One-stage Posterior Debridement, Bone Graft And Instrumentation For Multi Segmental Thoracic And Lumbar Tuberculosis

[Objectives]：To evaluate the clinical effectiveness and security of one-stageposterior debridement, bone graft, and instrumentation for multi segmental thoracicand lumbar tuberculosis.[Background]: In recent years for worldwide, tuberculosis incidence shows a risingtrend, but the multi segmental spinal tuberculosis is less common, the literature forthe treatment andoperation method of multi segmental spinal tuberculosisis seldomreported.[Methods]: In our study, the data were retrospectively analysed, there was aconsecutive series of623cases of spinal tuberculosis from Mar2008to Oct2012inThe First Affiliated Hospital of Fujian Medical University. Of all these patients,19patients with multi segmental thoracic and lumbar tuberculosis,who underwentone-stage posterior debridement, bone graft, and instrumentation were included.There were16males and3females with an average age of37.7years (range,21-76years). The average disease duration was15.2months (range,0.5-48months).The lesions were located at the level of thoracic segment (9cases), thoracolumbarsegment(9cases) and lumbar segment(1case).According to the ASIA gradingcriterion, the neurological function was rated as grade A in1case,grade B in2cases,grade C in4cases, grade D in9cases, and grade E in3cases. The preoperativeerythrocyte sedimentation rate (ESR) was18～87mm/1hour，average (35.9±11.2)mm/1hour. The Cobb angle was（17.88-40.66）°,average（29.48±6.04）°.Thefollow-up included the modified Kirkaldy-Willis evaluation criterion, ESR, Bridwenbone graft fusion classification standard, kyphosis angle and ASIA neural function grading.[Results]: All19cases were confirmed tuberculosis in postoperative pathologicalexamination. The average follow-up time for19patients was22.4months (range,9-36months), and there’s no recurrence of tuberculosis.The clinical efficacy wasevaluated by the modified Kirkaldy-Willis evaluation criterion. The result isexcellentin10cases,good in7cases,fair in2cases.and the good rate is89.5%.TheESR decreased to (25.37±11.51) mm/1hour1week postoperatively, showingsignificant difference when compared with preoperative value (t=3.46, P=0.01);itdecreased to (10.42±2.93) mm/1hour3months postoperatively, showing a normallevel. The postoperative neurological function in patients with ASIA grade wasbetter than pre-operation, B grade1cases, C grade1cases, D grade4cases, E grade13cases,showing significant difference when compared with preoperative value(Z=-3.107, p=0.002).All19cases achieved Bony fusion,there were nopseudoarticulation formation、 bone nonunion, bone absorption and othercomplications in the final follow-up.The efficacy was evaluated by Bridwen bonegraft fusion classification standard,15cases of grade I,4cases of grade II.Thepostoperative kyphosis angle in patients was improved than pre-operation, average（29.48±6.04）°,showing significant difference when compared with preoperativevalue(t=6.54，P=0.001), loss average <2°in final follow-up.[Conclusions]:One-stage posterior debridement, bone graft, and instrumentation is asafe and effective method in the treatment of multi segmental thoracic and lumbartuberculosis.