Surgical retreatment of thoracic and thoracolumbar spinal tuberculosis

Abstract

To explore the surgical measures and principles in the retreatment of thoracic and thoracolumbar spinal tuberculosis. Thirty retreatment cases of thoracic and thoracolumbar spinal tuberculosis in recent 3 years were retrospectively analyzed. The patients were hospitalized by inadequate decompression of spinal canal, tubercular toxic symptoms or sinuses. The disease course was an average of 6 months from the last operation. The patients were given anti-tuberculosis therapy according to the adjusted regimens for 2 - 8 weeks before reoperations. Ten cases were performed by anterior approach with debridement, 6 cases anterior approach (debridement, fusion & plate-screw fixation) and 4 cases dislodgment of transpedicular screw system and routine surgical treatment by anterior approach in one primary term. Debridement, Ti-mesh implantation and bone grafting, without taking out of the transpedicular screw systems was performed in 1 case of elder patient older than 70 years old with transpedicular screw system fixation. Nine cases underwent sinuses excision, debridement and dislodgment of transpedicular screw system in first attempt. After 2 - 3 weeks since incision healing, anterior approach was routinely performed. The tissues and liquor puris debrided from focus were sent for pathological examination, Bacillus tuberculosis detection and culture and drug sensitivity test. The patients were given anti-tuberculosis therapy according to the results of drug sensitivity test for 1 - 1.5 years. Follow-ups included relapse rate, fusion of bone graft and status of neurological recovery, etc. All 30 cases recovered from peroperation. The follow-up period ranged from 3 to 32 months (mean: 18 months). Fourteen of 21 cases with neurological deficits recovered partially or totally. All incisions had primary healing. No relapse occurred within follow-up period. All cases were confirmed with Bacillus tuberculosis infection by pathology. Bacillus tuberculosis was detected and cultured successfully in 16 cases (53.3%). Nine strains (56.3%) were drug resistant and in which 4 strains (25.0%) were multi-drug resistant. For the retreatment of thoracic and thoracolumbar spinal tuberculosis, targeted chemotherapy, thorough debridement and reasonable operative options are key to therapeutic success.