KẾT QUẢ ĐIỀU TRỊ PHẪU THUẬT LAO CỘT SỐNG NGỰC, THẮT LƯNG BẰNG NẸP VÍT QUA CUỐNG LỐI SAU VÀ THAY THÂN LỐI BÊN

Abstract

Objective: To describe the clinical characteristics, evaluate the symptoms in a cohort of patients, and assess the surgical outcomes of thoracic and lumbar spinal tuberculosis treated with posterior pedicle screw fixation and lateral body replacement. Subjects and methods: A retrospective and prospective study design, without a control group, was conducted on 52 patients with thoracic and lumbar spinal tuberculosis who were indicated for surgical intervention using posterior pedicle screw fixation and lateral body replacement. This study was conducted at the Central Lung Hospital from June 2022 to December 2023. Results: The average Visual Analog Scale (VAS) score was 5.46 ± 1.25. Kyphosis was observed in 61.54% of patients. Mixed pain due to instability and nerve compression was present in 61.54% of cases, and continuous pain was observed in 53.85%. The majority of patients were categorized as type C (40.38%) and D (42.31%) according to the ASIA impairment scale. Lesions involving two vertebral bodies were seen in 80.77% of cases, vertebral body abscesses in 76.92%, and spinal canal stenosis in 76.92%. Anterior and posterior vertebral body destruction was present in 88.4% of cases. Positive Bactec tests were found in 65.38% of cases, direct AFB positivity in 25%, LPA positivity in 84.62%, and histopathology positivity in 92.31%. The average operative time was 176.15 ± 25.06 minutes, with an average blood loss of 937.5 ± 276.15 ml. A total of 8 screws were used in 76.92% of cases. At 3 and 6 months postoperatively, the majority of patients reported mild or no pain (VAS), and most patients were classified as type D and E on the ASIA scale (p<0.05). The bone fusion rate reached 88.46%, with no recurrence of disease. Surgical outcomes according to Macnab were rated as good and very good in 90.38% of cases, with no poor results reported. Conclusion: Posterior pedicle screw fixation combined with lateral body replacement is an effective approach for the treatment of thoracic and lumbar spinal tuberculosis and is recommended for widespread clinical.