title: Tuberculosis of ultralong segmental thoracic and lumbar vertebrae treated by posterior fixation and cleaning of the infection center through a cross-window.
abstract: BACKGROUND
  Surgical treatment of thoracolumbar tuberculosis (TB) aims at spinal cord decompression, focus debridement, spine stability, and deformity correction. However, several problems exist in treating multiple segmental thoracolumbar TB, including reducing surgical trauma with effective incision exposure; ensuring the effective long-armed fixation, and maintaining the possibility for revisionary surgery in cases of treatment failure.
  
  
  OBJECTIVE
  To investigate the clinical efficacy and surgical technique of the single posterior midline approach for screw-rod fixation and debridement through the sacrospinalis muscle outer cross-window to treat multiple segmental thoracolumbar spinal TB.
  
  
  METHODS
  A retrospective cohort study.
  
  
  METHODS
  A group of 17 patients with spinal TB after surgical treatment, with a mean follow-up of 27.9 months (range, 18-48 months).
  
  
  METHODS
  Neurologic recovery, Cobb angle, and graft union assessed by the Moon standard.
  
  
  METHODS
  This study was approved by the local ethical committee and recruited patients from January, 2005 to January, 2011. We used a posterior midline incision for internal fixation of a pedicle screw system in the gap of the longissimus and spinal multifidus. Anterior lesion debridement and interbody fusions were performed through bilateral cross-windows in the outer edge of the sacrospinalis muscle. Using this technique, we treated 17 patients (10 men; aged 19 to 68 years; mean 39.8 years) with spinal TB involving more than four vertebrae. Nerve damage was classified by the Frankel classification. All patients were treated with regular anti-TB chemotherapy and were followed for 18 to 48 (mean: 27.9 months) months.
  
  
  RESULTS
  The mean (range) for operative time was 4.7 (3.6-6.3) hours, for blood loss during surgery was 1,100 (850-2,300) mL, and for time of interbody fusion was 6.3 (4 to 11) months. The Cobb angle correction rate is 67.1%. Nine of 11 patients' neurologic function returned to normal, which was statistically significant (p=.004). There was no TB recurrence or internal fixation failure.
  
  
  CONCLUSIONS
  Combined with anti-TB chemotherapy, the discussed surgical technique can show improved lesion clearance, decompression of the anterior aspect of the spine, bone graft fusion, internal fixation of outside lesions, drainage and lead to positive treatment outcomes.
authors.affiliation: Department of Orthopedics, Yuhang Hospital Affiliated to Medical College of Hangzhou Normal University, Hangzhou 311100, China. Electronic address: leadyourdream@163.com.
authors.forename: Zhichao
authors.initials: Z
authors.lastname: Gao
authors.affiliation: ICU, Yuhang Hospital Affiliated to Medical College of Hangzhou Normal University, Hangzhou 311100, China.
authors.forename: Mei
authors.initials: M
authors.lastname: Wang
authors.affiliation: Department of Orthopedics, Li Palit Hospital, Hangzhou 311100, Zhejiang Province, China.
authors.forename: Weimin
authors.initials: W
authors.lastname: Zhu
authors.affiliation: Department of Orthopedics, Yuhang Hospital Affiliated to Medical College of Hangzhou Normal University, Hangzhou 311100, China.
authors.forename: Guofu
authors.initials: G
authors.lastname: Zheng
authors.affiliation: Department of Orthopedics, Yuhang Hospital Affiliated to Medical College of Hangzhou Normal University, Hangzhou 311100, China.
authors.forename: Yongjun
authors.initials: Y
authors.lastname: Meng
mesh_terms: D000328:Adult; D000368:Aged; D016025:Bone Transplantation / Q000379:methods; D003646:Debridement / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008159:Lumbar Vertebrae / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D065289:Pedicle Screws; D012189:Retrospective Studies; D013123:Spinal Fusion / Q000379:methods*; D013904:Thoracic Vertebrae / Q000601:surgery*; D016896:Treatment Outcome; D014399:Tuberculosis, Spinal / Q000601:surgery*; D055815:Young Adult
keywords: Focal debridement; Lumbar vertebrae; Operative; Spinal fusion; Surgical procedures; Thoracic vertebrae; Tuberculosis