One-stage Unilateral Transforaminal Debridement And Non-structure Bone Grafting And Internal Fixation For Thoracolumbar Tuberculosis

Objective : To explore the clinical indication,surgical effect and safety of one-stage debridement and non-structural bone grafting and internal fixation through the intervertebral foramen for thoracolumbar tuberculosis by classifying the included cases of thoracic and lumbar tuberculosis.Method:A retrospective analysis was conducted to collect the clinical data of 89 patients who were hospitalized in spinal surgery department of the First Affiliated Hospital of Nanchang University from January 1,2012 to June 30,2018 and were followed up effectively.According to the classification of thoracic and lumbar tuberculosis cases by MRI,the cases were divided into three groups: group A,9 cases,lesions involving only the intervertebral disc;group B,19 cases,lesions involving only the vertebral body;group C,61 cases,lesions involving the vertebral body and the intervertebral disc.All patients were treated with transforaminal approach(TLIF)for thoracic and lumbar tuberculosis.The operation time,intraoperative bleeding volume,hospital stay,ASIA classification of neurological function before and after operation,pain visual analogue score(VAS),Cobb angle,C-reactive protein(CRP)and erythrocyte sedimentation rate(ESR)were compared among the three groups.The collected data were summarized and analyzed by SPSS20.0 software.Age,operation time,bleeding volume,hospitalization time,Cobb angle,ESR and other measurements were expressed as x ± s.Single factor analysis of variance was used to compare and analyze the data among the groups.P < 0.05 showed that there were significant differences.Result:All patients achieved good results after operation.The hospital stay in group A was lower than that in group B and C,and the intraoperative bleeding volume and operation time in group A were lower than those in group B and C.The preoperative Cobb kyphosis angle in group A was less than that in group B and C,and the preoperative VAS score in group A was higher than that in group B and C,The difference was statistically significant(P < 0.05).However,there was no significantdifference in VAS score between group A,B and C during the last follow-up.There was no significant difference in hospitalization time,VAS score after operation and VAS score during the last follow-up between the two groups(P > 0.05).There was no significant difference in age,Cobb angle after operation,ESR and CRP before,after and at the last follow-up among the three groups(P > 0.05).The neurological function of the patients recovered obviously after operation.Only one patient had no neurological dysfunction before operation and paraplegia after operation.The others had no obvious complications.All the patients were fused with bone graft at the last follow-up.Conclusion:One-stage unilateral transforaminal approach(TLIF)debridement and non-structural bone grafting and internal fixation for the treatment of thoracic and lumbar tuberculosis has reliable clinical effect and safety,of which group A has the best clinical effect and safety.