Surgical management of contiguous multilevel thoracolumbar tuberculous spondylitis.
BACKGROUND
Tuberculous spondylitis (TBS) is the most common form of extra-pulmonary tuberculosis. The mainstay of TBS management is anti-tuberculous chemotherapy. Most of the patients with TBS are treated conservatively; however in some patients surgery is indicated. Most common indications for surgery include neurological deficit, deformity, instability, large abscesses and necrotic tissue mass or inadequate response to anti-tuberculous chemotherapy. The most common form of TBS involves a single motion segment of spine (two adjoining vertebrae and their intervening disc). Sometimes TBS involves more than two adjoining vertebrae, when it is called multilevel TBS. Indications for correct surgical management of multilevel TBS is not clear from literature.


METHODS
We have retrospectively reviewed 87 patients operated in 10 years for multilevel TBS involving the thoracolumbar spine at our spine unit. Two types of surgeries were performed on these patients. In 57 patients, modified Hong Kong operation was performed with radical debridement, strut grafting and anterior instrumentation. In 30 patients this operation was combined with pedicle screw fixation with or without correction of kyphosis by osteotomy. Patients were followed up for correction of kyphosis, improvement in neurological deficit, pain and function. Complications were noted. On long-term follow-up (average 64 months), there was 9.34 % improvement in kyphosis angle in the modified Hong Kong group and 47.58 % improvement in the group with pedicle screw fixation and osteotomy in addition to anterior surgery (p < 0.001). Seven patients had implant failures and revision surgeries in the modified Hong Kong group. Neurological improvement, pain relief and functional outcome were the same in both groups.


CONCLUSIONS
We conclude that pedicle screw fixation with or without a correcting osteotomy should be added in all patients with multilevel thoracolumbar tuberculous spondylitis undergoing radical debridement and anterior column reconstruction.
Spine Unit, Orthopaedic Department, Combined Military Hospital, Rawalpindi, Pakistan. maqpgh@yahoo.com
Muhammad Asad
MA
Qureshi
Ahmed Bilal
AB
Khalique
Waseem
W
Afzal
Ibrahim Farooq
IF
Pasha
Max
M
Aebi
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001863:Bone Screws; D016025:Bone Transplantation / Q000379:methods; D002648:Child; D002675:Child, Preschool; D003646:Debridement / Q000379:methods; D005260:Female; D006801:Humans; D007223:Infant; D008159:Lumbar Vertebrae; D008297:Male; D008875:Middle Aged; D013123:Spinal Fusion / Q000379:methods*; D013166:Spondylitis / Q000382:microbiology / Q000601:surgery*; D013904:Thoracic Vertebrae; D014399:Tuberculosis, Spinal / Q000601:surgery*; D055815:Young Adult