Surgical treatment of multiple-level noncontiguous spinal tuberculosis.

Abstract

Objective To investigate the methods and results of surgical treatment of multiple-level noncontiguous spinal tuberculosis. Methods A retrospective review of 23 patients with multiple-level non-contiguous spinal tuberculosis who were surgically treated in our department from January 2000 to March 2007. The average age at the time of surgery was 41.5 years(range, 21-65 years). The sites of infection locat-ed at cervical and thoracic region in 3 cases, both at thoracic region in 3, thoracic and thoracolumbar in 6,thoracic and lumbar in 4, thoracolumbar and lumbar in 5, cervical, thoracic and thoracolumbar in 1, cervical, thoracolumbar and lumbar in 1. The mean preoperative angle of kyphotie deformity was 30.6° (range, -5.0°-65.0°). Eleven cases complicated with paraplegia. The surgical procedures of each site include: anterior de-bridement and bony grafting with anterior instrumentation fixation, anterior debridement and bony grafting with posterior fixation, posterolateral eostotransversectomy debridement and interbody fusion with posterior fixation, posterior debridement and posterior fixation,focus debridement only and conservative treatment. The patients were followed up for 1.5-6.0 years, with a mean period of 3.2 years. Results Tuberculous infection was controlled in all patients with no recurrence or reactivation occurred. Bony fusion was achieved in all patients who performed bony grafting. The mean angle of kyphotic deformity was reduced to 14.2 degrees at the final follow-up. Among 11 cases with paraplegia, 7 were completely recovered, 4 were partly improved. Conclusion The selection of the treatment of multiple-level noncontiguous spinal tuberculosis depends on the location, stability, deformity and neurologie status of each focus site. Under the condition of effective an-ti-tuberculosis chemotherapy, nutritional support and accurate preoperative management, all focus sites canbe treated in one-stage operation in most patients with multiple-level noncontiguous spinal tuberculosis. Key words: Tuberculosis; spinal; Surgical procedures; operative; Internal fixators