title: Single-stage internal fixation for thoracolumbar spinal tuberculosis using 4 different surgical approaches.
abstract: METHODS
  A retrospective study was conducted on 148 spinal tuberculosis (TB) patients (M:F, 92:56; mean age, 39.7±12.3; range, 16-74 y) treated with anterior debridement and bone graft fusion with nail and screw internal fixation (nails+screws group); posterior pedicle screw fixation (pedicle screw group); vertebral arch pedicle internal fixation through a posterior route (posterior arch fixation group); or posterior debridement, bone graft fusion, and vertebral arch pedicle internal fixation (arch fixation group).
  
  
  OBJECTIVE
  We investigated 4 variant surgical approaches for internal fixation of spinal TB.
  
  
  BACKGROUND
  The effectiveness of single-stage surgical fixation for different degrees of spinal TB is a matter of debate.
  
  
  METHODS
  Operation time and bleeding volume were recorded. Complications, American Spinal Injury Association (ASIA) score, C-reactive protein, and erythrocyte sedimentation rate were examined preoperatively and 6 months after surgery.
  
  
  RESULTS
  Overall, 78, 48, 16, and 6 patients underwent nails+screws, pedicle screws, arch fixation, and posterior arch fixation approaches, respectively. The mean operation times were 175.8±48.8, 308.5±76.7, 143.8±43.0, and 398.3±90.8, respectively (P<0.01). Mean blood transfusion volumes were 1227.1±988.2, 1771.7±794.7, 467.7±123.3, and 2833.3±1083.8 mL, respectively (P<0.01). Primary wound healing was achieved in 127 patients. No patients experienced spinal TB recurrence or failure of bone graft or fixation. All groups achieved significantly improved C-reactive protein and erythrocyte sedimentation rate, but significantly improved ASIA scores were only observed in the nails+screws and pedicle screw groups (P<0.01).
  
  
  CONCLUSIONS
  Surgical approach limitations and advantages should be considered based on the position and severity of spinal TB infection to maximize functional outcomes and minimize surgical risks.
authors.affiliation: *Department of Orthopedics, Kunming General Hospital of Chengdu Military Region, Kunming †Department of Epidemiology, Third Military Medical University, Chongqing ‡Department of Orthopedics, Changhai Hospital, Shanghai, China.
authors.forename: Jian
authors.initials: J
authors.lastname: Shi
authors.forename: Xun
authors.initials: X
authors.lastname: Tang
authors.forename: Yongqing
authors.initials: Y
authors.lastname: Xu
authors.forename: Tianhua
authors.initials: T
authors.lastname: Zhou
authors.forename: Xianfeng
authors.initials: X
authors.lastname: Pan
authors.forename: Hui
authors.initials: H
authors.lastname: Lin
authors.forename: Ningfang
authors.initials: N
authors.lastname: Mao
authors.forename: Xinming
authors.initials: X
authors.lastname: Xu
authors.forename: Wanqiu
authors.initials: W
authors.lastname: Zhao
authors.forename: Yang
authors.initials: Y
authors.lastname: Li
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D016063:Blood Loss, Surgical; D001858:Bone Nails; D016025:Bone Transplantation / Q000379:methods*; D003646:Debridement / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D005593:Fracture Fixation, Internal / Q000379:methods*; D006801:Humans; D007738:Kyphosis / Q000209:etiology / Q000601:surgery*; D008159:Lumbar Vertebrae / Q000601:surgery; D008297:Male; D008875:Middle Aged; D065289:Pedicle Screws; D011379:Prognosis; D012189:Retrospective Studies; D013123:Spinal Fusion; D013530:Surgical Wound Infection / Q000209:etiology / Q000517:prevention & control; D013904:Thoracic Vertebrae / Q000601:surgery; D016896:Treatment Outcome; D014399:Tuberculosis, Spinal / Q000150:complications / Q000601:surgery*; D055815:Young Adult