Realignment Of Sagittal Spine After Osteotomizing Debridement From Posterior Approach In Patients With Thoracolumbar Tuberculotic Kyphosis And The Correlation Of It With Health-related Quality Of Life

Objective:To study the improvement of the sagittal sequence of the spine and the improvement of the health-related quality of life index(HRQoL)after posterior osteotomy for patients with thoracolumbar kyphosis.So as to provide a reference for the treatment of patients with thoracolumbar kyphosis and to evaluate their postoperative improvement.Methods:Retrospective study in October 2014-March 2017,the treatment group received posterior bone cutting type lesions after removal of 22 cases of thoracic lumbar tuberculosis patients with protrusion deformity,records of patients general clinical data(age,BMI,blood sedimentation,c-reactive protein,hemoglobin,affected the vertebral segment section,operation time,intraoperative blood loss and follow-up time,etc.),preoperative and postoperative follow-up of patients with standing in the spine are lateral X ray film,review every 3 months after lumbar thoracic CT,Measure the preoperative and postoperative follow-up sessions at the end of the spine and pelvic sagittal parameters(including: tuberculosis after segmental convex Angle TSK(Tuberculotic segmental kyphosis),Lumbar lordosis Angle of LL(Lumbar lordosis),after Thoracic lobe TK(Thoracic kyphosis),Thoracic Lumbar posterior lobe TLK(Thoracolumbar kyphosis),Pelvic incidence Angle PI(Pelvic incidence),Pelvic tilt Angle PT(Pelvic tilt),Sacral slope Angle SS(Sacral slope)and spinal Sagittal balance of the index SVA(Sagittal vertical axis),Scores of Oswestry disability index(Oswestry disability index),Short Form 12 Health Survey(sf-12)and Scoliosis research society-22 patient questionnaire(srs-22)were assessed during the preoperative and postoperative follow-up visits.Statistically,the paired sample t-test was used to compare the differences in the parameters of the spine-pelvis sagittal plane and HRQoL score before and after the last follow-up.Pearson correlation testwas used to analyze the correlation between the improvement of spinal sagittal plane parameters and HRQoL score,and the independent sagittal plane parameters that could improve HRQoL score were obtained through multiple stepwise regression analysis.The patients were followed up for an average of more than 2 years after surgery.Results:1.The included patients were 36.7 13.3 years old,BMI 20.03 2.01kg/m2,preoperative esr 51.6 5.0mm/h,c-reactive protein 32.01 4.37mg/L,operative time206.1 22.08 min,intraoperative blood loss 879.6 31.7ml.CT reexamination 6 months after surgery showed that all patients had bone fusion at the osteotomy site,and no patients had recurrence of spinal tuberculosis or failure of internal fixation.Postoperative follow-up was 25.5 3.7 months.2.Comparison of spinal-pelvic sagittal plane parameters before and after the last follow-up: except for PI and SVA,the differences of spinal sagittal position sequence parameters before and after surgery were statistically significant(P<0.05),and the differences of HRQoL scores before and after surgery were also statistically significant(P<0.001).3.The results of multiple stepwise regression analysis showed that TSK and PT,TSK and TLK and TSK were independent sagittal plane parameters affecting ODI,srs-22 and sf-12,respectively.TSK is an independent sagittal plane parameter to improve HRQoL.Conclusion:1.Posterior osteotomy lesion removal can significantly improve the spinal-pelvic sagittal plane sequence of patients with thoracolumbar tuberculosis and their HRQoL;2.The sagittal plane parameter TSK can be used as an independent factor affecting the improvement of HRQoL and can be used to guide the preoperative surgical planning and postoperative surgical effect evaluation of patients.