Comparison of three surgical approaches for thoracolumbar junction (T12-L1) tuberculosis: a multicentre, retrospective study

Abstract

Background: The surgical approaches to thoracolumbar junction (T12-L1) tuberculosis were controversial. We aimed to compare the safety and efficacy of three different procedures through a multicentre retrospective study.

Methods: The medical records of thoracolumbar junction tuberculosis patients (n = 177) from January 2005 to January 2015 were collected and reviewed. Forty-five patients underwent anterior debridement and instrumented fusion (Group A), 52 underwent anterior combined with posterior debridement and instrumented fusion (Group B) and 80 underwent posterior-only debridement and instrumented fusion (Group C). Patients with neurological deficit were 10 in Group A, 23 in Group B, 36 in Group C. All patients had a standard preoperative and postoperative anti - tuberculous therapy regimen. Clinical outcomes, laboratory indexes and radiological evaluation of the three groups were compared. Operations at each centre were performed by the respective senior medical teams of the six different hospitals.

Results: All three surgical approaches achieved bone fusion and pain relief. Cases with neurological deficits had different degrees of improvement after surgery. The operative time was 330.2 ± 45.4 min, 408.0 ± 54.3 min, 227.9 ± 58.5 min, and the blood loss was 744.0 ± 193.8 ml, 1134.6 ± 328.2 ml, 349.8 ± 289.4 ml in groups A, B and C respectively. The average loss of correction was 5.5 ± 3.7° in group A, 1.6 ± 1.9° in group B, 1.7 ± 2.2° in group C, and the difference between groups except B vs C were of statistically significant (P < 0.05).

Conclusions: For patients with thoracolumbar junction (T12-L1) tuberculosis, the posterior-only procedure is the better than the anterior-only procedure in the correction of kyphosis and maintenance of spinal stability. The posterior-only procedure is recommended because it achieves the same efficacy as combined procedure with shorter operation time, less blood loss and trauma.

Keywords: Outcome; Spinal tuberculosis; Surgical treatment; Thoracolumbar junction lesion.

Fig. 1

Clinical study design flow diagram

Fig. 2

The graph showed a case underwent anterior debridement, bone grafting and screw-rods internal fixation. 25-year-old man with thoracolumbar junction (T12-L1) TB (a, b) preoperative anteroposterior and lateral X-rays; c, d preoperative computed tomography (CT); e preoperative 3D reconstruction of CT; f preoperative MRI; g, h) X-ray at 18-month postoperative; i CT at 24-month postoperative; j 3D reconstruction of CT at 24-month postoperative; k, l MRI at 18-month postoperative

Fig. 3

The graph showed a case underwent one-stage anterior debridement, decompression, bone grafting and posterior instrumentation. 38-year-old woman with thoracolumbar junction (T12-L1) TB (a, b) preoperative anteroposterior and lateral X-rays; c, d preoperative CT; e preoperative 3D reconstruction of CT; f preoperative MRI; g, h X-ray at 1-month postoperative; i CT at 6-month postoperative; j 3D reconstruction of CT at 6-month postoperative; k MRI at 13-month postoperative; l lateral X-rays at 56-month postoperative

Fig. 4

The graph showed a case underwent posterior debridement, decompression, bone grafting and internal fixation instrumentation. 18-year-old man with thoracolumbar junction (T12-L1) TB (a, b) preoperative anteroposterior and lateral X-rays; c, d CT preoperative; e 3D reconstruction of CT preoperative; f preoperative MRI; g, h X-ray at 1-month postoperative; i, j CT at 3-month postoperative; k 3D reconstruction of CT at 12-month postoperative; l MRI at 12-month postoperative