Different internal fixation treatment of thoracolumbar spinal tuberculosis: comparision of kyphosis Cobb angle and spinal stability

doi:10.3969/j.issn.2095-4344.2015.13.013

Abstract

Abstract:

BACKGROUND: Thoracic lumbar segment is prone to spinal tuberculosis, caseous necrosis tissue, dead bone compression of spinal cord and nerve root may cause neurological symptoms, and the majority of them is accompanied with mild and moderate spinal kyphosis deformity. Surgical treatment of spinal tuberculosis has been frequently reported in recent years, the commonly used treatment includes lesion clearance, bone graft fusion and internal fixation.
OBJECTIVE: To investigate the principle of choosing different internal fixation treatment for thoracolumbar spinal tuberculosis.
METHODS: 42 patients with thoracolumbar spinal tuberculosis were involved in this study from January 2001 to December 2011. All patients suffered from waist and back pains, with the disease course range of 1 month to 7
years. Four cases showed neurological deficit before surgery. According to the Frankel classification, 1 case was graded as Frankel C and 3 cases as Frankel D. The preoperative average Cobb angle of kyphosis was 27° (range 12°-45°). The internal fixation approaches were chosen according to the tuberculose focus and vertebral fracture extent. Thoraco-abdominal approach for thoracolumbar spine via diaphragm with the removal of 11 rib and(or) 12 rib was performed for all patients. Among these protocols, 25 cases underwent anterior focal debridement and bone grafting. 17 cases had anterior focal debridement and posterior pedicle screw internal fixation (one-stage surgery in 7 cases and second-stage surgery in 10 cases). All patients received anti-tuberculosis chemotherapy before and after operation. 36 cases used rib and 6 cases used iliac bone as bone graft. All patients were followed up from 17 months to 9 years. The correction of spinal deformity, spinal stability and spinal functional recovery were observed.
RESULTS AND CONCLUSION: 30 patients were followed up after operations and the back pains disappeared. X-ray examination showed that, all patients were fixed well without no loosening and rupture, and achieved bony fusion (the mean time were 5.4 months). No tuberculosis recurred. Four cases complicated with spinal cord injury were E grade according to the Frankel classification. The Cobb angle was 0-26° (mean 14°) at 12 months after operation. On the premise of standard anti-tuberculosis chemotherapy, various internal fixation methods can be determined according to general conditions of patients and tuberculose focus site.

中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程

全文链接：

Key words: Tuberculosis, Spinal, Internal Fixators, Follow-Up Studies

CLC Number:

R318

Xing Wen-hua, Huo Hong-jun, Xiao Yu-long, Yang Xue-jun, Zhao Yan, Fu Yu, Zhu Yong, Li Feng, Xin Da-qi. Different internal fixation treatment of thoracolumbar spinal tuberculosis: comparision of kyphosis Cobb angle and spinal stability[J]. Chinese Journal of Tissue Engineering Research, 2015, 19(13): 2034-2039.

Figures/Tables 1

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