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| HUO Hongjun,XING Wenhua,YANG Xuejun.Surgical management of thoracic and lumbar tuberculosis[J].Chinese Journal of Spine and Spinal Cord,2011,(10):819-824. |
| Surgical management of thoracic and lumbar tuberculosis |
| Received:June 10, 2011 Revised:August 24, 2011 |
| English Keywords:Spinal tuberculosis Surgery treatment Choice of operation methods Outcome |
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| English Abstract: |
| 【Abstract】 Objective：To discuss the surgical principle for different types of thoracic and lumbar vertebrae tuberculosis.Method：A total of 57 cases with thoracic and lumbar vertebral tuberculosis between January 2003 and December 2008 were reviewed retrospectively.There were 28 males and 29 females with an average age of 43 years（range，11 to 68 years）.Of these，there were 20 thoracic vertebral tuberculosis，25 thoracolumbar vertebral tuberculosis，9 lumbar vertebral tuberculosis，3 lumbosacral vertebral tuberculosis.2 cases had 1 vertebral body involved；46 cases had 2 vertebral bodies involved；6 cases had 3 vertebral bodies involved；and 3 cases had 4 vertebral bodies involved.All cases presented with back pain，while 5 cases had neurological deficit prior to surgery.According to the Frankel classification，there were 1 Frankel C and 4 Frankel D.All patients received anti-tuberculosis chemotherapy before and after operation．The operative approach and instrumentation were determined by tuberculosis site，the vertebrae defect and the patients′ general conditions.3 cases underwent anterior focal debridement；26 cases（one stage in 11 cases and two-stage in 15 cases） underwent combined posterior pedicle screw fixation and anterior focal debridement and bone graft；27 cases underwent anterior spinal internal fixation and focal debridement；and 1 case underwent spinal osteotomy correction and instrumentation.20 cases used rib，and 34 cases used iliac bone as bone graft，while 1 case used auto iliac and allograft.The surgical outcome of all patients was followed up.Result：The average surgical time was 130 minutes（range，70-340min），with the average intraoperative blood loss of 520ml（range，100-2600ml）.No complications such as neurological injury and cerebrospinal fluid leakage were noted.Tuberculous sinus developed in 2 cases and healed by correspondent interventions for 5-7 months.All patients were followed up for an average of 3.4 years（range，2-6 years） and healed clinically at final follow-up.No recurrence and instrument failure were noted at final follow-up.5 cases with spinal cord injury recovered to Frankel E 6 months later.Bony fusion was achieved in all cases in the mean fusion period of 5.8 months（range，4-11 months）.13 cases undergoing posterior approach had instrument removed 3-6 years later.Conclusion：On the premise of standard anti-tuberculosis chemotherapy，varied surgical management can be determined according to defect site，degree of destruction and patient′s general condition. |
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