One-stage posterior debridement, interbody grafting and internal fixation in the treatment of thoracolumbar tuberculosis

PU Xiaobing; KANG Jie; ZHOU Qiang; XIA Hong

doi:10.3969/j.issn.1674-666X.2016.05.004

Abstract：Objective To investigate the clinical outcome of one-stage posterior debridement, interbody grafting and internal fixation for thoracolumbar tuberculosis. Methods Clinical data of 25 patients with thoracolumbar tuberculosis, treated from January 2004 to March 2010 in Guangzhou General Hospital of Guangzhou Military Command, were analyzed retrospectively. All patients underwent one-stage posterior debridement, interbody grafting and internal fixation. Operation time, intraoperative estimate blood loss, hospital stay, American Spinal Injury Association (ASIA) grading and Cobb angle before and after surgery, bony fusion, tuberculosis recurrence and perioperative complications were evaluated. Results The average operation time was 390 min (240-440 mL), the average intraoperative estimate blood loss was 858 mL (200-1 600 mL) , the average hospital stay was 18 d (14-25 d). All patients were followed up for 12 to 62 months with the average of 25.2 months. During the follow-up, recurrence of tuberculosis and internal fixation breakage was found in one case, and then was cured by secondary posterior debridement, internal fixation and anti-tuberculosis treatment. The remains of cases had the evidences of solid bony fusion. For 10 patients with neurological deficit, spinal cord function all improved from preoperative ASIA grade D to postoperative ASIA grade E. For 12 patients with kyphosis, Cobb angle decreased from (24 ± 13)° preoperatively to (8 ± 5)° one week after the surgery, and was (12 ± 7)° at the final follow-up, the differences between preoperation and postoperation had statistical significance (P <0.05). Conclusion One-stage posterior debridement, interbody bone grafting and instrumentation is an alternative choice for thoracolumbar tuberculosis because it could obtain satisfactory deformity correction effect with thorough debridement and high bony fusion rate.