Clinical Observation Of One-stage Posterior Approach For Treatment Of The Leaping Spinal Tuberculosis

Objective:Objective to evaluate the clinical efficacy of one-stage posterior debridement,bone graft fusion and internal fixation for the treatment of the leaping spinal tuberculosis.Methods:Retrospective analysis of 327 spinal tuberculosis patients from January 2010 to January 2015 treated in spinal surgery,the First Hospital Affiliated of Fujian Medical University,including 17 cases of the leaping spinal tuberculosis patients and accounting for about 5.2%,all 17 the leaping spinal tuberculosis patients were treated with one-stage posterior debridement and bone graft fusion and internal fixation after antituberculosis treatment.Among the 17 patients,there were 10 males and 7 females,with the age range is 23-65 years and a mean age of 47.2 years.The location of lesions was 2,involving thoracic spine in 5 cases,thoracic and lumbar spine in 7 cases,lumbar spine in 3 cases,lumbosacral vertebrae in 2 cases.According to the ASIA(American Spinal Injury Association)spinal cord injury classification before operation: B level in 2 cases,grade C in 3 cases,grade D in 7 cases,grade E in 5 cases.For inspection,ESR(Erythrocyte Sedimentation Rate)kyphosis angle measurement,preoperative ESR was 25-56 mm / h,average 44.24 + 7.68 mm / h;the kyphosis angle is 19.6°-51.2°before operation,with an average of 32.95°±8.95°.After the operation by improved Macnab method,ESR examination,kyphosis angle measurement,Bridwell fusion classification,ASIA classification of spinal cord injury and postoperative complications to evaluate clinical curative effect.Results:All the 17 patients were followed up regularly,the follow-up time was 9-46 months,with an average of 18.8 ±10.5 months,all patients were regular medication and all the patients were not found to have tuberculosis recurrence.At the end of the follow-up,the improved Macnab method was excellent in 11 cases,good in 5 cases,can 1 cases,the excellent rate reached 96%;one week after operation the ESR was 19-37 mm / h,the average was 28.76 ± 4.88 mm / h,there was significant difference compared with that before operation(P<0.05),postoperative ESR was recovered within 3 months,the last follow-up ESR of 11.53 ± 2.96 mm / h,there was significant difference compared with that before operation(P<0.05);postoperative kyphosis angle measurement was 15.14°±3.51°,and at the end of the follow-up postoperative kyphosis angle of 16.90°±3.53°,compared with preoperative difference were statistically significant(P<0.05),angle less than 2 degrees were lost;all patients were followed up for 9 months,all of them got bony union,and there were no cases of nonunion,internal fixation loosening and so on,the last follow-up Bridwell bone graft fusion classification,grade I was 12 cases,grade II was 5 cases,the second grade fusion rate was 100%;at the end of the follow-up of all patients with nerve function had improved,ASIA standard B grade in patients with spinal cord injury in 1 cases improved to grade C,1 case was improved to grade D,C grade 1 case improved to grade D,2 cases were improved to grade E,and 7 cases of D patients were improved to grade E;there was 1 case of incision infection after operation.Conclusion:In the regular anti tuberculosis treatment,one-stage posterior debridement,bone graft fusion and internal fixation in the treatment of the leaping spinal tuberculosis,and can obtain good clinical curative effect,is a safe and simple operation.