Surgical Treatment For Multiple-level Non-contiguous Spinal Tuberculosis In Discussion

Objectives Multiple-level non-contiguous spinal tuberculosis patients part of thesection treated by surgery, part of the section with non-surgical treatment. By comparingthe preoperative and postoperative VAS, JOA scale, COBB Angle, ESR indicators suchas the change of the clear effect of surgical treatment before and after operation and toexplore the personal surgical treatment of multiple-level non-contiguous spinal tubercu-losis.Methods Choose between January2008and January2013in hebei province, TheSecond Hospital of Tang Shan,(Hebei united university affiliated orthopaedic hospital)spine surgery in hospital, confirmed by clinical examination and imaging examinationand surgical treatment of19patients with multiple-level noncontiguous spinaltuberculosis.3patients with neurological symptoms (1case Frankel C,2cases FrankelD), multiple vertebral body lesions involving different segmental spinal. Fill in allpatients with preoperative Visual analogue scale (Visual Analogous Score, VAS), JOAlow back pain scale, Cobb Angle measurement and ESR. All of the patients with surgicaltreatment, according to the disease of vertebral the location, can use the appropriatesurgical approach, such as the use of anterior or posterior or anterior and joint into theroad, and straight on the breast bone way. For surgical treatment of patients withtraumatic multiple-level non-contiguous spinal tuberculosis, bleeding, patients withunbearable, according to the vertebral body destruction, with or without spinal cordcompression or without spinal cord, the existence of spinal instability, and so on and soforth in order to make clear whether disease of vertebral surgery or nonoperativetreatment.Results All patients were followed up. Parts with surgical treatment and parts with non-operative therapy were all cured. All patients with preoperative and postoperativeevaluation index changes:(1) VAS score by preoperative6.95±1.27to3.47±1.17inpostoperative, the last follow-up was0.5±0.69. Postoperative compared with preoperati-ve significant differences (P<0.01), the last follow-up compared with preoperative signi-fycant differences (P<0.01), at the end of the time there was a significant differencecompared with the postoperative follow-up (P<0.01). JOA score improved obviously, preoperative25.63±2.83,26.68±2.00after the last follow up was28.47±1.47. Signifi-cant differences before and after operation (P<0.01), the last follow up compared withpreoperative significant differences (P<0.01), at the end of the time there was a signify-cant difference compared with the postoperative follow-up (P<0.01).(3) Cobb Anglebefore and after treatment had obvious changes, preoperative23.45°±6.35°, postope-rative11.55°±1.54°, the last follow-up of11.70°±1.56°. Postoperative compared withpreoperative significant differences (P<0.01), the last follow-up on admission more signi-ficant differences (P<0.01).(4)ESR change obviously before and after the treatment,47.53±9.70preoperation, postoperation was30.47±4.38, the last follow-up was20.95±2.78. Postoperation compared with preoperation significant differences (P<0.01), thelast follow-up preoperative more significant differences (P<0.01).Conclusions On the premise of anti-tuberculosis drug treatment, according to thepreoperative imaging findings and seen in fixed scope, according to the disease degree ofvertebral destruction, and the patient’s own condition, bone destruction for serious,protrusion deformity after spine, spinal cord and nerve root compression, and nervedamage symptoms and spinal instability was treated with surgery. Bone destruction forlight, no neurological symptoms, spinal cord and nerve root cause pressure, spinalstability good segment can adopt nonoperative treatment, has obtained the satisfactorycurative effect. This personal treatment is safe and feasible, is worth promoting.