Application Of Small Incision Approach In Anterior Surgery Of Thoracic And Lumbar Spinal Tuberculosis

Objective: To investigate the value of small incision approach in the anterior operation of thoracic and lumbar spinal tuberculosis.Methods: Retrospectively analyze the clinical data of 65 patients with thoracic and lumbar spine tuberculosis treated by posterior-anterior surgery in our hospital from January 2015 to January 2018.The patients were divided into small incision group and traditional incision group according to the length of anterior surgical incision.The general data of anterior operation in two groups were compared and analyzed,including length of anterior incision,operation time,intraoperative blood loss,postoperative complications,postoperative hospitalization days.Evaluation of operative efficacy values including Erythrocyte Sedimentation Rate(ESR),C-reactive protein(CRP),improvement of neurological function,Visual Analogue Scale(VAS),Cobb angle,and the fusion of bone grafts.Results: All patients were followed up for 20 months,average for 12~29 months.The length of anterior incision,the operative time,the intraoperative blood loss and the hospitalization days after anterior operation of group A were all less than that in group B(P<0.05).The rate of postoperative complications in group A were significantly lower than that in group B(P<0.05).The VAS score in two groups all significantly decreased after operation,the VAS score in group A was significantly lower than that in group B after operation,and there was statistically significant difference between two groups(P<0.05),but there was no significant difference between two groups at last follow up.The ESR and CRP all reduced to normal range at 6 months after operation in two groups,when compared intra-groups,the difference of ESR and CRP between pre-operation and 3 months after operation,6 months after operation and last follow-up was statistically significant(P<0.05).When compared between two groups,there was no statistically significant difference between ESR and CRP at 3 months after operation,6 months after operation and last follow-up(P>0.05).The Cobb angle of vertebral body of patients with spinal kyphosis in two groups was significantly decreased after operation in two groups,and the difference was statistically significant(P<0.05).There was no significant difference in the correction rate and loss of angle between the two groups after operation and last follow-up(P>0.05).At the last follow-up,there was no significant difference in the fusion rate of bone grafting between the two groups(P>0.05).The neurological function of patients with neurological symptoms all returned to normal at the last follow-up.All patients were cured,and no recurrence occurred.Conclusion: In the anterior operation of thoracic and lumbar tuberculosis,the small incision approach can achieve the same curative effect as traditional incision surgery,but it has the advantages of minimally invasive,less complications and quick recovery.