Two one-stage posterior approaches for treating thoracic and lumbar spinal tuberculosis: A retrospective case-control study

Abstract

The aim of this retrospective study was to analyze the results of two surgical treatments for thoracic and lumbar spinal tuberculosis. A total of 73 patients with monosegmental thoracic or lumbar spinal tuberculosis were enrolled from January 2006 to April 2011. The patients were divided into two groups. Patients in group A (n=34) underwent one-stage posterior debridement, limited decompression, bone grafting and internal fixation combined with lamina reconstruction, while those in group B (n=39) underwent one-stage posterior debridement, decompression, bone grafting and posterior instrumentation. Clinical and radiographic results were analyzed and compared between the groups. Patients were followed for a mean 31.3 months (range, 21-42 months). Fusion occurred at 4-12 months (mean, 7.7 months). Surgical complications affected one and five patients in groups A and B, respectively. There was extraction of internal fixation in two group B patients. Postoperatively, there was significant Cobb angle correction in the two groups. By the last follow-up, the Cobb angle and correction loss in group A were significantly better than that in group B; the group A Oswestry Disability Index and Frankel grade were better than that in group B. In conclusion, one-stage posterior limited decompression, bone grafting and internal fixation combined with lamina reconstruction enables rapid management of monosegmental thoracic and lumbar spinal tuberculosis with fewer complications and minimal invasion.

Keywords: bone grafting; fixation; lamina reconstruction; limited decompression; posterior debridement; spinal tuberculosis.

Figure 1.

Resection range (shaded portion). The (A) facet joint, (B) costotransverse joint and (C) small portion of ribs, and bone graft were resected in lesions following the debridement.

Figure 2.

A 58-year-old male with T10 and T11 lesions involving bone destruction, epidural cold abscess formation and kyphosis angle of 24° underwent one-stage posterior debridement, limited decompression, bone grafting and internal fixation combined with lamina reconstruction. (A-D) Pre-operative images. (E) Postoperative radiograph revealing that kyphosis was corrected to 8°. (F-H) CT revealing a clear gap between the reconstructed lamina and dural sac with no evident scar tissue formation; the reconstructed lamina was in situ. (I and J) Postoperative radiograph and CT at 30 months depicting internal fixation in a good position, 2° loss of kyphosis angle and bone fusion.CT, computed tomography.

Figure 3.

A 34-year-old female with L1 and L2 lesions involving bone destruction, epidural cold abscess formation and a kyphosis angle of 32° underwent one-stage posterior debridement, decompression, interbody fusion and posterior instrumentation. (A-C) Pre-operative images. (D) Postoperative radiograph indicating that kyphosis was corrected to 2°. (E) Postoperative computed tomography at nine months depicting successful fusion. (F) Image at 24-month follow-up indicating the fixation in good shape, a kyphosis angle of 6° and no signs of tuberculosis recurrence.