Symbol: Screw and rod system fixation combined with debridement treats tuberculosis of the thoracic, lumbar and sacral spine in the elderly

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Abstract

BACKGROUND:

Screw and rod system is a priority choice fixation material for the reconstruction and spine stabilization of elderly spinal tuberculosis patients. There are controversies on the debridment, internal fixation, interbody fusion and the selection of anterior approach operation for the treatment of tuberculosis of thoracic, lumbar and sacral spine in elderly patients.

OBJECTIVE:

To observe the effect of screw and rod system fixation combined with debridement in treating tuberculosis of thoracic, lumbar and sacral spine in elderly patients, and to compare the difference of treatment effect of anterior and posterior surgery.

METHODS:

Forty-seven elderly patients with tuberculosis of thoracic, lumbar and sacral spine were selected, and divided into two groups according to the surgery program. There were 27 patients in posterior operation group, and the patients in the posterior group were treated with debridment, bone graft fusion and screw and rod system internal fixation. There were 20 patients in anterior operation group, and the patients were treated with debridment, bone graft fusion and posterior screw and rod system internal fixation. Frankel neurological grade was used to evaluate spinal cord injury and recovery situations before and after treatment. The clinical efficacy was evaluated with X-ray films before and after treatment, and the changes of erythrocyte sedimentation rate and Cobb angle were observed before and after treatment.

RESULTS AND CONCLUSION:

All the 47 patients were followed-up for 10-36 months, and all the patients were cured. No severe complications occurred during and after operation. Spinal fusion occurred in all the patients at 10-18 months after operation. Frankel neurological grades were improved significantly. There were no significant differences of the improvement of Frankel neurological grades, Cobb angle and erythrocyte sedimentation rate between two groups (P > 0.05). Both of anterior and posterior screw and rod system fixation combined with debridement for the treatment of tuberculosis of thoracic, lumbar and sacral spine in elderly patients can obtain the satisfactory effect, reconstruct the spinal stability and restore normal spine sequence. Reasonable surgical approach should be chosen based on the type of spinal tuberculosis, the extent of the damage and surgery caused spine stability changes.

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