Single-stage anterior debridement, posterior instrumentation and global fusion in thoracic and thoracolumbar tubercular spondylodiscitis.

Abstract

The present study evaluated the clinical and radiological outcomes in patients with tuberculosis of the thoracic and thoracolumbar spine, treated by an operative technique in which anterior debridement with posterior instrumentation and global fusion was performed through a single-stage posterior approach. Ninty-seven patients with spinal tuberculosis, between T1 and L1, in whom anterior debridement, bone grafting, with posterior instrumentation and fusion was performed through a single-stage posterior approach, with a minimum follow-up of 2years, formed the basis of this study. During each follow-up, neurological recovery was assessed using modified American Spinal Injury Association grading, healing of the disease was assessed by appearance of sclerosis and interbody fusion and the degree of kyphotic deformity was analysed using the modified Konstam's angle. Two hundred and twenty-six lesions were found in the radiographs of 97 patients with 28.9% of them having multiple lesions. The mean ± SD preoperative, post-operative, and 2-year follow-up kyphotic angle were 49.5 ± 18.4°, 22.6 ± 7.1° and 24.5 ± 7.6°, respectively, and showed significant kyphosis correction (P < 0.01). Sclerosis was seen as early as 3months in 82(84.5%) patients whereas interbody fusion started appearing at the end of 6months in 38.14% of patients and peaked at 1year. All patients recovered neurologically, with no significant loss of kyphosis correction, at final follow-up. The surgical technique described in this study had favourable clinical and radiological outcomes. Early surgery helps in having a definitive diagnosis and detects the presence of drug-resistant strains.