Retrospective study of anterior lesion clearance and posterior bone graft fusion internal fixation surgery for treatment of misdiagnosis lumbar vertebra tuberculosis

To investigate the clinical efficacy of gelatin sponge-embedded streptomycin to construct an anti-tuberculosis sustained-release vector combined with primary anterior lesion clearance and post-bone grafting fusion internal fixation in patients with thoracic and lumbar tuberculosis after mistreatment. Retrospective analysis was made on 23 patients with thoracolumbar tuberculosis who were wrongly treated as (percutaneous vertebroplasty) fractures in our Hospital from March 2018 to January 2022. Four combination antituberculosis drugs were used for 2-4 weeks before operation, and standardized antituberculosis therapy was used for 12-18 months after operation. The main outcome measures included the visual analog scale (VAS), the Japanese Orthopedic Association (JOA), the Oswestry disability index (ODI), 36 short form health surveys (SF-36 scores), erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) and bone graft fusion assessed by patients before operation, one week after operation, and 12 months after operation. All 23 patients successfully completed the operation. The average operation time was (364.26±20.149) min, the average intraoperative blood loss was (864.21±54.81) mL, the average hospital stay was (21±1.9) days, and the bone graft fusion time was (6±0.62) mon. The VAS score of chest and back pain in the first week after operation was lower than that before operation (all P<0.001), which was further reduced in follow-up. The JOA score, ODI score and SF-36 score after operation were significantly different from those before operation (P<0.05). At the last follow-up, erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) of all patients returned to normal. The satisfaction rate was 86.9% one week after operation and 95.7% 12 months after operation. The rates of significant and effective clinical effects 1 week and 12 months after operation were 21.7% and 69.6%. Respectively, the use of gelatin sponge-embedded streptomycin to construct an anti-tuberculosis sustained-release vector combined with a stage I anterior lesion combined with posterior bone graft fusion internal fixation has a good clinical effect in the treatment of mistreated lumbar vertebra tuberculosis, which is a safe technique for spine surgeons to choose.