Clinical efficacy of the one-stage posterolateral debridement, wedge bone graft and instrument for the treatment of thoracolumbar tuberculosis

Abstract

Objective To investigate the clinical results and the feasibility of one-stage posterolateral debridement, wedge bone graft and instrument for thoracolumbar tuberculosis in adults. Methods Twenty-eight patients with thoracolumbar tuberculosis, from December 2013 to June 2015, including 16 males and 12 females, with an average of 36.4 (from 16 to 59) years, were reviewed retrospectively. Four patient were in T10-11, 4 patients in T11-12, 4 patients in T12-L1, 3 patients in L1-2, and 13 patients in L2-3. Twenty-eight patients were found with the mean VAS grade (6.29±1.27), erythrocyte sedimentation rate (ESR) was (46.29±15.49)mm/1 h and C-reactive protein(CRP) was (32.50±21.55)mg/L preoperatively. ESR and CRP appear abnormal in 27 and 21 patients, respectively. All patients were classified with ASIA grade, 6 patients with grade C, 18 patients with grade D, and 4 with grade E. Twenty-one patients were found with the mean Cobb's angle 24.62°±9.42° (range 12°-46°). Paraspinal abscess was found in 20 patients. All patients were treated by one-stage posterolateral debridement, wedge bone graft combined with instrumentation and regular antituberculosis therapy. The efficacy of the operation was evaluated by observing the VAS grade, the improvement of the spinal deformity, the function of the spinal cord, bone fusion, erythrocyte sedimentation rate and CRP after operation. Results All patients underwent operation successfully, the average operation time was (220.86±11.77) min (210-270 min), and the average blood loss was (562.86±195.99) mL (300-1 100 mL), There was no injury of vessels and nerves, no leakage of cerebrospinal fluid and neurological impairment. The average follow-up period was 16.5 months (12-30 months). The mean VAS score was 1.54±0.58 (range 0-3) points at 14 days after operation, which was significantly decreased compared with preoperative points, there was statistically significance (t=16.168, P<0.01). The kyphosis Cobb's angle in 21 patients was 11.67°±3.37°(7°-19°) at third days postoperatively and 11.26°±3.63°(6°-19.5°) at final follow up, there was statistically significance (t=4.879, 4.900, P<0.01). Nerve function of 4 cases improved to grade D, 24 cases improved to grade E at final follow-up. ESR and CRP returned to normal levels at the last follow-up in 28 patients. Nine cases achieved bone fusion at 6 months, 12 cases at 9 months and 7 cases at 12 months. Twenty-seven patients achieved osseous bone fusion, there was no surgical site infection, and chronic sinus in 27 cases. Because of drug resistance, there was one recurrence of spinal tuberculosis in 40 days postoperatively, which got healed after revision surgery and adjustment of antituberculosis medicine, and there was no failure of fixation during the follow-up. Conclusions One-stage posterolateral total debridement, wedge bone graft and instrument is effective and reliable for thoracolumbar tuberculosis in adults with low complication rate. Key words: Spinal fusion; Tuberculosis; Lumbar vertebrae; Thoracic vertebrae; Single-stage posterior