[EFFECTIVENESS OF POSTERIOR UNILATERAL TRANSPEDICULAR DEBRIDEMENT, BONE GRAFT FUSION, AND PEDICLE SCREW FIXATION FOR THORACOLUMBAL TUBERCULOSIS].Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2015 Oct; 29(10):1259-64.ZX
To explore the effectiveness of posterior unilateral transpedicular debridement, bone graft fusion, and pedicle screw fixation for thoracolumbar tuberculosis.
Between January 2009 and January 2013, 97 patients with thoracolumbar tuberculosis were treated with posterior unilateral transpedicular debridement, bone graft fusion, and pedicle screw fixation in 53 cases (group A), and with traditional posterior operation in 44 cases (group B). There was no significant difference in age, sex, disease duration, affected segments, Frankel grade, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), sagittal Cobb angle, visual analogue scale (VAS), and Oswestry disability index (ODI) between 2 groups (P > 0.05). The surgery and follow-up results were compared between 2 groups.
The patients were followed up 24-60 months. All patients achieved intervertebral bone fusion after operation. The bone graft fusion time of groups A and B was (6.79 ± 1.68) months and (6.89 ± 2.00) months respectively, showing no significant difference (t = -0.251, P = 0.802). There was no significant difference in operation time, intraoperation blood loss, and postoperative hospitalization time between 2 groups (P > 0.05); the postoperative drainage volume of group A was significantly less than that of group B (P < 0.05). The CRP and ESR at 1 year and the VAS score at last follow-up were significantly decreased when compared with preoperative values in 2 groups (P < 0.05), but no significant difference was found between 2 groups (P > 0.05). The Cobb angle at 1 week and at last follow-up and ODI at 3 months and at last follow-up were significantly improved in 2 groups (P < 0.05), but there was no significant difference between the time points after operation (P > 0.05). At 3 months after operation, the ODI of group A was significantly lower than that of group B (t = -2.185, P = 0.027), but no significant difference was found in Cobb angle, Cobb angle loss, and ODI at other time points between 2 groups (P > 0.05). At last follow-up, the Frankel classification of nerve function was improved 1-2 grades in 2 groups, showing no significant difference between 2 groups (Z = -0.180, P = 0.857). No complication of internal fixation breakage or loosening was observed.
The effectiveness of posterior unilateral transpedicular debridement, bone graft fusion, and pedicle screw fixation in the treatment of thoracolumbar tuberculosis is satisfactory, with the advantages of less trauma, strong spinal stability, and fast function recovery.