[Combination of intensified anti-tuberculosis with operation for treatment of thoracolumbar tuberculosis].

ABSTRACT

OBJECTIVE: To evaluate the clinical significance of the combination of intensified anti-tuberculosis treatment, posterior transpedicular screw system internal fixation, intertransverse bone grafting, and anterior approach focus debridement for the treatment of thoracolumbar tuberculosis. METHODS: From January 2005 to December 2007, 20 patients with thoracolumbar tuberculosis (T10-L3) were treated. There were 13 males and 7 females aged 21-64 years old (average 44 years old). The course of disease was 3 months to 3 years (average 10 months). The focus involved single vertebrae bodies in 8 cases, two vertebrae bodies in 9 cases, and three vertebrae bodies in 3 cases. The preoperative Cobb angle was 9-35 degrees (average 26.7 degrees). The neurological function was evaluated according to the Frankel grading criterion, there were 2 cases of grade B, 5 of grade C, 7 of grade D, and 6 of grade E. Vertebral body defect index score 9 cases of 1-2 points, 7 cases of 2-3 points, and 4 cases above 3 points. After receiving the systemic five-drug treatment of anti-tuberculosis for 2-3 weeks, the patients underwent the posterior transpedicular screw system internal fixation and intertransverse bone grafting, and then received tuberculosis focus debridement via anterior approach, nerve decompression, and bone grafting fusion. RESULTS: The time of operation averaged 210 minutes and the mean blood loss during operation was 650 mL. Postoperatively, 2 patients had mild belting sensation in their thorax and 2 patients had mild pneumothorax. Their symptoms relieved 2-3 weeks later without specific treatment. All the patients were followed up for 12-23 months. X-ray films showed that all the patients achieved successful bony fusion 6-18 months after operation, and the Cobb angle was 7-21 degrees (average 15.2 degrees) 12 months after operation without aggravation. The Frankel grading system was used to assess the postoperative neurological function, 1 patient in grade B before operation was improved to grade C after operation, 1 patient in grade B was improved to grade D, 1 patient in grade C was improved to grade D, 4 patients in grade B were improved to grade E, and 7 patients in grade D were improved to grade E. All of the incisions healed and erythrocyte sedimentation rate became normal 2 weeks to 3 months after operation. All the patients showed no obvious abnormity in liver and kidney function. There was no recurrence of tuberculosis. CONCLUSION: It seems that the systemic drug treatment of anti-tuberculosis before and after operation, the thorough debridement of focus during operation, and the effective and reliable way to reconstruct for the spinal stability are the key points for the treatment of spinal tuberculosis.