Thoracic Tuberculous Spondylitis: Posterior Approach Single-Stage Stabilization, Debridement, and Local Grafting

Abstract

Background: Different approaches are employed to treat patients with Pott’s disease who are candidates for surgical intervention. Each of these approaches has advantages and disadvantages. Objectives: This retrospective study presents the surgical, clinical, and radiological outcomes of posterior alone single-stage debridement and grafting of single-level tuberculous discitis using local graft from the decompression and nearby spinous processes. Patients and Methods: Between 2012 to June 2016, 15 patients with thoracic tuberculous spondylitis were operated up through posterior approach starting with one side fixation thorough debridement of the lesion and the use of local graft form decompression and spinous process bone. Clinical evaluation was done using Visual Analogue Scale (VAS) for back pain, Oswestry Disability Index (ODI), and Frankel Grade classification. Radiological assessment of kyphotic angle and fusion was also performed. Results: The mean operative time was 115.3 ± 23.6 minutes. The mean amount of blood loss was 571.3 ± 142.4 ml. Hospital stay ranged from 3 to 7 days (mean 4 ± 0.6 days). Patients were followed for 30.27 ± 6.5 months. All patients showed significant improvement in clinical and radiological parameters. Twelve patients showed neurological improvement. One patient required reoperation for neurological deterioration. Radiological follow-up showed solid fusion within 6 months postoperatively. Conclusion: Single-stage debridement of thoracic Pott’s lesion with the use of transpedicular fixation and local graft under perioperative coverage of antitubercular chemotherapy yielded satisfactory results avoiding the need for the more morbid and technically demanding anterior procedures and the graft donor site morbidity.