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. 2013 Mar;22(3):616-23.
doi: 10.1007/s00586-012-2470-1. Epub 2012 Aug 18.

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

Hongqi Zhang  1 , Bin Sheng, Mingxing Tang, Chaofeng Guo, Shaohua Liu, Shu Huang, Qile Gao, Jinyang Liu, Jianhuang Wu
Affiliations

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

Hongqi Zhang et al. Eur Spine J. 2013 Mar.

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 posterior-only 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.

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Figures

Fig. 1
Fig. 1
Preoperative lateral X-ray film. Destructive segments located at T4
Fig. 2
Fig. 2
Preoperative anteroposterior X-ray film
Fig. 3
Fig. 3
Preoperative CT. The almost total disappearance of T4 vertebral body
Fig. 4
Fig. 4
Preoperative MRI. The spinal cord was severely compressed by the local abscess. The local kyphotic Cobb angle was 35°
Fig. 5
Fig. 5
Postoperative anteroposterior X-ray film. Internal fixation was in good position
Fig. 6
Fig. 6
Postoperative lateral X-ray film. Local kyphosis had improved significantly, and the Cobb angle was 12°
Fig. 7
Fig. 7
6-month follow-up. The patient’s ASIA grade had recovered to E
Fig. 8
Fig. 8
Postoperative CT. Solid bone fusion in diseased segments
See this image and copyright information in PMC

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