Treatment of tuberculous spondylitis with anterior stabilization and titanium cage.
We retrospectively reviewed 12 patients with spinal tuberculosis of the thoracic and lumbar spine who had radical débridement, anterior decompression, interbody arthrodesis with an anterior interbody titanium cage, and autologous bone grafts, combined with a standardized perioperative antituberculous regimen. Their mean age was 55.1 years and they were observed for a mean of 65.3 months. Indications for surgery included epidural abscess, structural destruction with instability, progressive kyphosis, and/or neurologic deterioration. Kyphotic deformity was corrected from a mean of 24.6 degrees (range, 15 degrees-32 degrees) to a mean of 10 degrees (range, 4 degrees-18 degrees). Tuberculous infection was controlled and bony fusion was achieved in all patients. No recurrence of infection or construct failure was recorded. All patients were safely mobilized within the first postoperative week; back pain fully resolved in eight patients and improved in the remaining four. We conclude that radical débridement followed by anterior stabilization with a titanium cage and bone grafting is a reasonable alternative for tuberculous spondylitis requiring surgical treatment. It enables accurate and lasting deformity correction and provides adequate stability to allow early mobilization. The presence of a titanium cage in an area of mycobacterial infection did not preclude infection control or lead to recurrence.


METHODS
Therapeutic study. Level IV (case series). Please see Guidelines for Authors for a complete description of levels of evidence.
Christodoulou
Anastasios G
AG
First Orthopaedic Department, Aristotelian University of Thessaloniki, G. Papanikolaou General Hospital, Thessaloniki, Greece.
Givissis
Panagiotis
P
Karataglis
Dimitrios
D
Symeonidis
Panagiotis D
PD
Pournaras
John
J
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000995:Antitubercular Agents / Q000627:therapeutic use; D016025:Bone Transplantation; D003646:Debridement; D005260:Female; D006801:Humans; D007738:Kyphosis / Q000382:microbiology / Q000601:surgery*; D008159:Lumbar Vertebrae; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013123:Spinal Fusion / Q000295:instrumentation* / Q000379:methods; D013526:Surgical Mesh; D013904:Thoracic Vertebrae; D014025:Titanium; D016896:Treatment Outcome; D014399:Tuberculosis, Spinal / Q000150:complications / Q000628:therapy*
D000995:Antitubercular Agents; D014025:Titanium