Clinical efficacy of one-stage posterior debridement, Smith-Petersen osteotomy, compressive fusion and instrumentation for treatment of thoracolumbar tuberculosis

Abstract

Objective To discuss the clinical efficacy and surgical indications of one-stage posterior debridement, Smith-Petersen osteotomy(SPO), compressive fusion and instrumentation for treatment of thoracolumbar tuberculosis. Methods All of 32 patients with thoracolumbar spinal tuberculosis were retrospectively analyzed, treated by one-stage posterior debridement, SPO, compressive fusion and instrumentation from March 2010 to October 2016, including 23 males and 9 females, aged 2 to 77 years old, average (39.2±17.8) years. All patients were treated by preoperative quadruple anti-tuberculosis drugs therapy for 2-4 weeks, postoperative regular chemotherapy for 12-18 months. Preoperative and postoperative changes in clinical symptoms, nervous function, the situation of the erythrocyte sedimentation rate (ESR) and C-reactive protein(CRP) with strict follow-up, as well as other related complications were observed. The spinal fusion rate and fusion situation, changing of the physiological curvature, as well as loosening or breaking of the internal fixation device were detected through regular imaging examination. Results The surgery duration time was 90-150 min, average (120±19.6) min, and the blood loss was 150-600 ml, average (320±88.9) ml. Postoperative follow-up time was 1 to 3 years, average 2.3 years. The symptoms of tuberculosis poisoning in all patients were obviously relieved and the nutritional status was improved gradually. The visual analogue scale(VAS) improvement rate was about 92%. The VAS score in the preoperative and the last follow-up was statistically significant. All patients' ESR and CRP returned to normal levels at the last follow-up. The Kirkaldy-Willis function score showed that the total fine rate was 93.75%. 9 patients with spinal neurological impairment were postoperative improved significantly. Except 1 patient’s Asia grade improved from the B to C, others returned to normal condition. 30 cases recovered. Pleural effusion was observed in 3 cases treated with closed thoracic drainage and antibiotics. The drainage tube was removed after 5-7 d. Incision fistula were observed in 1 patient at 1 month after discharge and recovered after debridement and drugs adjustment. Internal fixation loosening was found in 1 elderly patient after 6 months after surgery which was treated with hyperextended brace and anti-osteoporosis drugs. No tuberculosis recurrence was found. Conclusion One-stage posterior debridement, SPO, compressive fusion and instrumentation is a simple, effective and safety surgical approach, which has great application value for surgical treatment of patients with thoracolumbar spinal tuberculosis. Key words: Thoracic vertebrae; Lumbar vertebrae; Tuberculosis, spinal; Spinal fusion