A 270° Retention of Spinal Structure in the Treatment of Thoracic and Lumbar Tuberculosis via Posterior-Only Approach

Abstract

Objective The necessity of radical debridement in the treatment of thoracic and lumbar tuberculosis is increasingly challenged. We introduce the 1-stage surgical treatment with 270° retention of the spinal structure via a posterior-only approach and investigate the clinical efficacy and feasibility of this method in treating thoracic and lumbar spinal tuberculosis. Summary of Background Data In former research articles, many potential disadvantages are found in the treatment of thoracic and lumbar tuberculosis after radical debridement, such as prolonged operative time, increased the surgical trauma, unsatisfactory bony fusion, instability of the spine, and too much blood loss. Methods Twenty-one patients who had thoracic and lumbar tuberculosis were admitted to our hospital between January 2013 and September 2014. All of them were treated with 1-stage surgical treatment by internal fixation, focal debridement, and fusion via the posterior-only approach. Then, the clinical efficacy was evaluated, with the Cobb angle reflecting spinal kyphotic angles, erythrocyte sedimentation rate (ESR), Frankel Grade scores, and imaging examination preoperatively and postoperatively. Results Patients were followed up for 24 to 40 months (mean, 29.95 months), Fusion occurred at 4 to 9 months (mean, 5.86 months). There were significant differences between groups regarding the Cobb angle, ESR, and Frankel Grade scores. Delayed wound healing affected 1 patient because of diabetes. No complications regarding the internal fixation and no tuberculosis recurrence were observed during follow-up. Conclusions Combined with anti-tuberculosis chemotherapy, the method, characterized by 270° retention of the spinal structure, can be an effective and feasible method in treating thoracic and lumbar spinal tuberculosis.