One-stage posterior approach for the treatment of tuberculous spondylitis with kyphosis

Abstract

Background Patients with Pott's disease who are candidates for surgical intervention can be approached posteriorly, anteriorly, or combined. Each of these approaches has advantages and disadvantages. In this study we evaluated the results of one-stage posterior approach by using anterolateral rachotomy with radical excision of the lesion, correction of kyphotic deformity, and fixation with trans pedicular screw fixation (TPSF) in 22 patients with thoracic tuberculous spondylitis with kyphosis. Patients and methods A total of 22 patients with thoracic tuberculous spondylitis with kyphosis were treated by using the one-stage posterior approach. Preoperatively all patients were suffering from pain, and had neurological deficit (20 Frankle B and two Frankle C). The maximum kyphotic angle was 45°, whereas the minimum was 25°. All cases underwent radical excision of the lesion, strut iliac graft, and TPSF through posterior approach. Results Immediately postoperatively all patients showed improvement in pain severity; all patients with neurological deficits improved within 2 months after surgery; hematological parameters demonstrated a significant clinical improvement in all patients. Radiological follow-up showed solid fusion within 6 months in 20 patients. The mean kyphotic angle was corrected from 30 to 15° after surgery. Conclusion Anterolateral rachotomy of thoracic Pott's lesion by using radical excision of the lesion, strut iliac bone graft, and TPSF under the umbrella of antituberculous preoperative and postoperative give satisfactory results without the need for the more morbid and technically demanding anterior or combined procedures in patients with mild kyphosis (<45°).