One-stage Posterior Debridement Interbody Fusion And Instrumentation For The Treatment Of Adult Lumbar Tuberculosis Spondylitis

Objective:To investigate the the single posterior debridement, interbody fusion and internal fixation treat spinal tuberculosis with spinal deformity.Methods:A retrospective study105cases of spinal tuberculosis with spinal deformity admitted to our department from January2007to January2012.63cases underwent isolated posterior debridemen, interbody fusion and internal fixation. Inclusion criteria:(1) adult spinal tuberculosis;(2) low back pain symptoms, accompanied by neurological symptoms; accompanied or not accompanied by fever, fatigue, night sweats and other symptoms of Tuberculosis;(3) the lesion is localized in a single segment (refer to a vertebral gap and the adjacent vertebral bodies);(4) no significant flow injection abscess;(5) with or without kyphosis.Standard anti-TB chemotherapy was used at. preoperative and postoperative time. WBC, ESR, CRP, the lesion segments Cobb’s angle, Oswestry Disability Index (ODI) were detected at preoperative, at14th day after surgery, at the postoperative1-year follow-up and final follow-up, respectively. Bone graft fusion was evaluated with bridwell grading criteria, as well as the clinical effecacy was observed. Results were statistically analyzed with SPSS19.0. Resrlts:All patients were safe at perioperative period. All cases in this study, recurrence was not fund; TB symptoms in patients with low back pain disappeared. All cases were not fund chronic infection or sinus formation, no loose screws, broken nails or broken rods occurred. Surgical or drug-related complications did not occur at the last follow-up. For the patients who underwent isolated posterior debridemen, interbody fusion and internal fixation. The mean operative time was168.32±41.36min, the average blood loss was346.41±37.18mL. ESR decreased to14.07±8.64mm/h and11.34±3.12mm/h at posteroperative1-year and final follow-up from preoperative68.41±13.73mm/h, respectively. For the cases with spinal kyphosis caused by anterior vertebral body severely damaged, the cobb’s angles changed frome reoperative average23.37±9.28°to2.77±2.03°and2.79±2.31°at posteroperative1-year and final follow-up, respectively. ODI, lumbar dysfunction index, improved frome preoperative39.14±12.38to7.29±3.09and6.77±2.53at posteroperative1-year and final follow-up, respectively. At posteroperative1-year follow-up,30cases spinal graft fusion were Bridwell Ⅰ Grade;22cases were Bridwell Ⅱ Grade;11case BridwelⅢ Grade. At final follow-up,38cases Bridwell Ⅰ Grade;19cases were Bridwell Ⅱ Grade,6case BridwellⅢ Grade.. The clinical efficacy evaluated at posteroperative1-year follow-up, According to Zhang Xi-Feng criteria, the outcomes were excellent in22ases, good in 34, fair in7; The result improved at final follow-up, excellent in35cases; good in24; fair in4. and excellent and good rate was93.65%. Conpareed with the cases in the group who underwent anterioroperative, there is a statistically significant difference, P<0.05.Conclusion:For the adult patients with single segment pinal tuberculosis, basised on the effective anti-TB drugs, the the single posterior debridement, interbody fusion and internal fixation orthopedic surgery, belonging to a relative sense "minimally invasive" surgery for it’s less invasive and less interference on the chest and abdominal organs, was a safe and effective procedure. It can meet the possible that the lesion was removed, the spinal decompression, deformity correction and spinal27°bone graft fusion were achieved.