospital stay days. Application of SPSS for windos 17.0 software for statistical analysis,P <0.05 as significantly differentence. Patients were followed-up X-ray films and CT after surgery 3 months, 6 months and 12 month.Result: Incisions of conventional surgery group (C group) and minimally invasive surgery group (M group) were healed without sinus formation. Operation time: C group, 100-170min, an average of 141±25min; M Group for the 130-240min, an average of 188±36min. Blood loss: C group, 390-680ml, an average of 487±105ml; M group was 150-570ml, an average of 354±134ml. Days of hospitalization: C group 10-27d, an average of 17.8±5.6d; M group of 8-23 days, average 14±4.8 days. Application of analgesia pump in both groups (main ingredient tramadol), and oral analgesic drugs Jitongan (each containing tramadol hydrochloride 37.5mg, paracetamol 325mg). C group pain medication pump depletion of time 28-49h, mean 37±4.6h, M group 36-60h, mean 45±3.9h, An oral Jitongan 2 pills Bid, C group use of time 4-10d, an average of 6.8±1.2d, M group, 3-7d, an average of 4.7±1.1d; After retractors placed in surgery,the deep muscle pressure: C group 56.20±4.57mmHg; M group 30.07±2.13 mmHg. creatine kinase levels after surgery: C group 456±38.9u / L, M group was 272±6.9u / L. between the two groups, The mean operative time for minimally invasive was 45min more than the conventional group, there was significant difference (P = 0.006); the average blood loss of minimally invasive group was less than the conventional group, there was significant difference (P = 0.037); the average length of stay in Minimally invasive group was less than the conventional group, but the difference was not significant (P = 0.17); C group pain medication pump depletion was less than the minimally invasive group, there was significant difference (P = 0.02), use of oral pain medication longer than C group M group, there was significant difference (P = 0.02);the muscle pressure of M group was lower than C group, there was a significant difference (P = 0.003); Postoperative creatine kinase level of M group was significantly lower than C group (P = 0.002). There were no spinal cord, nerve roots, vascular injury and other serious complications postoperatively.There were 1 case of L5 nerve root irritation in M group, considering it caused by pulling the nerve root surgery, it was recovery after follow-up therapy. 7 patients of C group were followed up after 5-12m, with an average follow-up time 7m. follow-up after 3 months: X-ray films showed the fixation is in place; follow-up after 6 months: X-ray films and CT showed fixation in place, no recurrence of tuberculosis, ESR level was in the normal range, and continuous trabecular bone could be found in 3 cases; follow-up after 12 months: X-ray films and CT showed fixation in place, no recurrence of tuberculosis, ESR level was in the normal range, and continuous trabecular bone could be found in 5 cases; 6 patients of M group were followed up after 3-15m, the average follow-up time was 6m. follow-up after 3 months: X-ray films showed the fixation is in place; follow-up after 6 months: X-ray films and CT showed fixation in place, no recurrence of tuberculosis, ESR level was in the normal range, and continuous trabecular bone could be found in 3 cases; follow-up after 12 months: X-ray films and CT showed fixation in place, no recurrence of tuberculosis, ESR level was in the normal range, and continuous trabecular bone could be found in 5 cases. Conclusion: minimally invasive approach next to the erector spinae is a safe, minimally invasive approach to spinal tuberculosis.it can achieve effective debridement, spinal decompression, posterior fixation and interbody fusion purposes. Reduced the injury of soft tissue and muscle caused by iatrogenic factor,it can reduce the intraoperative bleeding and analgesic use . It is a direct vision minimally invasive surgical approach for spinal tuberculosis,and it should be promoted.