OBJECTIVE: To evaluate the efficacy of the vertebral body implant internal fixation system in treating tuberculosis of the thoracolumbar vertebrae. METHODS: Forty-one patients with thoracolumbar vertebral body tuberculosis were treated by applying vertebral body internal fixation technique from 2001 to 2006. RESULTS: With a follow-up period of 1~5 years, of the 4 patients who showed different degrees of nerve compression symptoms before surgery, 2 recovered to normal, 1 recovered from B grade to E grade, and 1 recovered from C grade to D grade. CONCLUSION: Internal fixation of vertebral implants can greatly improve the survival rate of the implant and the stability of the spine after thoracolumbar tuberculosis, and effectively decompress the spinal canal and promote the effective recovery of neurological function. Spinal tuberculosis is one of the common orthopedic diseases that jeopardize human health in clinic, accounting for about 60% of systemic osteoarticular tuberculosis [1], all vertebrae can be involved, but thoracolumbar vertebrae are more common, often accompanied by vertebral body bone destruction and necrosis, with caseous changes and abscess formation, vertebral body collapses due to lesions and load bearing, so that the spine forms a curvature, sphenoidal bulge, and the back has a hump deformity, and the severe cases can lead to paraplegia of the patient. Now, we analyze the treatment experience of 41 patients with thoracolumbar vertebral body tuberculosis treated with intravertebral fixation plate technology from 2001 to 2006 in our hospital, and report as follows: 1, data and methods 1.1 General data: There were 41 cases in this group, 24 male and 17 female; age 23-74 years old, average age 53.5 years old. Lesion site: T42 cases, T5, 64 cases T6, 75 cases, T86 cases, T9, 105 cases, T11, 126 cases, T12L1 2 cases, L1, 2 4 cases, L2 4 cases, L3 3 cases. 41 cases were photographed with spinal frontal and lateral X-rays and CT scans before the operation in order to determine the presence of a dead bone mass protruding into the vertebral canal, the presence of paravertebral abscesses, and the degree of spinal cord compression. The results showed that 41 cases were combined with vertebral destruction and paravertebral abscess formation to different degrees, of which 4 cases had dead bone mass and necrotic tissue protruding into the spinal canal and nerve compression symptoms, 2 cases of T4, 71 cases of T6, 21 cases of L1, and 3 cases of paraplegia in this case. 1.2 Surgical method: General anesthesia with tracheal intubation was used, and the lateral position or flat position was taken to pad up the operative side by about 30 degrees. Thoracolumbar vertebral lesions and lumbar vertebral lesions are usually performed in the flat position with the operative side elevated by about 30 degrees, through an inverted “eight” incision on the side with the larger paraspinal abscess, centered on the diseased vertebrae with a length of about 15cm, and resecting the twelfth floating rib if necessary to reveal the extraperitoneal fat and peritoneum, pushing the peritoneum to the center, and then pulling the peritoneum along with the ureter to the center line to reveal the paraspinal abscess and reveal the extraperitoneal fat and peritoneum. The peritoneum is pushed toward the center, and the peritoneum, together with the ureter, is pulled toward the median line. 1.3 Postoperative treatment: Remove the drain 24-48 hours after operation, start to move under the protection of chest or waist circumference after 3 weeks, anti-tuberculosis treatment for 18-24 months, and regular review of blood sedimentation, liver function, and radiographs. 1.4 Results: The follow-up time of this group was 1~5 years, which was carried out by means of follow-up, home visit and phone call, in which one case of L3 vertebral body lesion patient had a cold abscess of lumbar psoas major muscle 3 months after the operation, which was cured after removing the lesion by another operation; one case of T6 and 7 vertebral body lesion patient was found to have a plate fixation screw loosened and semi-dislodged in the review of the patient 8 months after the operation, but the implant was healed well, and the patient had his internal fixation plate removed by the operation. The patient was discharged from the hospital without recurrence. Neurological recovery: According to Frankel’s criteria, of the 4 patients with different degrees of nerve compression symptoms before surgery, 2 recovered to normal; 1 recovered from grade B to grade E; and 1 recovered from grade C to grade D. All of the patients in this group did not suffer from spinal cord injury at the end of the surgery. The spinal cord nerve compression aggravation occurred at the end of this group after surgery. 