Clinical Study Of One-stage Anterior-posterior Combined Approach For Treatment Of Skipped Multi-segmental Spinal Tuberculosis

Objective:Spinal tuberculosis accounts for about 50% of bone and joint tuberculosis.In recent years,the incidence of spinal tuberculosis has increased due to many factors.Typical spinal tuberculosis has been reported in many literatures and comprehensive treatment programs have become mature,but few reports about skipped multi-segmental spinal tuberculosis have been reported.In this study,a retrospective clinical study and clinical effect were carried out on the treatment of jumping spinal tuberculosis by anterior debridement,posterior fusion and internal fixation.Methods:A retrospective analysis was made of 98 patients with spinal tuberculosis who were admitted to the First Affiliated Hospital of Anhui Medical University and the First Affiliated Hospital of Fuzhou General Hospital of PLA from January 2012 to December 2017.10 of them were skipped multi-segmental spinal tuberculosis,accounting for 10.2%.They were included in this study.All the 10 cases were treated with symptomatic,supportive and adequately chemotherapeutic anti-tuberculosis therapy for 2-4 weeks.They were treated by one-stage combined approach before and after operation.The comprehensive treatment including symptomatic,supportive and adequately chemotherapeutic anti-tuberculosis therapy was maintained after operation.There were 6 males and 4 females,aged 19-55 years,with an average age of38.9 years.The cumulative distribution of vertebral bodies was 2,including 3 cases of thoracic vertebra,3 cases of thoracolumbar vertebra and 1 case of lumbosacral vertebra.Visual Analogous Score(VAS)score was 6-8,with an average of 7.2±0.79.According to ASIA spinal cord injury classification,there were 2 cases in grade B and C,3 cases in grade D and E.X-ray,MRI and ESR examination showed that the preoperative erythrocyte sedimentation rate was 25-48 mm/h,with an average of 34.6±7.38 mm/h.The preoperative and postoperative protrusion angles were measured,with an average of 32.23 ±6.55 mm/h.The preoperative protrusion angles were18.6 °-40.2°,and the preoperative protrusion angles were measured.The clinical effects were studied by visual analogue scale(VAS)and X-ray film to reexamine kyphosis and ESR.Results:All the 10 cases were followed up for 18-48 months,with an average of30.±12.3months.All cases followed the prescription of anti-tuberculosis drugs.At the last follow-up,both subjective and objective indicators such as kyphosis,neurological function and VAS score improved significantly.One week after operation,the VAS score was 3-5,with an average of 3.7 ±0.67,and the last follow-up VAS score was 0-3,with an average of 1.7 ±1.16,which was significantly different from that before operation(P < 0.05).Bone fusion was achieved 6-24 months after operation.Postoperative kyphosis measurements ranged from 8.6-4.5 degrees,with an average of 11.21±1.58 degrees.At the last follow-up,kyphosis measurements ranged from 9.5-15.2 degrees,with an average of 11.47±3.45 degrees.There was significant difference compared with preoperative measurements(P < 0.05).The angle of last follow-up was less than 2 degrees.Bone fusion was achieved in all cases within 24 months of follow-up.There were no cases of nonunion or loosening of internal fixation.Bridwell grade of bone graft fusion was improved in 7 cases of grade I,3cases of grade II.The fusion rate of grade I and II was 100%.The neurological function of all cases was improved in the last follow-up.ASIA grade of spinal cord injury was improved in 3 cases to grade D,and in 7 cases to grade E.One week after operation,the ESR was 16-39 mm/h,with an average of 24.3±7.99 mm/h,which was significantly different from that before operation(P < 0.05).After operation,the ESR returned to normal within 3-4 months.At the last follow-up,the ESR was 5-14 mm/h,with an average of 8.6 ±3.10 mm/h,which was significantly different from that beforeoperation(P < 0.05).There were no intraoperative complications such as large vessel injury,ureter injury and autonomic nerve injury,no recurrence or failure of internal fixation.Conclusion:On the premise of standardized anti-tuberculosis chemotherapy before operation,combined with liver protection,symptomatic treatment and supportive treatment for2-4 weeks,and continued regular anti-tuberculosis chemotherapy,symptomatic treatment,anti-neuroedema,nutritional nerve,blood transfusion as appropriate,albumin supplementation and other supportive treatment after operation,one-stage combined approach for the treatment of skipped multi-segmental spinal tuberculosis has no complications and recurrence cases,the operative risk is controllable,and the clinical effect is definite.Cut,suitable for the treatment of this type of spinal tuberculosis,worthy of clinical promotion.