Abstract:

Objective To investigate the efficacy of anterior revision, which is complete focus debridement and/or bone graft fusion, on failure in patients with thoracolumbar tuberculosis underwent posterior fixation.Methods The clinical data were collected from 32 failure patients with thoracolumbar tuberculosis underwent anterior revision and performed anterior revision in Guangzhou City chest hospital during March 2011 to January 2017. Operative treatment scheme was evaluated and the clinical manifestations, erythrocyte sedimentation rates (ESR), pain visual analogue scale (VAS) before operation and three months after operation were compared. At last follow up, neurological function and bone graft fusion were evaluated according to the criteria approved by American Spinal Injury Association (ASIA). SPSS 19.0 software was used for statistical analysis of the data. The data were measured by paired t-test. The difference was statistically significant when P less than 0.05.Results All the patients were treated with anti-tuberculosis drugs for 1.5-2 years after operation and followed up for 2-2.5 years. During the follow-up period, no loosening of internal fixation, obvious displacement of bone graft and rupture of bone graft were observed by X-ray and CT. At the last follow-up, all patients were cured and no case was relapse. At the time of discharge, 2 patients with a long sinus had not completely healed, but they were cured underwent dressing change for 2 to 3 months, the others were good healing. The VAS score(1.25±0.87) and the ESR value ((7.09±3.59)mm/1h) at the third month after operation were significantly lower than those ((6.06±1.60) in VAS score and (69.21±25.76)mm/1h in ESR) before operation with significant statistically difference(t=18.004 and 13.766,Ps<0.05). The ASIA neurological function was improved from grade E in 29 cases, grade D in one case and grade C in 2 cases before operation to grade E in 29 cases, grade D in 3 cases and no case with grade C after operation. The bone graft fusion according to Brantigan fusion standard was grade E in 31 cases and grade C in one case.Conclusion Anterior revision is an effective treatment for failure patients with thoracolumbar tuberculosis underwent posterior fixation.

Key words: Tuberculosis, spinal, Treatment failure, Recurrence, Reoperation, Treatment outcome