关键词: 结核, 脊柱, 骨折固定术, 内, 外科手术, 微创性, 脊柱融合术, 治疗结果, 清除, 前路, 后路

Abstract: ObjectiveTo review and analyze the clinical effect of combined posterior mini-invasive fixation with anterior debridement via small incision for the treatment of single segment lumbar vertebral tuberculosis. MethodsTotal 31 cases with single segment lumbar tuberculosis(both borderline tuberculosis) without attachment involvement underwent one-stage anterior debridement, interbody fusion and posterior mini-invasive fixation from July 2010 to July 2015. Among them, 19 were male and 12 were female. The average age was 36.1±17.8 years old (ranged 21 ~ 61 years old). The average course of disease was 10 months (ranged from16 to 2 months). All were single segment involvement, and the involved segment was L2~3 in7 cases, L3 ~ 4 in 10 cases, L4 ~ 5 in 6 cases, and L5 ~ S1 in 8 cases. The clinical manifestations included lumbar back painin31 cases with an average pain visual analog score (VAS) of 6.6 ±1.4 points, lower limb numbness and weakness in 6 cases, and low fever in the afternoon in20 cases.ASIA grade was E in 25 cases and D in 6 cases. Paravertebral abscess occurred in 22 cases and iliac fossa gravity abscess appeared in 9 cases. Kyphosis was observed in 12 cases and the average Cobb angle was 21°±6 °. Quadruple anti-tuberculosis chemotherapy was used for at least 2 weeks preoperatively. Posterior mini-invasive fixation was fulfilled on prone position, including mini-invasive percutaneous screws in 18 cases and pedicle screw fixation viaWiltse approach in 13 cases. Posterior distraction and deformity correction was performed simultaneously for patients with kyphosis. Then the patients were changed to lateral position for anterior debridement, bone grafting and / or titanium mesh fusion. ResultsThe average operation time was 204min (ranged 160 ~ 240min) in 31 patients, and the mean blood loss was 168ml (ranged 100 ~ 300ml). Delayed healing of anterior incision occurred in 1 caseand the incision healed after 2 weeks’dressing of wound.The incision healed well in the rest30 cases.No complications such as nerve function, blood vessel injury and so on.The VAS scores of the 3 days after operation were 1.3±0.3 and 1.4±2.1 in percutaneous group and Wiltse approach group, respectively, and the difference was statistically significant (P<0.05). Low back pain VAS score was 1.4±1.5 points in all the 31patient three months after operation, was significantly lower than that before surgery (P<0.05). The patients with neurological symptoms recovered to E grade after operation. The average Cobb angle correction was 15±5°in the patients with kyphosis (P<0.05). All patients were followed up for an average of 36.8 months (ranged from 12 to 72 months). The clinical healing of tuberculosis was achieved at the final follow-up in all the 31 patients. No complications were observed, such as lumbar kyphosis, internal fixation loosening and breakage, dislocation, titanium mesh subsidence and so on. ConclusionsMini-invasive posterior internal fixation and anterior debridement via small incision was effective for the treatment of single segment lumbar vertebral tuberculosis in lesion debridement and spine stability reconstruction by short segment fixation.This technique can reduce fused segments, surgical trauma of anterior approach and related complications.

Key words: tuberculosis, spinal, fracture fixation, internal, surgical procedures, minimally invasive, spinal fusion, treatment outcome, debridement, anterior approach, posterior approach