Clinical outcomes of posterior debridement, bone graft and internal fixation for complicated thoracolumbar tuberculosis

Abstract

Objective To assess the clinical effect,safety,indications and techniques of posterior debridement,bone graft and internal fixation for complicated thoracolumbar tuberculosis.Methods Twenty-eight patients from June 2008 to August 2012 were retrospectively analyzed.15 males and 13 females with an average age of 34 (7 to 58) years old were evaluated.Thoracic,thoracolombar and lumbar lesions were found in 12,7 and 9 cases,repectively.There are 12 cases with single segment,12 cases with two segments and 3 cases with at least three segments.7 cases with psoas abscess,13 with neurological defect and 17 with kyphosis.All patients had undergone posterior debridement transforaminally and paravertebrally,combined with bone graft and internal fixation.Anti-TB treatment was given to all patients.The curative effect of tuberculosis,neurologic function and angle of kyphosis were observed in regular follow-up time.Results All patients were followed up for an average of 20.7 (12 to 57) months.26 cases were cured 12 to 18 months postoperatively.One patient had two recurrence,which were successfully treated with reoperations.Although one child was found with loosening of internal fixation,she got full fusion.Only one case was evaluated to be grade D in ASIA scoring,while others were completely recovered.The average preoperative kyphosis angle was 37.1 °± 18.5°,compared to 13.6°±9.8° postoperatively.At the final follow-up time,the average kyphosis angle was 15.8°± 10.3°.Serious perioperative complications occurred in 2 cases.One with massive hemorrhage was cured after interventional embolization and reoperation,while the other with infection was cured after reoperation.Conclusion The clinical outcomes of posterior debridement,bone graft and internal fixation for complicated thoracolumbar tuberculosis are satisfactory.Effective lesions debridement,canal decompression,kyphosis correction,bone graft and stable fixation can be achieved in this operaion with fewer traumas.However,there's still a problem in debridement and a risk of damaging vascular during this operation,which needs further research. Key words: Thoracic vertebrae; Lumbar vertebrae; Tuberculosis, Spinal