Extended Posterior Decompression and Instrumented Fusion for Spinal Tuberculosis

Abstract

Study design: Retrospective cohort.

Purpose: To evaluate clinical outcomes, including pain and neurologic status, and to evaluate radiographic outcomes of patients treated with extended posterior decompression, posterior fixation, and fusion in different vertebral segments.

Overview of literature: The standard surgical treatment of spinal tuberculosis is radical debridement via anterior approach. However, this approach may lead to several serious complications. Meanwhile, extended posterior approach, the posterior surgical approach, involving the removal of posterior elements, ribs, and pedicles, is an alternative option that can achieve the aims of treatment in this disease and may reduce the serious complications from anterior approach.

Methods: The medical records and imaging of 50 patients admitted with spinal tuberculosis from January 2010 to June 2016 were reviewed. The Visual Analog Scale (VAS), Frankel grading scale, and kyphotic Cobb angle between the pre- and postoperative periods were used to evaluate the patients.

Results: The patients had significant improvement of VAS score in all the groups. The T/T-L, L, and L-S group scores improved from 7.2±1.5 to 1.7±1.2 (p<0.01), from 8.1±1.8 to 1.7±1.4 (p<0.01), and from 7.9±2.2 to 1.7±0.8 (p<0.01), respectively, and overall, the patient scores (n=50) improved from 7.8±1.4 to 1.7±1.3 (p<0.01). Ten patients (20%) had Frankel grade E preoperatively, which was improved to 38 patients (76%) postoperatively. A significant improvement of the kyphotic Cobb angle was observed when compared at the preoperative, early postoperative, and final follow-up period in the T/T-L, L, and L-S groups. The loss of correction angle in the LS group was 7.7°±4.3° at the final follow-up compared with the early postoperative correction angle at 9.1°±5.8°, with no statistically significant difference.

Conclusions: Extended posterior decompression, posterior instrumentation, and fusion are effective methods of surgery for treatment of spinal tuberculosis involved in the thoracic, thoracolumbar, lumbar, and lumbosacral regions.

Keywords: Lumbosacral; Spinal tuberculosis; Thoracolumbar; Transpedicular decompression.

Fig. 1.

Preoperative radiograph showing destructive segments at the T8–T9 and L1–L2. (A, B) The Cobb angle from the radiograph was 30° at the L1–L2. (C, D) Magnetic resonance imaging showing paravertebral abscess with spinal cord compression. (E) Transpedicular decompression is performed at the L1–L2 on the right. (F, G) Early postoperative radiograph shows that fixation was in good position, kyphosis has significantly improved, and the Cobb angle is 12° in kyphosis. (H, I) The radiograph at the 12-month follow-up period shows the union of the L1–L2 vertebrae with the Cobb angle at 14° in kyphosis.