Posterior debridement and internal fixation for ultralong segmental tuberculosis in thoracic and lumbar vertebra through cross-window

Abstract

Objective To investigate the clinical efficacy of posterior debridement and internal fixation for ultralong segmental tuberculosis in thoracic and lumbar vertebra through cross-window.Methods From January 2005 to January 2011,17 cases with tuberculosis of more than four segments had undergone posterior internal fixation,debridement and bone graft through bilateral cross-windows in sacrospinalis' outer edge.There were 10 males and 7 females,with an average age of 39.8 years (range,19-68 years).There were 6 cases with four segments,7 cases with five segments,and 4 cases with six or more segments,including 2 cases with jump segments.There were 2 cases with Frankel B,3 with Frankel C,6 with Frankel D and 6 with Frankel E.Nutritional support and quadruple chemotherapy were conducted more than 3 weeks preoperatively and 3 months postoperatively.Then triple chemotherapy of HRE was conducted for 9 to 15 months.Uric acid,ESR and liver function were monitored monthly.The evaluation of efficacy referred to MA Yuanzheng' s spinal tuberculosis cure standard.Results All patients were followed up for 27.9 months (range,18 to 48 months).The mean time of interbody fusion was 6.3 months (range,4 to 11 months).The mean time of ESR returning to normal was 3.8 months postoperatively (range,2 to 7.5 months).The mean Cobb angle was corrected from 29.2° (range,11° to 35°) to 9.6° (range,5.5° to 14.8°) two weeks postoperatively.9 of 11 patients with neurological damage returned to normal at the follow-up of 12 months.The other 2 cases recovered to Franke1 D.At last follow-up,CT showed paravertebral abscess was disappeared and fusion was achieved; no recurrence was found.Conclusion Posterior internal fixation and debridement through cross-window may be a good method to achieve lesions clearing,anteriorlateral decompression,interbody fusion,internal fixation,thorough drain and so on.The clinical efficacy could be satisfactory. Key words: Thoracic vertebrae; Lumbar vertebrae; Tuberculosis, Spinal; Spinal fusion