Anterior Approach Operation For Thoracic And Lumbar Spinal Tuberculosis:the Case Of Recurren And Reversion

Objective : To evaluate the recurrent cause of thoracic and lumbar spinal tuberculosis treated by one-staged anterior debridement,bone fusion and spinal reconstruction,and analyze the outcomes and strategies of reversion.Methods :15 cases of thoracolumbar spinal tuberculosis with anterior postoperative recurrence and sinus formation after conservative treatment invalid were analyzed retrospectively.15 patients had undergone one-stage anterior sinus clearing and debridement,instrument removal,bone graft and internal fixation by posterior approach.Results :All 15 cases,follow-up time 12 ~ 48 months.Primary surgical lesions were 10 cases with incomplete removal,the use of allograft bone block,artificial bone,fills with the titanium cage bone graft bone grain support 9 cases,13 cases of internal fixation loosening.Postoperative mycobacterium tuberculosis culture positive in 5 cases,including 3 cases exist different levels of resistance(2 cases of resistance to isoniazid and rifampicin,1 case of resistance to isoniazid and rifampicin,the amino acid sodium).Neurologic Frankel classification: 1 case of class C to D;8 cases of D to E 6 cases,2 cases without recovery;6 case of class E to E.14 cases were cured after surgery,imaging showed bone graft fusion,found no loosening of internal fixation fracture;1 case of relapse again,again,the recurrence rate was 6.67%(1/15),after anti-tuberculosis and treatment cured after 4 months.Postoperative 1 week after convex Cobb Angle of 2 ° ~ 3 °(4.3 ° ± 2.5 °),the correct rate of 80.7% plus or minus 80.7%,compared with the preoperative difference was statistically significant(P < 0.001);The last follow-up for 2 ° ~ 3 °(4.5 °± 2.6 °),the correct rate of 79.6% plus or minus 9.3%,compared with the postoperative 1 week no statistical significance(P > 0.05).Conclusion :The recurrent cause of thoracic and lumbar spinal tuberculosis treated by one-staged anterior operation include uncompleted debridement,drug-resistant strains of TB,redundant inactive foreign body,loosening of instrumentation,chronic malnutrition and irregular chemotherapy.Methods to reduce the recurrence rate of spinal tuberculosis treated by reversion include anterior radical debridement and satisfactory bone graft,posterior stable internal fixation,which must combine with effective chemotherapy.