title: Debridement, internal fixation, and reconstruction using titanium mesh for the surgical treatment of thoracic and lumbar spinal tuberculosis via a posterior-only approach: a 4-year follow-up of 28 patients.
abstract: BACKGROUND
  The standard recommended method for surgical treatment of spinal tuberculosis is an anterior approach for debridement and fusion combined with posterior instrumentation. However, the method has its disadvantages. The aim of this study was to analyze the effectiveness and safety of treating thoracic and lumbar spinal tuberculosis with debridement, internal fixation reconstruction, and using specially formed titanium mesh cages via a posterior-only approach.
  
  
  METHODS
  The authors retrospectively reviewed the cases of 28 patients with spinal tuberculosis treated by debridement, internal fixation, and reconstruction with a specially formed titanium mesh cage via a posterior-only approach. The levels involved were less than two contiguous vertebrae: 13 thoracic vertebrae, 5 thoracolumbar vertebrae, and 10 lumbar vertebrae. All patients suffered from back pain, and nine patients had neurologic deficits (two were class C and seven were in class D according to the American Spinal Injury Association classification). All patients were followed up every 3 months after surgery, with a minimum 48-month follow-up. The clinical efficacy was evaluated based on the visual analog scale (VAS), the Oswestry Disability Index (ODI), neurological status, kyphosis angle, and erythrocyte sedimentation rate (ESR).
  
  
  RESULTS
  All patients obtained solid bony fusions without failure of fixation. The infections were resolved in all patients, as noted by normalization of their ESR. The average surgery time was 2 h and 15 min, with an average blood loss of 435 ml. The VAS scores dropped from a preoperative level of 6.31 ± 1.25 to the final follow-up level of 0.57 ± 0.14. The ODI scores dropped from 39.14 ± 12.38 preoperatively to 7.29 ± 3.09 at 1 year postoperatively and 6.77 ± 2.53 at final follow-up. The kyphosis Cobb's angle was corrected from 22.31° ± 4.26° preoperatively to 5.86° ± 0.57° at final follow-up. No subsidence of titanium mesh cage or posterior instrumentation failure was observed postoperatively. The neurological outcome increased by 1-2 grades in the patients with neurological deficits.
  
  
  CONCLUSIONS
  Debridement, internal fixation, and reconstruction using specially formed titanium mesh cages via a posterior-only approach is effective and safe for treating adults with thoracic and lumbar spinal tuberculosis involving less than two contiguous levels.
authors.affiliation: Department of Spine Surgery, Xiangya Hospital of Central South University, Xiangya Road 87, Changsha, China. zhq9996@163.com.
authors.forename: Hongqi
authors.initials: H
authors.lastname: Zhang
authors.affiliation: Department of Spine Surgery, Xiangya Hospital of Central South University, Xiangya Road 87, Changsha, China. 393132836@qq.com.
authors.forename: Kefeng
authors.initials: K
authors.lastname: Zeng
authors.affiliation: Department of Spine Surgery, Xiangya Hospital of Central South University, Xiangya Road 87, Changsha, China. 1220399112@qq.com.
authors.forename: Xinghua
authors.initials: X
authors.lastname: Yin
authors.affiliation: Department of Spine Surgery, Xiangya Hospital of Central South University, Xiangya Road 87, Changsha, China. 532943071@qq.com.
authors.forename: Jia
authors.initials: J
authors.lastname: Huang
authors.affiliation: Department of Spine Surgery, Xiangya Hospital of Central South University, Xiangya Road 87, Changsha, China. 42095581@qq.com.
authors.forename: Mingxing
authors.initials: M
authors.lastname: Tang
authors.affiliation: Department of Spine Surgery, Xiangya Hospital of Central South University, Xiangya Road 87, Changsha, China. 343942471@qq.com.
authors.forename: Chaofeng
authors.initials: C
authors.lastname: Guo
mesh_terms: D000328:Adult; D000368:Aged; D003646:Debridement / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016268:Internal Fixators; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011859:Radiography; D019651:Plastic Surgery Procedures / Q000295:instrumentation / Q000379:methods*; D012189:Retrospective Studies; D013904:Thoracic Vertebrae / Q000000981:diagnostic imaging / Q000601:surgery*; D013997:Time Factors; D014025:Titanium; D016896:Treatment Outcome; D014399:Tuberculosis, Spinal / Q000000981:diagnostic imaging / Q000601:surgery*
chemical_list: D014025:Titanium