2, Discussion In recent years, due to the irregular application of anti-tuberculosis drugs, the increase of drug-resistant strains, spinal tuberculosis has an increasing trend of spinal tuberculosis and spinal cord nerve compression in about 10% of the causes of spinal cord nerve compression: ① bone disease activity: tuberculous granulation tissue, pus, necrotic tissue invasion of the spinal canal, compression of the spinal cord and nerve roots; ② bone disease cure type: spine due to tuberculosis damage, resulting in instability, deformity, posterior protrusion or lateral protrusion to the local narrowing of the spinal canal, the proliferation of fibrous tissue in the spinal canal and thickening of the dura mater, compression of the spinal cord and nerve roots [2]; (3) tuberculosis inflammatory tissues of the spinal cord nerves and their periosteum stimulation, infiltration, causing inflammatory reaction, may aggravate the damage to the spinal cord nerves. 2.1 Surgical timing: The choice of surgical timing is crucial to the postoperative prognosis of spinal tuberculosis, for patients who do not have obvious nerve compression symptoms before the operation, it is required to require formal, systematic and standardized intensive anti-TB treatment for about 3-4 weeks, and at the same time give nutritional supportive therapy, combined with sinusoidal patients should be added with sensitive antibiotics, to be stable temperature, blood sedimentation decreased significantly ( When the body temperature is stable, the blood sedimentation decreases significantly (generally, the blood sedimentation decreases to about 40mmMh), and the general condition improves, surgery can be carried out; for the choice of the timing of surgery for patients with paraplegia, the time of intensive anti-TB treatment and the decrease of blood sedimentation should not be overemphasized, and the preoperative preparations should be made as soon as possible, and at the same time, the intensive anti-TB treatment and supportive nutritional treatment should be carried out to carry out the surgery as soon as possible. In this group, 3 patients who had paraplegia before operation were operated in time because of progressive aggravation of spinal nerve compression symptoms, and their neurological functions recovered well after operation. 2.2 Purpose of surgery: The purpose of removing the thoracolumbar tuberculosis foci and internal fixation of vertebral implantation is to completely remove the dead bone and necrotic tissues in the vertebral body and the spinal canal, relieve the compression of the spinal cord, correct the deformity of the spinal column, and promote the recovery of the spinal cord and neural function. The use of autogenous bone implantation and internal fixation of the plate can greatly improve the survival rate of the bone implantation and the stability of the spinal column, and reduce the bed resting time of the patients after the operation as well as the complication of the disease. Clinical observation shows that after spinal tuberculosis surgery, because of the serious damage of spinal stability, it affects the bony healing between the diseased vertebrae, leading to easy absorption, subsidence and slippage of the implanted bone block, and the high incidence of spinal kyphosis deformity and pseudoarthrosis [3], in order to prevent the occurrence of deformity after purely performing spinal tuberculosis foci removal and implantation, the use of internal fixation of the foci removal bone grafting in order to rebuild the stability of the spinal column is of important significance. 2.3 Safety: Whether the implantation of internal fixation in tuberculosis foci will increase the rate of tuberculosis recurrence, some people have made experiments that Mycobacterium tuberculosis has a lower ability to adhere to the endoplant material [4], which provides an experimental basis for the implantation of internal fixation, and Oga explored the safety of internal fixation of spinal tuberculosis from the point of view of bacterial adherence. He pointed out that the cause and intractability of biomaterial-associated infections lies in the fact that the extracellular matrix in the body of bacteria can adhere to the surface of the material to form a biofilm, which allows the bacteria to evade the effects of the body’s immunity and antimicrobial drugs, among others, thus resulting in a persistent infection. Scanning electron microscopy observed the adhesion of tuberculosis bacteria to the stainless steel sheet, with Staphylococcus epidermidis as a control, and found that the latter can secrete more extracellular mucus and a large number of adhesion to the surface of the material to form a thick film-like material, while Mycobacterium tuberculosis adheres to a very small number of, that the tuberculosis bacteria of this nature may be the spinal tuberculosis of internal fixation of the safer one of the reasons, and at the same time, clinical also did not find that due to the use of the internal fixation materials and trigger an increase in the recurrence rate of tuberculosis foci At the same time, there is no clinical report that the use of internal fixation materials can increase the recurrence rate of tuberculosis, so the bone grafting and internal fixation of patients suffering from thoracolumbar tuberculosis combined with severe bone destruction should be safe and reliable, and the success rate of the operation can be improved.