One-stage Combined Posterioanterior Approachesfor The Treatment Of Tuberculosis Of Lumbosacral Spine

Objective:To treat tuberculosis of lumbosacral spine with debridement of thefocus of infection through anterior approach and bone graft combined with pediclescrew-rod internal fixation through posterior approach,so as to explore the feasibilityand therapeutic efficacy of the operation method.Methods:nineteen cases with tuberculosis of the lumbosaeral spine were treatedby one-stage anterior approach and bone graft combined with pedicle screw-rodinternal fixation through posterior approach.All patients included11males and8females,and the averageage was47.3years (range36-76years).The affection segmentall were L4/L5. On the basic of the ASIA in preoperative,the level C was four,level Dwas ten and level E was five. The average ESR (erythroeyte sedimentationrate) of thepreoperative was40.8mm/h (range28-65mm/h).The average CRP (C-reactiveProtein)of the preoperative was16.2mg/L(range9.6-22.5mg/L). Operative Procedure: Thepatient was placed in a prone positionon the operating table. The skin incision was madein the midline and the paravertebral muscles were elevated off of the spinous processesand laminae.Pedicle screw-rod internal fixation through posterior approach wereapplied at the normal vertebral body. Following the posterior procedure,the patient wasturned to a supine position. In all patients, radical curettage around intervertebral discand anterior interbody arthrodesis with autologous iliac tricortical bone graft wasperformed through an anterior retroperitoneal approach.Results:There were not the main vessal and nerve injury and seriouscomplieations in the operation. On the basic of the ASIA,3of the level C recovered tolevel D,1of the level C recovered to level E，8of the level D recovered to level E afterthe operation.The ESR and the CRP were all recovered to normal three months after theoperation. we found that it had the statistical significance between preoperative and postoperative as well as late follow-up (P<0.05).Conelusions:one-stage anterior approach and bone graft combined with pediclescrew-rod internal fixation through posterior approach can signify-cantly improvedclinical symptoms,rebuilded and protected the stability of the spine，fasted bonegraft,obviated or reeted postconvex malformation, degraded the Mutilation rate andshortened bed rest time as well. It is the utility method to the treatment of thelumbosacral tubereulosis.