Single-stage posterior debridement, decompression and transpedicular screw fixation for the treatment of thoracolumbar junction (T12-L1) tuberculosis with associated neurological deficit: a multicentre retrospective study

Yanping Zeng,Gaoju Wang,Yuan Chen,Jianzhong Xu,Jiulin Tan,Zehua Zhang,Yonghong Zheng,Xun Liu,Wenjie Wu,Jingtong Lyu,Zhilin Li,Litao Li

doi:10.1186/s12891-019-2466-7

Abstract

BackgroundA multicentre retrospective study was conducted to evaluate the safety and efficacy of single-stage posterior debridement, decompression and transpedicular screw fixation for the treatment of thoracolumbar junction (T12-L1) tuberculosis in patients with associated neurological deficit.MethodsThoracolumbar junction (T12-L1) tuberculosis patients (n = 69) with neurological deficit who underwent single-stage posterior debridement, decompression and transpedicular screw fixation from January 2005 to January 2015 were included in the study. Antituberculosis therapy was performed both before and after surgery. The surgery duration and patient blood loss were evaluated, in addition to the change in pain visual analogue score (pVAS), kyphotic angle, Oswestry disability index (ODI) score and American Spinal Injury Association (ASIA) grade assessed preoperatively, immediate postoperatively and at the final follow-up visit.ResultsThe average blood loss was 354 ± 291 mL. The average kyphosis angle was corrected from 21 ± 9° preoperatively to 9 ± 4° postoperatively, with a mean decrease in pVAS and ODI scores of 3.4 and 16, respectively. The postoperative ASIA grading was grade A for five patients, grade C for 15 and grade D for 49 patients, which had improved to grade C for four patients, grade D for three patients and grade E for 62 patients at the final follow-up. The neurological deficit did not worsen in any of the patients.ConclusionsSingle-stage posterior debridement, decompression and transpedicular screw fixation is an effective treatment method in thoracolumbar junction (T12-L1) tuberculosis patients with neurological deficit, with good neurological recovery and no progression of kyphosis.

Highlights

A multicentre retrospective study was conducted to evaluate the safety and efficacy of single-stage posterior debridement, decompression and transpedicular screw fixation for the treatment of thoracolumbar junction (T12-L1) tuberculosis in patients with associated neurological deficit
Surgery is necessary for cases of spinal tuberculosis with spinal instability, neurological deficit and severe and/or progressive kyphosis deformity, as well as for patients who do not respond to chemotherapy or those with a large paraspinal abscess [14]
We report our findings regarding the treatment of patients with thoracolumbar junction tuberculosis and a related neurological deficit by this approach

Summary

Introduction

A multicentre retrospective study was conducted to evaluate the safety and efficacy of single-stage posterior debridement, decompression and transpedicular screw fixation for the treatment of thoracolumbar junction (T12-L1) tuberculosis in patients with associated neurological deficit. Surgery is necessary for cases of spinal tuberculosis with spinal instability, neurological deficit and severe and/or progressive kyphosis deformity, as well as for patients who do not respond to chemotherapy or those with a large paraspinal abscess [14]. Advances in instrumentation systems and techniques have led to the increasing popularity of the posterior approach for the correction of kyphosis and spine stabilisation [20,21,22]. This approach has been proven to be effective for the treatment of many thoracolumbar and lumbar spinal disorders that lead to segmental instability [23]. The treatment strategy for spinal tuberculosis has become more conservative and less invasive [24]

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