Anterior Debridement and Strut Graft with Pedicle Screw Fixation for Tuberculous Spondylitis

Abstract

Study Design: This is a retrospective study Objective: We analyzed the clinical and radiographic results of surgical treatment for patients with tuberculous spondylitis. Material and Methods : Our study included 18 active tuberculous spondylitis patients (12 males and 6 females) who underwent anterior curettage, strut bone grafting and posterior instrumentation. Their average age was 50.1 years (age range: 24-76 years). The mean follow-up was 43 months. Vertebral bodies from T5 to L5 were involved. The anterior column support was iliac autograft in 10 patients and titanium mesh in 4. All the patients had transpedicular instrumentation with an additional hook in 3 and anterior instrumentation in 1. Except for one paraplegic patient, all the others were able to ambulate wearing TLSO. The mean duration of Anti-Tbc medication was 13.3 months (range: 12 to 18 months). The clinical and radiographic results were analyzed, and they included the segmental kyphotic angle and the complications of instrumentation on the involved vertebrae. Result: The subjective satisfaction was greater than good except for 2 patients. These 2 patients’satisfaction was fair due to incomplete neurologic recovery and persistent BG-donor site pain. The three paraplegic patients fully recovered postoperatively. The mean correction of the segmental kyphosis was 13°. The mean correction loss was 0.7°at the final follow-up. Pedicle screws were inserted in the involved vertebrae for 10 patients (n = 30). There was no loosening of instrumentation nor spread or recurrence of infection. One case was complicated by pneumonia. Conclusion: For the surgical treatment of active tuberculous spondylitis, anterior column support with strut grafting and posterior instrumentation is mandatory in the destabilized spine after anterior debridement or the correction of kyphosis.