A clinical study of internal fixation, debridement and interbody thoracic fusion to treat thoracic tuberculosis via posterior approach only

Abstract

Purpose We evaluated the clinical efficacy and feasibility of one-stage posterior internal fixation, debridement and interbody thoracic fusion in the treatment of thoracic tuberculosis. Methods Sixty adult patients with monosegmental thoracic tuberculosis were studied retrospectively: 34 men and 26 women with an average age of 37.5 years. Operating time, blood loss, time in bed, complications, neurological function, rate of deformity correction and rate of interbody fusion were investigated. Results All cases were followed up for 27.5 months on average. Average mean operating time was 251 min, evaluated blood loss during operation 780 ml, rate of kyphosis correction 79%, corrected kyphosis angle 25°and loss of corrected angle 1.2°. Patients whose neurological function improved accounted for 90.1%. Erythrocyte sedimentation rate (ESR) or C-reactive protein (CRP) decreased to normal levels three months after operation. The rate of bone fusion was 100%, with a 100% cure rate. No severe complications or spinal cord injury occurred. Conclusions This approach can successfully remove the focus of tuberculosis with complete interbody thoracic fusion after operation, which restores spinal stability.

Anterior and Posterior Instrumentation with Different Debridement and Grafting Procedures for Multi‐Level Contiguous Thoracic Spinal Tuberculosis

“…Thus, this approach is more applicable for thoracic spinal tuberculosis with adjacent segment lesions, particularly for patients with poor pulmonary function or extensive pleural adhesions. Second, through unilateral or bilateral facet joint resection and the excision of the adjacent costotransverse joint with a small fragment of the ribs, the focus can be exposed at a 270° angle under direct visualization of the outside of the dura mater without injuring the spinal cord. Third, kyphotic deformities can easily be corrected as in vertebral column resection (VCR) osteotomy procedures following radical debridement and interbody fusion with a titanium mesh or autogenous bone grafting.…”

“…The “Hong Kong operation” implements debridement and bone grafting in a single‐stage approach. However, graft failures, including slippage, absorption, and breakage, are major drawbacks of this method, particularly when more than three vertebrae are involved. Due to developments in international fixation, the stability of the spine can be efficiently reconstructed following radical debridement and graft fusion.…”

Spinal tuberculosis in western mexico, 2008-2013

“…13 The surgical approach used in the patients of this study was via the posterior approach, unlike the study published by Wang et al,17 in which the anterior approach was used. 17 According to the parameters established by Zhang et al, 18 for the clinical improvement of the patient with spinal tuberculosis, a return to normal conditions is expected within a period of six months to one year; due to the damage caused, some of the patients of the study were unable to return to work, although the majority had possibilities of leading an independent life. 18 Nowadays, knowledge of the presence of spinal tuberculosis is essential for any level of healthcare in our population, and a lack of such knowledge, on the part of physicians, can result in severe complications due to an inaccurate or late diagnosis, as well as delayed treatment.…”

Treatment of Spinal Tuberculosis by Debridement, Interbody Fusion and Internal Fixation via Posterior Approach Only

“…Lesion debridement to drain the prevertebral abscess and expose the diseased vertebral bodies was performed from the side with more bone destruction and a larger abscess (left). The facet joint was resected unilaterally and the lower costotransverse joints excised with a small fragment of adjoining rib if in the thoracic segment, retaining contralateral structural integrity (Figs ), while protecting the spinal cord and nerve root. Spatulas of various sizes and angles were used from a posterior approach to remove all lesions, including sequestra, abscesses and granulation tissues.…”