Single-stage transpedicular decompression, debridement, posterior instrumentation, and fusion for thoracic tuberculosis with kyphosis and spinal cord compression in aged individuals

Abstract

Background contextThe single-stage posterior approach only for spinal tuberculosis (TB) has been reported by some surgeons recently, but few studies have reported single-stage transpedicular decompression, debridement, posterior instrumentation, and fusion in treatment of thoracic TB with kyphosis and spinal cord compression in patients older than 65 years. PurposeThe purpose of this study was to investigate the effectiveness and feasibility of single-stage transpedicular decompression, debridement, posterior instrumentation, and fusion in the treatment of thoracic TB with kyphosis and spinal cord compression in aged individuals. Study designThe study used a retrospective review. Patient sampleBetween January 2004 and March 2010, 37 cases of thoracic TB with kyphosis and spinal cord compression in individuals older than 65 were treated with single-stage transpedicular decompression, debridement, posterior instrumentation, and fusion. Outcome measuresThe patients were evaluated based on ASIA (American Spinal Injury Association) classification, kyphotic Cobb angle, fusion status of affected segment via computed tomography scans, and visual analog scale pain score. MethodsThere were 23 men and 14 women with an average age of 72.08±4.49 years (range, 65–81 years). The mean disease duration was 6 months (range, 3 to 21 months). The involved vertebral bodies were T2–T11, including two segments in 29 cases and three segments in 8 cases. The kyphosis Cobb angle was 39.46±4.71° before operation. ResultsThe follow-up period ranged from 24 to 61 months (mean 41.43±3.40 months). No mortality occurred. One case of recurrence due to irregular antitubercular treatment was cured by abscess clearing and regular chemotherapy. A solid fusion was achieved in the other 36 cases. According to the ASIA score system, 10 cases were rated as grade D, and 27 cases as grade E at last follow-up. The kyphosis Cobb angle was 22.32±3.41°, showing significant difference when compared with the value before operation (t=17.146, p<.001). ConclusionSingle-stage transpedicular decompression, debridement, posterior instrumentation, and fusion is an effective and safe method in treatment of thoracic TB with kyphosis and spinal cord compression in aged individuals.