Transpedicular Decompression/Debridement and Posterior Spinal Fusion With Instrumentation for Single-Level Thoracic Spinal Tuberculosis With Myelopathy—Is Anterior Column Reconstruction Necessary?

Abstract

ObjectivesThe purpose of this study is to study the safety and efficacy of single-stage transpedicular decompression/debridement and instrumented posterior spinal fusion for single-level thoracic spinal tuberculosis with myelopathy without anterior column reconstruction. Summary of Background DataExisting literature has many reports of transpedicular decompression/debridement and instrumented posterior spinal fusion with anterior column reconstruction. The quoted loss of correction is around 2°, but there is no strong evidence analyzing the loss of kyphosis correction, assessment of fusion in the same, without anterior column reconstruction. Study DesignRetrospective study. MethodsStudy consisted of 57 patients of single-level thoracic tuberculosis with myelopathy from a single center who fulfilled the selection criteria. All underwent pedicle screw-rod instrumentation (2 up and 2 down), bilateral transpedicular decompression/debridement of granulation tissue/abscess, followed by instrumented posterior spinal fusion with local bone/B-tri-calcium phosphate. Patients were analyzed clinically (ASIA scoring) and radiologically by radiographs for kyphosis correction and CT scans at 2 years (for assessment of fusion). The grade of destruction was correlated with loss of kyphosis correction and neurologic improvement. ResultsThere are 43 female and 14 male patients with a mean age of 46.7 years (18.4-74.2), mean follow-up of 3.4 years (2.1-8.4). The mean pre-op Cobb angle is 26.4° and mean correction obtained is 12.6° (47.8%). The mean loss of kyphosis after 2 years’ follow-up is 3.6° (13.6%). The mean American Spinal Injury Association (ASIA) grade improvement after surgery is 1.05 (p = .001). There is no correlation observed between neurologic recovery and grade of destruction (R = −0.11). There is no correlation between the improvement in kyphosis and neurologic recovery (R = −0.05). Two-year postoperative CT scan showed solid interbody (55 patients) and posterior fusion (57 patients). ConclusionSignificant neurologic recovery, kyphosis correction, and posterior/interbody bony fusion can be obtained by transpedicular decompression/debridement and instrumented posterior spinal fusion (without anterior reconstruction) with maintained correction at 2 years.