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.

Fig. 1

Lesions involved in the segment of spinal distribution in the posterior spinal fusion (PSF) and anterior/posterior combined surgery (A-P) groups

Fig. 2

Resection range (shaded portion). C resected zygapophyseal joint, costotransverse joint and small portion of ribs, outward pressure on pleura, bone graft after debridement (shaded portion above discretionary resection portion)

Fig. 3

Segmental deformity Angle measurement schemes. Lesions involving the cephalic vertebral endplate above normal and end the vertebral endplate below the normal do two parallel lines, measurement of vertical line Angle

Fig. 4

a1, a2 Preoperative lateral X-ray; b2 preoperative computed tomography (CT); c1, c2 preoperative magnetic resonance image (MRI)clearly shows T5–6bone destruction, peripheral abscess formation, oppressed spinal cord, stable fixation location and bone graft has integrated. d1, d2 Intraoperative images: d1 arrow shows implanted bone mass of between vertebral bodies; d2 bone graft on the vertebral plate and reconstruction. e1, e2 Postoperative lateral X-ray: arrow shows bone graft between vertebral bodies. e1, e2 Postoperative CT; h postoperative MRI shows stable bone mass and internal fixation. i Two years later, CT review shows interbody bone graft has merged