关键词: 脊柱结核, 截瘫, 减压, 内固定

Abstract: Objective To evaluate the efficacy and results of single-stage posterior circumferential decompression, interbody bony fusion and posterior instrumentation in the treatment of spinal tuberculosis complicated with paraplegia, in order to investigate the indications and feasibility of this procedure.  Methods Eighteen patients with thoracic or thoracolumbar spinal tuberculosis with paraplegia treated by single-stage posterior circumferential decompression, interbody bony fusion and posterior instrumentation at the authors’ clinic from Jun 2008 to Jun. 2012 were retrospectively analyzed. There were11 males and 7 females, the mean age at the initial treatment was （39.5±4.8）years (range: 23 to 72 years). The mean duration of symptoms was （3.5±0.7）months (range, 1 to 18 months). 2 or 3 contiguous vertebrae were involved in 15 patients, and more than 4 vertebrae were involved in 3 patients. The patients had varying degrees of paraplegia (3 with Frankel grade A, 9 Frankel B, and 6 Frankel C). The kyphotic angles were more than 45° in 12 patients before operation. The mean preoperative kyphotic angle was （48.5±7.0）° (range, 20° to 75 °).The chemotherapy course were 12-18 months and adapted individuately according to following up. The clinical outcomes were evaluated in terms of clinical manifestation, the improvement in Frankel grade, radiographical changes, and the complications of the operations. The mean follow up was (3.4±0.6) years (range:2.0 to 6.0 years).  Results All patients received follow-up. The operation time was average （5.2±0.5）h (range 4.0-7.5 h), and the bleeding was average (1400±150)ml (range 850-2000 ml). All these patients had their incision healed by first intention, no found sinus formation, vertebral tuberculous relapse. The completely neurological recovery occurred in 17 patients, The neurological function recovered from Fankel A grade to Fankel D grade in 1 patients. The average correction of kyphotic anglein the immediate postoperative period was (36.5±6.8) degrees, and the average loss of correction of local kyphosis at the final follow-up was (3.0±0.6) degrees. Bony fusion was achieved in 17 patients, 1 patient received reoperation owing to bad bony fusion and the fracture of the rods.  Conclusion Single-stage posterior circumferential decompression, interbody bony fusion and posterior instrumentation is an reasonable and effective choice in treatment of some kinds of thoracic or thoracolumbar spinal tuberculosis with paraplegia. This procedure could promote the recovery of the paraplegia through complete decompression. But it has high technical requirements and associated with greater trauma, may not be routine method in the treatment of spinal tuberculosis.

Key words: Spinal tuberculous, Paraplegia, Decompression, Internal fixation