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| CHEN Ming,ZHAO Jinmin,LI Bing.The clinical study of anterior approach operation for the thoracic and lumbar tuberculosis with huge abscess[J].Chinese Journal of Spine and Spinal Cord,2012,(5):433-438. |
| The clinical study of anterior approach operation for the thoracic and lumbar tuberculosis with huge abscess |
| Received:October 13, 2011 Revised:January 10, 2012 |
| English Keywords:Spinal tuberculosis Paravertebral abscess Debridement Bone grafting Anterior approach Internal fixation |
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| English Abstract: |
| 【Abstract】 Objectives: To investigate the results of a simple anterior surgical treatment for thoracic and lumbar tuberculosis with huge abscess with debridement, bone grafting and internal fixation. Methods: A total of 9 cases suffering from thoracic and lumbar tuberculosis with huge abscess involvement between January 2009 and January 2010 underwent a simple anterior surgical treatment with debridement, bone grafting and internal fixation. The destruction lession range involving 2 vertebral bodies in 6 cases(T9, T10 1 case, T10, T11 2 cases, T12, L1 1 case, L2, L3 2 cases), involving 3 vertebral bodies in 3 cases(T10-T12 1 case, T7-T9 1 case, L2-L4 1 case). All cases were involved more than 3 vertebral abscesses. Spinal function assessment of ASIA grade B in 1 case, C in 5 cases, D in 2 cases, E in 1 case. The preoperative average Cobb angle of kyphosis was 28.3°±13.5°(range, 5°-45°); average VAS score was 6.0±1.2 points(range, 3 to 8 points); average ODI was (68.6±17.6)%(range, 50% to 95%). All cases underwent anterior debridement with autograft of ilium bone graft fusion and internal fixation. 1 case not completely paralyzed received emergency operation. 4 cases acquired poor effect of preoperative oral isoniazid(H), rifampicin(R), pyrazinamide(Z), ethambutol(E)(HRZE) drug antituberculous therapy for 1 week and then were treated with operation. 4 patients with preoperative HRZE antituberculous therapy for 2 weeks before undergoing operation treatment continued to HRZE postoperative antituberculous therapy for 12 months. The clinical manifestations were observed, the X ray and CT or MRI were received after 1 month, 6 months and 12 months postoperatively, observing the incision healing, complications, bone graft fusion rate, neural symptom recovery. Wear of thoracic and lumbar spine brace for 3 months. Results: The average sugrical time was 135min（range，120-150min）, an average loss of blood was 900ml（range, 400-1400ml）. There was no neurological handicaps, two cases suffered from cerebrospinal fluid leakage, 1 case accepted routine repair and the other one who did not healed itself. 2 cases of postoperative wound healed occurs sinus Ⅱ, the rest were stage Ⅰ healing. 1 case of the injury of left L3, L4 nerve root, the strength of left femoral head four muscle was 3 level until 1 week postoperation. With the application nervous nutrition drugs and acupuncture, physiotherapy and symptomatic treatment, the muscle strength level was 4 level after 12-month follow-up. All cases were followed up for an average of 17 months(ranges, 12-20 months). The time of the abscess completely absorption was an average of 4.5 months(3-6 months). The average time of fusion was 8.5 months(range, 5-14 months). At the last follow-up, the kyphosis Cobb angle was an average of 10.3°±3.3°（5°-15°）. ASIA evaluation of spinal cord function in 1 case of grade B preoperatively returned to grade D, 8 cases recovered to level E. ODI was 1%-3%, average(2.8%±0.9%). VAS to 0-1, average 0.6±0.5 point. During the follow-up period, all patients were without internal fixation loosening and fracture. At the last follow-up, all patients were clinically cured. Conclusions: Based on the regular antituberculosis drug therapy, it is reliable in the treatment of thoracolumbar spinal tuberculosis with huge abscess to use anterior debridement with autologous iliac bone graft and internal fixation. |
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