One-stage surgical treatment for upper thoracic spinal tuberculosis by internal fixation, debridement, and combined interbody and posterior fusion via posterior-only approach

Abstract

Purpose To investigate the clinical efficacy and feasibility of one-stage surgical treatment for upper thoracic spinal tuberculosis by internal fixation, debridement, and combined interbody and posterior fusion via a posterioronly approach. Methods Fourteen patients (eight males, six females) with upper thoracic tuberculosis whose lesions were confined to two adjacent segments were admitted to our hospital. Their ages ranged from 23 to 72 years (average, 50 years). The American Spinal Injury Association (ASIA) impairment scale was used to assess neurological function. ASIA classification showed that preoperatively, one patient was grade A, two patients were grade B, eight patients were grade C, and three patients were grade D. All patients were treated with one-stage surgical treatment by internal fixation, debridement, and combined interbody and posterior fusion via a posterior-only approach. Patients were evaluated preoperatively and postoperatively by measurement of thoracic kyphotic angles using Cobb angle evaluation, determination of erythrocyte sedimentation rate (ESR), evaluation of ASIA impairment scale, and radiological examination. Results Operation time ranged from 70 to 135 min, (average, 110 min). Intraoperative blood loss ranged from 200 to 950 mL (average, 450 mL). All patients were followed up for 22 to 48 months postoperatively (average, 31.5 months). No sinus tract formation, cerebrospinal meningitis, or recurrence of tuberculosis occurred. All patients had significant postoperative improvement in ASIA classification scores. The thoracic kyphotic angles were significantly decreased to 12°-26°postoperatively, and at final follow-up were 13°-28°. The ESR recovered to normal within 6 months postoperatively in all patients. Bone fusion was achieved within 3-8 months (average, 5.5 months). Conclusions One-stage surgical treatment for upper thoracic spinal tuberculosis by internal fixation, debridement, and combined interbody and posterior fusion via a posterior-only approach can be an effective and feasible treatment method.

The Clinical Outcomes of Surgical Treatment of Noncontiguous Spinal Tuberculosis: A Retrospective Study in 23 Cases

“…Nowadays, management strategies of STB include conservative therapy and various advanced surgical techniques [8], [10], [15]–[17]. STB often involves adjacent vertebras and the intervening disc, while leaping and remote lesion is not common and does not characterize the disease.…”

Outcomes of radical debridement versus no debridement for the treatment of thoracic and lumbar spinal tuberculosis

“…After the technique was introduced, the Hong Kong operation became a popular method to treat spinal tuberculosis [8,15,16]. Taking into account the intense trauma, higher incidence of complications and instability of the spine from the anterior approach [17], more surgical methods paid attention to the treatment of spinal tuberculosis from the posterior approach within the last one to two decades [18][19][20].…”

The Michel Benoist and Robert Mulholland Yearly European Spine Journal Review: a survey of the “surgical and research” articles in the European Spine Journal, 2013

“…The concept that serious posterior disease could be treated by posterior approaches only was demonstrated in the paper by Zhang et al [35] in treating tuberculosis. In fact at the diseased level they did a costo-transversectomy to do an adequate debridement, and then do an interbody fusion.…”