A. Minimally invasive treatment concept 1. Unlike spinal tumors, spinal tuberculosis does not require complete resection or lesion removal. 2. Various kinds of drains can be placed in the lesion and in the abscess of flow injection. 3.In addition to increasing the dose of oral drugs, the drug concentration within the lesion can be increased by using minimally invasive methods, and there are no obvious toxic side effects. 4.No fusion and internal fixation are also possible. Fixation alone is a method of treating spinal tuberculosis. 5, from a minimally invasive point of view, the acute phase requires spinal decompression mainly for patients who develop spinal cord compression. Deformities and other problems can be left until the second stage for treatment. What kind of active spinal tuberculosis can be treated with drugs alone, without minimally invasive or surgical treatment? Early stage lesions are limited in extent and the destruction of the vertebral body is not serious. After a certain period of treatment, the body temperature is normal and the blood sedimentation is decreased or normal. Minimally invasive and surgical treatment is not needed. As for the advanced retrobulbar deformity, it can be treated in the second stage. Third, what kind of active spinal tuberculosis needs minimally invasive surgical treatment? Minimally invasive methods: local anesthesia, CT-guided lesion puncture, tube placement, drainage, and local chemotherapy. 75% of patients who are not treated with drugs alone can be cured by minimally invasive surgery alone. The options for minimally invasive treatment are very wide, and there are 2 simple ones 1. After simple drug treatment, clinical symptoms are not relieved. 2. Active spinal tuberculosis without compression of the spinal canal. Patients who meet the above conditions can receive minimally invasive treatment. Posterior convexity deformity is not a problem that can be solved by minimally invasive treatment. If the posterior convexity deformity appears in the acute stage, it is advocated to control the lesion first and correct the posterior convexity deformity in the second stage after the lesion is stabilized. What kind of active spinal tuberculosis requires minimally invasive internal fixation surgery? 1.After minimally invasive treatment, the spinal cord compression symptoms do not relieve or worsen. 2.Symptoms of spinal cord compression appear at the time of consultation and are not relieved or aggravated by short-term conservative treatment or minimally invasive treatment. 3.Can’t tolerate long-term bed rest. V. Types and indications of minimally invasive open surgery 1. Decompression of the spinal canal through the intervertebral plate foramen, which is suitable for cases with intravertebral compression. 2.Internal fixation via intervertebral plate foramen with spinal canal compression + pedicle nail, suitable for patients with intravertebral canal compression who need to be on the ground early. VI. What are the differences and advantages of minimally invasive internal fixation surgery and open surgery treatment? Traditional open surgery for spinal tuberculosis requires general anesthesia, which is very traumatic for patients and slow in recovery. Longer preoperative preparation, lesion removal and bone grafting are required. Minimally invasive surgery does not perform lesion debridement or focal bone grafting, and can perform second-stage minimally invasive bone grafting. The advantages of minimally invasive internal fixation surgery: 1. It is performed under local anesthesia and can be tolerated by patients with poor bilateral lung conditions. 2.It can be done for decompression of the spinal canal, which is suitable for patients with paraplegia due to spinal tuberculosis. 3.It can be done for internal fixation of the spine, and the patient can go to the ground early after surgery, which overcomes the disadvantages of using minimally invasive methods alone. 4.Ineffective special preparation before surgery, no need for long-term medication, no need for strict restriction on blood sedimentation. 5.Mild correction of part of the posterior convexity deformity. 6.Avoid the traditional open chest, inverted octagon and other large trauma surgery. Disadvantage: need to wear external fixation brace to strengthen stability. What should be noted in the rehabilitation treatment after surgery? 1.Enhance nutrition and physical fitness. 2. Regular anti-tuberculosis medication must be adhered to for 1 year or more after surgery. 3.Regularly review liver and kidney function and blood sedimentation monthly for more than 3 months until normal. If the symptoms recur, it is necessary to continue to recheck. 4. 3-5 days after surgery, you can wear a protective brace to get out of bed, gradually resume normal life, and resume daily life and part of physical labor as soon as possible according to your physical condition. 8.Does the internal fixation need to be removed? If there is no surgical complication, no breakage or loosening of the internal fixation, the internal fixation can not be taken out.