Treatment of mono-segmental thoracic spine tuberculosis with one-stage posterior focus debridement and internal fixation of inter-centrum non-structural bone grafting

Abstract

Objective To evaluate the clinical efficacy and feasibility of treatment of mono-segmental thoracic spine tuberculosis with one-stage posterior focus debridement and internal fixation of inter-centrum non-structural bone grafting. Methods Retrospective study of patients with mono-segmental thoracic spine tuberculosis who underwent surgery in our hospital from January 2010 to January 2013 was conducted. 27 patients were involved in the study, including 16 male patients and 11 female patients. The age of patients is from 23 to 69 (average age 40.3). 22 patients suffered from combined spinal cord dysfunction. For the classification of ASIA, 2 cases were of Grade B, 8 cases were of Grade C and 12 cases were of Grade D. All patients had obvious bone destruction in thoracic spine shown on CT and MRI before the operation. All patients were given anti-tuberculosis drugs (Isoniazid, Rifampicin, Ethambutol, Streptomycin) for 2-3 weeks, preoperatively. And all patients underwent one-stage posterior focus debridement, and bone particles gained from partial decompression and spina iliaca posterior superior bone particles were planted among the centrum. Pedicle screw fixation was conducted internally. Thoracic vertebra X-ray film and CT were rechecked per 3 months after the operation. Bone grafting fusion and physiological curvature change of thoracic vertebra were evaluated. Results All patients were followed up for 12-24 months with the average time of 21.7±2.3 months. The operating time was 110-190 min (average time 167±35 min) and the bleeding amount during the surgery was 350-700 ml (490±160 ml on the average). The bone grafted in centrum achieved bone fusion with the average fusion time of 6.5±2.4 months. The neurological function was improved for all patients, including 19 cases (Grade 1 improvement) and 3 cases (Grade 2 improvement). The preoperative and postoperative Cobb angles of thoracic vertebra were 47°±11° and 41°±9°, respectively. And it was 43°±10° at the final followup period. Conclusion Based on the standardized treatment of antituberculosis drugs and strong fixation with pedicle screw and rod, one-stage posterior focus debridement and internal fixation of inter-centrum non-structural bone grafting are effective and feasible to treat mono-segmental thoracic spine tuberculosis. Key words: Thoracic vertebrae; Tuberculosis; Internal fixators