Abstract
Objective: To evaluate the clinical feasibility and efficacy in treatment of thoracic tuberculosis via paraspinal approach. Methods: From June 2011 to August 2016, 24 patients with mono-segmental thoracic spine tuberculosis were treated by transfacet debridement combined with bone grafting and internal fixation through paraspinal approach. There were 11 males and 13 females with age ranging from 21 to 63 years (average, 39.5). There were 3 patients in T4/5, 2 patients in T5/6, 3 patients in T7/8, 3 patients in T8/9, 4 patients in T9/10, 3 patients in T10/11, and 6 patients in T11/12. Patients had different degraded local kyphosis deformity shown on X-ray, and different degraded bone destruction and abscess in thoracic spine shown on CT and MRI before the operation. All of the patients before the regular anti tuberculosis treatment for 2 to 4 weeks, the surgical approach used by paraspinal muscle approach, postoperative regular anti tuberculosis treatment for 9 to 12 weeks. Record the clinical symptoms of patients before and after surgery, preoperative Frankel functional classification of spinal cord injury, the operative time, intraoperative blood loss, postoperative ESR, CRP, complications, VAS score, ODI score and Cobb angle changes, imaging check regularly to evaluate the fusion and follow-up of nerve functional recovery. Results: The average operation time was 198 min. The average blood loss was 436 ml. There were no severe complications during and after operation. All patients were followed up for 1 year to 2 years, average 1.5 years of follow-up, the clinical symptoms improved significantly after operation and last follow-up ESR, CRP, VAS score, ODI score and Cobb angle were significantly improved after operation (P < 0.05), grade I Eck fusion, the fusion rate was 100% and the neurological function were improved. Conclusion: on the basis of strict anti tuberculosis chemotherapy, the use of paraspinal muscle gap approach for the treatment of thoracic tuberculosis is less invasive, less destructive to spinal stability, and can achieve obvious curative effect. It is worthy of clinical application.
Highlights
Spine is a common site of extrapulmonary tuberculosis, about 10% of tuberculosis patients with bone and joint tuberculosis, the part of the patients involved in about 50% of the spine [1]
All of the patients before the regular anti tuberculosis treatment for 2 to 4 weeks, the surgical approach used by paraspinal muscle approach, postoperative regular anti tuberculosis treatment for 9 to 12 weeks
Adult spine tuberculosis mainly to the edge of tuberculosis is more common, because the thoracic spinal canal volume is small, spinal canal reserve gap is small, and thoracic blood supply Poor [2], due to the thoracolumbar anatomical structure of the particularity and complexity of spinal tuberculosis often occur in the thoracolumbar, lesions mainly involved in the spine before the column
Summary
Spine is a common site of extrapulmonary tuberculosis, about 10% of tuberculosis patients with bone and joint tuberculosis, the part of the patients involved in about 50% of the spine [1]. Non-surgical treatment of spinal tuberculosis is the main treatment, commonly used in the early stage of spinal tuberculosis, poisoning symptoms of light, no obvious bone destruction, sequestrum, empty or abscess formation, the patients are sensitive to tuberculosis drugs, or patients are generally worse than recent surgery [3]. Spinal tuberculosis surgery is more generally divided into anterior, posterior, before and after the joint approach, the choice based on the lesion involving the site, the scope of vertebral destruction, kyphosis and patients in general to conduct a comprehensive assessment [8] [9]. The literature reported by the paravertebral space approach (Wiltse gap approach) in the treatment of thoracolumbar fractures, lumbar intervertebral protrusion and lumbar spondylolisthesis compared to the traditional posterior median approach to retain a large part of the split muscle, Column stability, reducing the incidence of postoperative low back pain, which has been widely used.
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