| Objective:The objective of this study was to evaluate the efficacy of transforaminal debridement combined with percutaneous internal fixation using the expanding tubular retractor in the treatment of spine tuberculosisMethods:A retrospective evaluation containing 18 cases of spinal TB(10 males,8 females;average age 49 years old;2 thoracic tuberculosis,11 thoracolumbar tuberculosis,5 lumbar tuberculosis,)between December 2013 and March 2018 was conducted.The lesions involved 2 vertebral bodies in 16 cases and 3 vertebral bodies in 2 cases.5 patients had neurological deficit,with 1 case in ASIA grade C,and 4 cases in ASIA grade D.All patients were treated with transforaminal debridement combined with percutaneous internal fixation using the expanding tubular retractor.The clinical and imaging data of these patients were collected.The operation time,bleeding volume,hospitalization time,ESR,CRP,X-ray,CT,MRI,VAS score,ODI,Cobb angle of lesion segment,ASIA grade and postoperative complications were included in this study.The indexes of ESR,CRP,VAS,ODI and Cobb angle of lesion segment were analyzed using method of statistics.The clinical outcome was measured by the criterion of curing spinal tuberculosisResults:The average follow-up time of 18 patients was 19±8 months(range:12-36 months).The average operation time was 165±42 minutes(range:100-240 minutes).The average bleeding volume was 223±7 ml(range:150-500 ml).The average hospitalization days were 42±8 days(range:31-58 days).The average ESR before the operation was 64.5±24.4 mm/h and after the operation it decreased to 47.3±18.3 mm/h,with a statistical difference(t=2.964,P<0.05).And the average ESR became 13.1±3.7 mm/h during the last follow-up time,with a statistical difference(t=8.039,P<0.05).The average CRP before the operation was 23.2±11.7 mg/L and after the operation it decreased to 12.9±7.3 mg/L,with a statistical difference(t=4.235,P<0.05).It became 4.3±1.7 mg/L during the last follow-up time,with a statistical difference(t=6.209,P<0.05).The average VAS score before the operation was 7.6±0.9 and after the operation it decreased to 5±1.1,with a significant statistical difference(t=7.511,P<0.05).It became 1.5±0.7 during the last follow-up time,with a statistical difference(t=19.610,P<0.05).The preoperative average ODI was 74.2±6.7.At the last follow-up,the index was 26.5±6.8,with a statistical difference(t=14.196,P<0.05).The average Cobb angle of lesion segment before the operation was 23.2±5.5 degrees and after surgery it decreased to 13.2±5.3,with a statistical difference(t=8.531,P<0.05)..At the last follow-up,it was 13.4+5.6 degrees,with no statistical difference compared with post-operation(t=-1.000,p=0.33).At the last follow-up,X-ray and CT showed bone healing of the diseased vertebrae and good position of pedicle screw without loosening or breaking.MRI showed that signs of inflammation disappeared in the diseased vertebral body.All 5 patients with neurological impairment reached ASIA grade E.Only one patient had poor healing of drainage tube orifice due to drug resistance after operation.The other patients had no complications such as nerve function deficit and lower extremity thrombosis.At the last follow-up,all patients achieved clinical recovery.Conclusion:Transforaminal debridement combined with percutaneous internal fixation using the expanding tubular retractor can be recommended to treat spinal tuberculosis in term of minimal invasive surgery,fast postoperative recovery and low incidence of complications. |
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