Abstract
ObjectiveTo investigate the clinical efficacy and feasibility of posterior-only debridement, internal fixation, and interbody fusion using titanium mesh in the surgical treatment of thoracolumbar tuberculosis (TB) with spinal epidural abscess.MethodsFrom January 2008 to January 2014, a total of 45 patients (27 male and 18 female) were reviewed. The patients were diagnosed with thoracolumbar TB with spinal epidural abscess. The patients underwent posterior-only debridement, internal fixation, and interbody fusion using titanium mesh. Hence, we assessed the intraoperative and postoperative complications, disease recurrences, kyphosis deformity correction, and neurological improvement following the American Spinal Injury Association (ASIA). We used SPSS 22.0 for the statistical analyses. An independent Student’s t-test was used for the analysis of preoperative and postoperative continuous variables. The value of P (P < 0.05) was considered statistically significant.ResultsThe mean age of patients was 37.76 ± 10.94 years (17–59 years). The mean follow-up time was 82.76 ± 12.56 months (60–128 months). The mean kyphosis Cobb angle preoperative was 29.36 ± 13.29° (5–55°) and postoperative was 3.58 ± 5.44° (− 6–13°), given the value of P (P < 0.001). According to the neurological score by the ASIA scale, there were 3 cases of grade B, 11 cases of grade C, 16 cases of grade D, and 15 cases of grade E preoperatively. The neurological score improved by 1 ~ 2 grades. All patients achieved pain relief and the VAS score significantly reduced at the last follow-up (P<0.05). While 1 patient had cerebrospinal fluid leakage, 1 had a neurological complication, 1 had delayed surgical wound healing, and 1 had a disease recurrence. No pseudoarthrosis or implant failure occurred in our patients. All patients achieved solid bone graft fusion.ConclusionFor thoracolumbar TB patients with spinal epidural abscess, posterior-only debridement, internal fixation, and interbody fusion using titanium mesh are safe and effective surgical treatments.
Highlights
Spinal tuberculosis (TB) called Pott’s disease, is the most common and severe form of osteoarticular TB
If TB remains uncontrolled after conservative treatment, surgery is considered as an effective treatment for patients affected by bone destruction, angular deformity, spinal instability, paraspinal or spine canal abscess, or nerve impairment
Thoracolumbar spine TB, in combination with the spinal canal abscess, can induce nerve damages caused by spinal cord compression
Summary
Spinal tuberculosis (TB) called Pott’s disease, is the most common and severe form of osteoarticular TB. If TB remains uncontrolled after conservative treatment, surgery is considered as an effective treatment for patients affected by bone destruction, angular deformity, spinal instability, paraspinal or spine canal abscess, or nerve impairment. The surgical strategy for the treatment of Pott’s disease is to meticulously debride the diseased lesion, provide standard anti-tuberculosis chemotherapy, alleviate the symptoms of nerve compression, correct kyphosis deformity, and restore spinal stability. Thoracolumbar spine TB, in combination with the spinal canal abscess, can induce nerve damages caused by spinal cord compression. For thoracolumbar spine TB patients, active surgical treatment is recommended. Bone grafting, and anterior- or posterior- internal fixation operations have been considered as the standard methods for the treatment of spinal TB; these methods always lead to substantial surgical trauma [1, 2]
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