Surgical Treatment of Tuberculous Osteomyelitis of the Spine

Abstract

Background and Purpose: Infection of the spine is a serious morbidity for centuries. Even with the recent advances in diagnostic modality, chemotherapy agents and surgical techniques, infections of the spine have remained a formidable challenge to even the most learned of spine specialists(superscript [1,2]). Among infections of the spine, tuberculous osteomyelitis requests special care because of its insidious onset, nonspecific symptoms, its late sequela of structural destruction and deformity, and severe neurologic complications including paraplegia reported in literature(superscript [1,2,3]). Early and aggressive treatment should be given to eradicate the focus (superscript [3,4].) In such cases with neurologic deficit caused by direct compression of the dural sac, either by sequestrated fragments or cold abscess, or in cases with evidences of instability, operation is indicated to stop dissemination of infection, avoid late deformity, and restore neurologic function. Methods: Three senile patients with their ages being 72, 73 and 84 years underwent surgical treatment for tuberculous osteomyelitis of the spine due to either neurologic deficit or instability. Since there was no sings of instability both radiographically and surgically in the 2 thoracic vertebral ostoemyelitis patients, simple partial corpectomy and discectomy was performed with multiple rib grafts used to fill in the defects. The other case was involved in lower lumbar region and x-ray demonstrated gross instability, so anterior corpectomy, discectomy was followed by posterior instrumentation. Results: These 3 cases were followed from 18 months to 31 months with no recurrence of infection and regained ambulation. All of them were satisfied with the treatment and were grateful about the surgery. Conclusion: The clinicians should not be mislead to use conservative treatment for tuberculous spinal osteomyelitis in cases with neurological deficit or instability. These cases should be urged to anterior decompression with strut graft with or without instrumentation, dependent upon whether instability exists or not (superscript [5]). The use of anterior or posterior instrumentation is another issue and is left to surgeon's preference.