Anterior debridement and bone grafting with posterior single-segment internal fixation for the treatment of mono-segmental spinal tuberculosis

摘要

Backgrounds: Short-segment or long-segment fixation is the most commonly used method for treating spinal tuberculosis with damage to a single motor segment (mono-segmental spinal tuberculosis). However, these methods incorporate several of the normal adjacent motor segments surrounding the damaged motor segments during surgery and subsequent healing, leaving them prone to adjacent segment degeneration. A single-segment fixation approach may offer an alternative solution for the surgical treatment of mono-segmental spinal tuberculosis. Patients and methods: 102 Retrospectively studied patients with mono-segmental spinal tuberculosis were divided into two groups: single-segment (the fixed/fused range was limited to only one damaged motion segment n = 54) and short-segment (the fixed/fused range included both the damaged segment and the normal motion segment located above and below the damaged motion segment, respectively n = 48). Responses to postoperative chemotherapy and changes in the Cobb angle for kyphosis, fusion time, and Frankel grading were recorded. Each patient's quality of life and ability to return to work, as determined by the Oswestry Disability Index (ODI), were also evaluated. Results: At the end of the final follow-up, the degree of correction was 12.69 ± 4.56°and 13.44 ± 4.53°for the single-segment and short-segment groups, respectively, with a loss of 1.80 ± 1.19°and 1.60 ± 1.16°, respectively. The differences between the two groups were not significant (P > 0.05). The average bone healing time was 4.4 ± 0.9 months in the single-segment group and 4.4 ± 1.0 months in the short-segment group. The Frankel grade for neurologic function returned to normal in >94% of patients. The ODI was 13.5 ± 2.8 and 14.1 ± 3.7 for the single-segment and short-segment groups, respectively. The rates of improvement were 64.0 ± 5.5% and 65.9 ± 4.9% for the single-segment and short-segment groups, respectively. The differences between the two groups were not significant (P > 0.05). Conclusion: After bone fusion, single-segment fixation is effective in restoring and maintaining spinal stability and retains normal motion segment more than short-segment fixation approach. Strict adherence to the clinical indications must occur in order to optimize the overall outcome.