Clinical Research Of Combined Anterior And Posterior Surgies For Thoracic-waist-sacral Vertebrae Tuberculosis

Objective To study the safety and curative effect of one-stage surgical management for thoracic-waist-sacral vertebrae tuberculosis by posterior pedicule screw-rods system fixation and anterior decompression,grafting,fusion.Methods A total of32patients with thoracic-waist-sacral vertebrae tuberculosis were treated with combined anterior(radical debridement and autograft) and posterior(instrumentation) surgeries between July2009and September2011in deparment of Spinal Surgery,The first hospital of Lanzhou university,including18males and14females,with the age of18to64years,40.7years on average, The course of disease was3months to24months,8months on average,of them, There were12cases of thoracic tuberculosis,12of thoracolumbar and8of lumbosacral.The involved vertebral bodies were at1segment in two patients, two segments in21patients, three segments in8patients and four segments in1patient,which was jumpimg lesions. The primary symptom of all patients was back pain.The preoperative kyphosis was10to60°,6had tuberculosis,The sinus was associated in one patients,There were2cases of grade of B,three cases of grade C and20of grade of D in Frankel grading.There was abscess formation in30cases, Imaging examination showed bone destruction and intervertebral space narrowing or vashing.The average erythrocyte sedimention rate on admission was75mm/H,and the average preoperative ESR was40mm/H.Results In addition to one case of skin flap necrosis by dressing healing,and the remaining healed.The ERS at one week postoperative was30mm/H,and decrsead to normal range in1-3months postoperative,The postoperative kyposis was5to40°,spinal fusion was achieved in5to7months,6months on average,no infection or recurrence, on fixation loosing or fracture at the final follow-up,The2cases of grade B recoverd to grade C,3of grade C to grade D and20of grade D to grade E.Conclusion Thoracic-waist-sacral vertebrae tuberculosis treated with this surgical technique can achieve a high satisfactory rate providing early fusion,restoring spinal stability,correcting and preventing progression of kyposis,particularly safe and easy to operation.