The outcomes of combined posterior instrumentation and anterior radical debridement with fusion for multilevel spinal tuberculosis

Abstract

Background: Aside from antituberculous drugs, anterior radical debridement with fusion has been recommended to eradicate the infectious foci and promote early bone healing in spinal tubercular patients. The addition of spinal instrumentation to stabilize the spine and restore physiologic alignment has also been proposed.

Objective: This study was undertaken to evaluate the effectiveness of the combined posterior instrumentation and anterior spinal fusion procedure.

Material and method: Eleven consecutive patients who were diagnosed with tubercular spondylosis involving more than one vertebral level and who received combined posterior instrumentation and anterior spinal fusion were reviewed. The number of vertebrae involved was three levels in four patients and two levels in seven patients. There were 8 one-stage and 3 two-stage procedures. The mean follow-up time was 16 months (range 7-33). Patients were evaluated before and after surgery for kyphotic correction, fusion formation, and neurological status.

Results: The average pre-operative, immediate postoperative, and last follow-up kyphotic angles were 40, 19, and 23 degrees, respectively. All patients obtained solid bony fusion, except for one who had partial graft dislodgment. There was no serious complication, such as neurological injury or deep wound infection.

Conclusion: Posterior instrumentation and anterior interbody fusion was effective in the management of multilevel spinal tuberculosis, as this procedure can effectively eradicate disease, provide bony fusion, correct deformity and prevent the progression of kyphosis.