Anterior Approaches Versus Posterior Approaches And Combined Anterior And Posterior Approaches For Spine Tuberculosis In Adults

Objective To explore the curative effect of the spinal tuberculosis surgical and the advantages and disadvantages of different surgical methods.Methods 62 patients meet the inclusion criteria of spinal tuberculosis who treated in the Xizang peoples First hospital from January 2010 to December 2017.There were 37 male patients and 25 female patients,the course of disease was 1-36 months,the average of it was 10±4.5months.These patients can be divided into:(group A)28 cases ware treated with anterior debridement and strut grafting with instrumentation,including 18 male cases,10 femalecases,8 patients had neurological impairment;(group B)11 cases were treated with posterior instrumentation,and anterior debridement and bone graft in a single or two-stage procedures,including 7 male cases,4 female cases,8 patients had neurological impairment;(group C)23 cases were treated with single-stage posterior debridement,with or without interbody fusion and instrumentation,including 12 male cases,11 female cases,16 patients had neurological impairment.The operation time,operative bleeding volume,hospitalization time,preoperative kyphosis angle,postoperative kyphosis angle and kyphosis angle of final fellow-up after operation,neural function recovery were be compared.Results 62 patients were followed up,the hospitalization time was 11-122 days,follow-up time was 5-96 months.In group A,the average of operation time was 260.9±58.1minutes.The average of operative bleeding volume was 885.7±321.7ml.The average of hospitalization time was 29.7±19.5 days.The recovery of neurological function was 1.25 level,and the correction rate of kyphosis angle was 30.1%.In group B,the average of operation time was 292.7±45.2minutes.The average of operative bleeding volume was 981.8±221.7ml.The average of hospitalization time was 28.4±8.6 days.The recovery of neurological function was 1.1 level,and the correction rate of kyphosis angle was 22.9%.In group C,the average of operation time was 213.5±42.3minutes.The average of operative bleeding volume was 802.2±280.6m1.The average of hospitalization time was 23.0±8.6 days,The recovery of neurological function was 1.1 level,and the correction rate of kyphosis angle was 30%.The operation time of group B are greater than group A and group C.There no difference in operative bleeding volume and hospitalization time.Group A、B、C both have moderate correction effect to the kyphosis.In 32 patients who with neurological symptoms,postoperative average level of Frankel grade recovery is 1.1 level.Conclusion For those patients who need surgical treatment of spinal tuberculosis,we should select the appropriate individual operation.Combined with tregular antituberculosis drug treatment,the patients can achieve good clinical curative effect.