title: Anterior debridement may not be necessary in the treatment of tuberculous spondylitis of the thoracic and lumbar spine in adults: a retrospective study.
abstract: OBJECTIVE
  Many aspects of the surgical treatment of patients with tuberculosis (TB) of the spine, including the use of instrumentation and the types of graft, remain controversial. Our aim was to report the outcome of a single-stage posterior procedure, with or without posterior decompression, in this group of patients.
  
  
  METHODS
  Between 2001 and 2010, 51 patients with a mean age of 62.5 years (39 to 86) underwent long posterior instrumentation and short posterior or posterolateral fusion for TB of the thoracic and lumbar spines, followed by anti-TB chemotherapy for 12 months. No anterior debridement of the necrotic tissue was undertaken. Posterior decompression with laminectomy was carried out for the 30 patients with a neurological deficit.
  
  
  RESULTS
  The mean kyphotic angle improved from 26.1° (- 1.8° to 62°) to 15.2° (-25° to 51°) immediately after the operation. At a mean follow-up of 68.8 months (30 to 144) the mean kyphotic angle was 16.9° (-22° to 54°), with a mean loss of correction of 1.6° (0° to 10°). There was a mean improvement in neurological status of 1.2 Frankel grades in those with a neurological deficit. Bony union was achieved in all patients, without recurrent infection.
  
  
  CONCLUSIONS
  Long posterior instrumentation with short posterior or posterolateral fusion is effective in the treatment of TB spine. It controls infection, corrects the kyphosis, and maintains correction and neurological improvement over time.
  
  
  CONCLUSIONS
  With effective anti-TB chemotherapy, a posterior only procedure without debridement of anterior lesion is effective in the treatment of TB spondylitis, and an anterior procedure can be reserved for those patients who have not improved after posterior surgery. Cite this article: Bone Joint J 2016;98-B:834-9.
authors.affiliation: Taipei Veterans General Hospital, 201, sec. 2 Shih-Pai Rd, Taipei, 11217, Taiwan.
authors.forename: S-T
authors.initials: ST
authors.lastname: Wang
authors.affiliation: Taipei Veterans General Hospital, 201, sec. 2 Shih-Pai Rd, Taipei, 11217, Taiwan.
authors.forename: H-L
authors.initials: HL
authors.lastname: Ma
authors.affiliation: Nan-men General Hospital, No.20, Linsen Rd., Hsinchu City, 30042, Taiwan.
authors.forename: C-P
authors.initials: CP
authors.lastname: Lin
authors.affiliation: Taipei Veterans General Hospital, 201, sec. 2 Shih-Pai Rd, Taipei, 11217, Taiwan.
authors.forename: P-H
authors.initials: PH
authors.lastname: Chou
authors.affiliation: Taipei Veterans General Hospital, 201, sec. 2 Shih-Pai Rd, Taipei, 11217, Taiwan.
authors.forename: C-L
authors.initials: CL
authors.lastname: Liu
authors.affiliation: Taipei Veterans General Hospital, 201, sec. 2 Shih-Pai Rd, Taipei, 11217, Taiwan.
authors.forename: W-K
authors.initials: WK
authors.lastname: Yu
authors.affiliation: Taipei Veterans General Hospital, 201, sec. 2 Shih-Pai Rd, Taipei, 11217, Taiwan.
authors.forename: M-C
authors.initials: MC
authors.lastname: Chang
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000995:Antitubercular Agents / Q000627:therapeutic use; D019299:Decompression, Surgical; D004359:Drug Therapy, Combination; D004977:Ethambutol / Q000627:therapeutic use; D006801:Humans; D007538:Isoniazid / Q000627:therapeutic use; D007738:Kyphosis / Q000209:etiology / Q000601:surgery; D007796:Laminectomy; D008159:Lumbar Vertebrae / Q000382:microbiology / Q000601:surgery*; D008875:Middle Aged; D011718:Pyrazinamide / Q000627:therapeutic use; D012189:Retrospective Studies; D012293:Rifampin / Q000627:therapeutic use; D013123:Spinal Fusion; D013166:Spondylitis / Q000382:microbiology / Q000628:therapy*; D013904:Thoracic Vertebrae / Q000382:microbiology / Q000601:surgery*; D014399:Tuberculosis, Spinal / Q000628:therapy*
chemical_list: D000995:Antitubercular Agents; D011718:Pyrazinamide; D004977:Ethambutol; D007538:Isoniazid; D012293:Rifampin
keywords: Kyphotic angle; Posterior approach; Posterior instrumentation; TB spondylitis