Clinical evaluation of anterior operation for treatment of thoracic or lumbar tuberculosis

[Objective]To analyze the feasibility and clinical effect of treating thoracic or lumbar tuberculosis by one-stage anterior radical debridement,bone graft and internal fixation.[Method]Thirty-seven patients with thoracic or lumbar tuberculosis were treated by one-stage anterior radical debridement,bone graft and internal fixation from July 1999 to July 2006.There were twenty-one males and sixteen females with an average age of 39.6 years(range 21~67 years).The location of lesions were T4~10 in 10,T11～L1 in 11,L3~5 in 16.The preoperative kyphosis angle was(21.5 ±4.5)°.20 cases of the patients had spinal compression,Frankel grade was that 4 cases with grade B,6 cases with grade C,10 cases with grade D.After intensive anti-tuberculosis medication in vein for 1~2 weeks before operation,then underwent radical debridement thoroughly,to select the different methods of treatment corresponding to different segments.20 patients were reconstructed with Ti-Mesh bone fusion,sixteens were reconstructed with costal or tri-face os integumentale flank bone and anterior internal fixation.After operation,the anti-tubereulosis medication was continued for one year on the basis of the test of medicamentous sensitive.[Result]All the patients were followed up for 0.5 to 3.5 years postoperatively,with the average of 1.5 years.All the wounds healed in the first stage except that a patient died in the second day after operation.The postoperative ESR became normal 3 months later,the postoperative kyphosis angle was(7.2±3.5)°.The loss angle of kyphosis correction of the team of Ti-Mesh bone fusion and intenal fixation was(4.2±1.6)°,which of the team of the simple bone graft was(5.6±2.1)°at lastest follow up,the neural symptoms were all improved in different degree.[Conclusion]Radical debridement and sufficient anti-tuberculosis medication are essential for anterior approach operation of thoracic or lumbar tuberculosis.To much defect of vertebra can be implanted by Ti-mesh or artifical vertebra,which can overcome the shortcoming of simple bone graft.