Single-stage Posterior Debridement Of Anterior Focus, Interbody Bone Grafting, Instrumentation In The Treatment Of The Thoracic And Lumbar Multilevel Noncontiguous Spinal Tuberculosis In Adults

Objective. To evaluate the efficacy of posterior radical debridement of anterior focus and interbody bone grafting and instrumentation in patients with the thoracic and lumbar multilevel noncontiguous spinal tuberculosis.Summary of Background Data. The morbidity of spinal tuberculosis is increasing but multilevel noncontiguous spinal tuberculosis is seldom reported. Moreover, the treatment and surgical methods have been much more rarely reported in the literature.Methods. In our retrospective study, there was a consecutive series of 539 cases of spinal tuberculosis from Sept 2005 to July 2009 in our hospital.Of all these patients, we evaluated 13 patients (9 male and 4 female;average age,47 years) with the thoracic and lumbar multilevel noncontiguous spinal tuberculosis, who underwent single-stage posterior radical debridement, interbody bone allografting, and instrumentation. Antituberculous chemotherapy regimens of 9-12 months'duration with isoniazid, rifampicin and pyrazinamide was given for all the patients ambulatory with braces after surgery. The average follow-up period was 23.5 months (range,13-41 months), which included ESR, kyphosis angle, neural function and graft fusion.Results. The clinical symptoms of all the patients after surgery were disappeared or released. The value of ESR was reduced from an average of 44.5mm/h on admission to an average of 9.7mm/h.The neural improvement of Frankel scale was 1.36 grades averagely. Of all 4 patients with bladder and bowel dysfunction preoperatively, the deficits were disappeared in 2 patients and the function was improved in the other 2 patients.The postoperative kyphosis angle was corrected for 7.4°in thoracic spine,5.1°in thoracolumbar spine,8.0°in lumbar spine and 2.0°in lumbosacral spine averagely. All the patients got bony spinal fusion within 6 to 12 moths by X-ray. No complications happened in all the post-operative patients.Conclusion. Single-stage posterior debridement of anterior focus, interbody bone grafting and instrumentation are a safe and effective method in the treatment of the adult patients with the thoracic and lumbar multilevel noncontiguous spinal tuberculosis.