Surgical management for multilevel noncontiguous thoracic spinal tuberculosis by single-stage posterior transforaminal thoracic debridement, limited decompression, interbody fusion, and posterior instrumentation (modified TTIF)

Abstract

Purpose: Multilevel noncontiguous thoracic spinal tuberculosis has rarely been reported in the literature. We present a retrospective clinical study of 14 patients with multilevel noncontiguous thoracic spinal tuberculosis treated by single-stage posterior transforaminal thoracic debridement, limited decompression, interbody fusion, and posterior instrumentation (modified TTIF) and determine the clinical effectiveness of such surgical treatment for MNTST.

Methods: Fourteen patients with multilevel noncontiguous thoracic spinal tuberculosis were treated with modified TTIF. The mean follow-up was 27.36 ± 10.46 months (range 13-42 months). The kyphotic angle ranged from -2° to 47° before operation, with an average of 19.21° ± 12.63°. The erythrocyte sedimentation rate (ESR) of patients upon admission ranged from 30 to 62 mm/h before operation, with an average of 46.43 ± 10.77 mm/h. The Frankel Grade was used to evaluate the neurological deficits.

Results: The average ESR got normal (8.14 ± 5.89 mm/h) within 3 months in all patients. The average kyphotic angle decreased to 8.07° ± 6.91° postoperatively. Mean deformity angle was measured as 8.79° ± 7.29° at the last visit. Solid fusion was achieved in all cases. Neurologic status of the 12 patients with preoperative neurologic deficit was 6 with grade D recovered to normal; 2 with grade B, both of them to grade D; 4 with grade C, 2 to grade D, 1 to grade E, and 1 still in grade C.

Conclusions: Modified TTIF can be an effective treatment method of multilevel noncontiguous thoracic spinal tuberculosis.