Anterior Debridement,Bone Graft Fusion,and Internal Fixation Combined with Anti-Osteoporosis Treatment in Elderly Patients with Spinal Tuberculosis

Li Jikai; Wang Huiwang; Li Tongxian; Wu Huarong

Abstract：Objective To evaluate the clinical efficacy of anterior debridement,bone graft fusion,and internal fixation combined with anti-osteoporosis treatment in elderly patients with spinal tuberculosis and osteoporosis.Methods This study encompassed 98 elderly patients with spinal tuberculosis and osteoporosis who were treated from March 2021 to June 2022.Utilizing a random number table method,the patients were divided into two groups:The observation group,consisting of 48 patients(28 males and 20 females),with an average age of(65.35±8.20)years,ranging from 60 to 73 years old,and the control group,comprising 50 patients(28 males and 22 females),aged between 62 and 75 years,with a mean age of(67.20±7.60)years.Both groups underwent anterior debridement,bone graft fusion,and internal fixation,accompanied by anti-tuberculosis treatment administered pre-and post-operatively for 12～18 months.The observation group additionally received anti-osteoporosis treatment,encompassing calcium carbonate D3,alfacalcidol,and zoledronic acid injection,whereas the control group did not receive formal anti-osteoporosis medication.Parameters such as surgical time,intraoperative blood loss,post-operative bed rest duration,erythrocyte sedimentation rate(ESR),visual analogue scale(VAS)for pain assessment,kyphotic Cobb angle,bone graft fusion time,post-operative complications,and bone mineral density(BMD)at the final follow-up were recorded and statistically analyzed.Results All patients were followed up for a duration ranging from 13 to 17 months,with an average follow-up period of(14.00±2.30)months.The observation group demonstrated notable benefits from the anti-osteoporosis treatment.Specifically,the post-operative bed rest time in the observation group was(3.95±0.76)weeks,which was considerably shorter than the(4.58±1.01)weeks required by the control group(P=0.027).At the six-month post-surgery mark,the ESR in the observation group measured at(27.60±3.40)mm/h,whereas the control group recorded an ESR of(30.20±2.97)mm/h(P=0.008).Additionally,the VAS in the observation group stood at(2.20±0.83),notably lower than the(3.40±0.77)score observed in the control group(P=0.001).Furthermore,the bone graft fusion time in the observation group was(3.95±0.43)months,significantly shorter compared to the(4.57±0.79)months in the control group(P=0.003).Regarding the correction degree of kyphotic Cobb angle,the observation group achieved(5.93±0.94)°,while the control group reached(6.73±1.80)°,although this difference was not statistically significant(P=0.081).Upon the final follow-up,the T-score for osteoporosis in the observation group was(-2.40±0.39),which was significantly higher than the(-3.20±0.40)recorded in the control group(P＜0.001).Lastly,the incidence of post-operative complications in the observation group was 5.00％,which was lower than the 9.10％seen in the control group,albeit this difference was not statistically significant(P=0.662).Conclusion Anterior debridement,bone graft fusion,and internal fixation combined with formal anti-osteoporosis treatment show significant advantages in post-operative recovery,inflammatory markers,osteoporosis,pain relief,and bone graft fusion in elderly patients with spinal tuberculosis and osteoporosis.This approach provides valuable insights for related clinical practices.