Efficacy of posterior-only decompression, focal clearance, and internal fixation in treatment of thoracic and lumbar tuberculosis

Abstract

Introduction: Thoracic and lumbar tuberculosis significantly affect the health of people and there is controversy on the therapeutic method. Aims: Our objective is to investigate the clinical efficacy of posterior-only decompression, focal clearance, and internal fixation in treatment of thoracic and lumbar tuberculosis. Methods: Totally 53 eligible patients with thoracic and lumbar tuberculosis were selected and divided into group A (27 patients) and group B (26 patients) according to the admission order. In group A, posterior-only focal clearance, pedicle screw fixation, and fusion of titanium web and the grafted bone were applied; while in group B, combined posterior and anterior surgery, namely posterior internal fixation with nail-stick system in the pedicle of vertebral arch to correct abnormalities first and then focal clearance, were applied. The operative time, intra-operative blood losses, drainage time, drainage volumes, and postoperative lengths of stay were compared between the two groups, and the time to fusion of the grafted bone, degree and rate of correction of kyphotic abnormality, and ASIA impairment scale of neurologic function were followed up. Results: The operative time, intra-operative blood loss, drainage time, drainage volume, and postoperative length of stay in the group A were better than the group B, which were statistically significant (all p<0.05). All the patients were followed up for 12 months-23 months. At 1 year after surgery, the time to fusion of the grafted bone was not statistically different between two groups (p>0.05), however, the degree and rate of correction of Cobb angle in the group A were better than the group B, which were statistically significant (both p<0.05). After the surgery, the improvement of neurologic function ASIA classification was not statistically different between two groups (p>0.05). Conclusions: Posterior-only decompression, focal clearance, and internal fixation in treatment of thoracic and lumbar tuberculosis have small operation wound and has definite effects of spinal reshaping and fusion.