Clinical Research On The Lateral Approach Combined With Minimally Invasive Posterior Fixation Versus Psoterior Approach For The Thoracolumbar And Lumbar Spinal Tuberculosis

ObjectiveTo investigate the clinical effect of debridement and bone grating via lateral approach combined with minimally invasive posterior pedicle screw fixation in the treatment of thoracolumbar and lumbar tuberculosis and comparison with posterior approach.MethodsA retrospective analysis was made on the clinical data of 41 patients with single-stage throacolumbar and lumbar spinal tuberculosis from January 2013 to December 2016,and divided them into two groups according to the different surgical methods.Seventeen patients(lateral approach group)underwent debridement and bone grating via lateral approach combined with minimally invasive posterior pedicle screw fixation while 24 cases underwent(posterior approach group)posterior approach combined with debridement,bone grating and pedicle screw fixation.The operative time,blood loss,length of incision,incision drainage,hospitalization time,preoperative and last follow-up visual analogue scale(VAS),Oswestry disability index(ODI)were compared between the lateral approach group and the posterior approach group.Complications and fusion time were also compared between two groups.ResultsThe assigned operation was completed successfully in all patients.The mean follow-up time was 16.1±4.3 months in lateral approach and 15.7±5.4 months in posterior group.The lateral approach group operation time(220.29 ± 20.50min)longer than posterior approach group(182.92 ±24.54min),there was significant difference(p <0.05).The lateral approach group displayed significant advantages over posterior approach group considering the blood loss(314.41±159.29 ml and 428.75±173.66ml)and incision drainage(197.35±64.03 ml and 273.13± 100.63ml)(p <0.05).The hospitalization time of lateral approach group(12.59±2.96 days)were lower than posterior approach group(16.71 ± 4.20 days),there was significantly different(p <0.05).In the two groups,there was no statistical difference in the length of total incision(11.82±0.64 cm and 12.25±0.85cm)(p >0.05).The preoperative and last follow-up VAS between lateral approach group(6.12 ± 0.70,1.53 ± 0.87)and posterior approach group(6.38±0.88,1.42±0.83)were not significantly different(p >0.05),and the ODI between lateral approach group(46.80±3.28,15.43±4.68)and posterior approach group(48.33±5.61,15.74±4.72)were also not significantly different(p >0.05),but the VAS and ODI at the last follow-up in the two groups were significantly lower than preoperative(p <0.05).The fusion time between lateral approach group(6.59 ± 1.58 months)and posterior approach group(6.44 ± 1.53 months)were no significant difference(p >0.05),although the lateral approach complication rate(17.6%)higher than the posterior approach group(16.7%),there was no statistical difference(p >0.05).At the last follow-up,the spinal internal fixation was not lossening,grafting was bony fusion,and there was no tuberculosis recurrence occurred.ConclusionCompared with posterior approach,the debridement and bone grating via lateral approach in combination with minimally invasive posterior pedicle screw fixation takes more time,but it can be also used as an option for the treatment of thoracolumbar and lumbar spinal tuberculosis for its safety,effectiveness and less damage to the surrouding tissues.