[Treatment of single-incision vertebral screw-rod fixation combined with pedicle screw-rod fixation for thoracolumbar tuberculosis].
OBJECTIVE
To investigate the effectiveness of debridement and single-incision vertebral screw-rod fixation combined with pedicle screw-rod fixation and autograft bone fusion in treatment of thoracolumbar tuberculosis.


METHODS
Between January 2008 and October 2010, 22 patients with thoracolumbar tuberculosis were treated by debridement and single-incision vertebral screw-rod fixation combined with pedicle screw-rod fixation and autograft bone fusion, and were given anti-tuberculosis therapy after operation. Of 22 patients, 14 were male and 8 were female with an average age of 42 years (range, 18-66 years). The disease duration was 2-16 months (mean, 6 months). Sixteen double-segment lesions included T7, 8 in 3 cases, T8, 9 in 1 case, T9, 10 in 3 cases, T11, 12 in 2 cases, L1, 2 in 4 cases, and L3, 4 in 3 cases; 6 three-segment lesions included T7-9 in 2 cases, T11-L1 in 1 case, and L2-4 in 3 cases. Preoperative visual analogue scale (VAS) score was 7.50 +/- 0.63. According to Frankel classification of America Spinal Injury Association (ASIA), 2 cases were rated as grade B, 4 cases as grade C, 9 cases as grade D, and 7 cases as grade E.


RESULTS
Twenty-two patients were followed up 15-36 months (mean, 25.2 months). Wound infection occurred in 1 case and was cured after corresponding treatment; incision healed by first intention in other patients. No loosening or breakage of internal fixator was found; the patients had no deteriorations in spinal cord injury or cerebrospinal fluid leakage. X-ray films and CT showed obvious bone fusion in the intervertebral space. The time of bone fusion was 3-6 months (mean, 5.2 months). The erythrocyte sedimentation rate after operation was significantly lower than that before operation (P < 0.05). The VAS scores were significantly improved to 2.90 +/- 1.00 at 2 weeks after operation and 2.60 +/- 0.81 at last follow-up (P < 0.05). At last follow-up, nerve function was significantly improved. According to Frankel classification, 2 cases were rated as grade C, 5 cases as grade D, and 15 cases as grade E.


CONCLUSIONS
Single-incision vertebral screw-rod fixation combined with pedicle screw-rod fixation for thoracolumbar tuberculosis is a stable and minimally invasive method. However, the long-term effectiveness need further follow-up.
Department of Spinal Surgery, Renmin Hospital of Wuhan University, Wuhan Hubei 430060, PR China. Fanli70@tom.com
Li
L
Fan
Bo
B
Yang
Qiao
Q
Shi
Yong
Y
Xu
Liao
L
Chen
Jialu
J
Chen
Wanggou
W
Zheng
D000293:Adolescent; D000328:Adult; D000368:Aged; D001863:Bone Screws; D016025:Bone Transplantation / Q000379:methods; D003646:Debridement; D005260:Female; D005593:Fracture Fixation, Internal / Q000379:methods; D006801:Humans; D016268:Internal Fixators; D008297:Male; D008875:Middle Aged; D013123:Spinal Fusion / Q000295:instrumentation / Q000379:methods*; D013904:Thoracic Vertebrae / Q000601:surgery*; D016896:Treatment Outcome; D014399:Tuberculosis, Spinal / Q000601:surgery*; D055815:Young Adult