Thoracic and lumbar tuberculous spondylitis treated by posterior debridement, graft placement, and instrumentation: a retrospective analysis in 19 cases.
OBJECTIVE
Surgical treatment of thoracic and lumbar tuberculous spondylitis is controversial. An anterior approach is usually recommended. The aim of the present study was to assess the efficacy of posterior debridement and the placement of posterior instrumentation for the treatment of patients with thoracic and lumbar tuberculous spondylitis.


METHODS
Nineteen patients with thoracic and lumbar tuberculous spondylitis underwent single-stage posterior decompression and debridement as well as the placement of posterior interbody grafts if necessary, instrumentation and posterior or posterolateral grafts. No postoperative neurological deterioration was noted. One patient died of myocardial infarction on Day 10. The mean follow-up duration, excluding the one death, was 52.7 months (range 16-125 months). In a 70-year-old patient, a single pedicle screw broke after 3 months. All patients were in better neurological condition after surgery and at the last follow-up examination. Neurological deficits were present in only two patients at the last follow up (one American Spinal Injury Association Grade B and one Grade C deficit preoperatively). Three other patients suffered intermittent back or low-back pain. The mean angulation measured in 13 patients with kyphotic deformity was 18.2 degrees (range 5-42 degrees) preoperatively; this was reduced to 17.3 degrees (range 0-42 degrees) after surgery. There was a 2.8 degrees loss of correction (range 2-5 degrees) after 44.3 months (16-64 months). Kyphosis did not progress beyond 15 months in any patient.


CONCLUSIONS
A posterior approach in combination with internal fixation and posterior or posterolateral fusion (with or without placement of posterior interbody grafts) may be sufficient for the debridement of the infection and to allow spinal stabilization in patients with thoracic and lumbar tuberculous spondylitis. This procedure is associated with easy access to the spinal canal for neural decompression, prevention of loss of corrected vertebral alignment in the long term, and facilitation of early mobilization.
Güzey
Feyza Karagöz
FK
Department of Neurosurgery, SSK Vakif Gureba Training Hospital, Istanbul, Turkey. fkarag@yahoo.com
Emel
Erhan
E
Bas
N Serdar
NS
Hacisalihoglu
Selim
S
Seyithanoglu
M Hakan
MH
Karacor
Sabri Emin
SE
Ozkan
Nezih
N
Alatas
Ibrahim
I
Sel
Baris
B
D000328:Adult; D000368:Aged; D001863:Bone Screws; D016025:Bone Transplantation; D003646:Debridement; D019299:Decompression, Surgical; D004868:Equipment Failure; D005260:Female; D006801:Humans; D017116:Low Back Pain / Q000209:etiology; D008159:Lumbar Vertebrae / Q000473:pathology / Q000601:surgery; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013166:Spondylitis / Q000382:microbiology* / Q000473:pathology / Q000601:surgery*; D013904:Thoracic Vertebrae / Q000473:pathology / Q000601:surgery; D014399:Tuberculosis, Spinal / Q000382:microbiology* / Q000473:pathology / Q000601:surgery*