Treatment of thoracic or lumbar spinal tuberculosis complicated by resultant listhesis at the involved segment

Abstract

PurposeThe purpose of this study was to present a singular pathological process of thoracic or lumbar spinal tuberculosis contributing to listhesis at the involved site, with special focus on clinical features and management of this disorder. MethodsWe retrospectively reviewed the medical records of 14 patients (5 males and 9 females, including 2 boys) admitted to our institution from April 2007 to March 2010 and were subsequently diagnosed with thoracic or lumbar spinal tuberculosis with resultant listhesis at the involved level. All patients underwent posterior instrumentation and reduction combined with single-stage anterior radical debridement and interbody fusion. Patients were followed-up clinically and radiographically. ResultsThe average follow-up duration was 54.6 months. All patients had a successful fusion. Complete reduction was achieved in 10 cases. Preoperative neurological injury was observed in six patients and all recovered after surgery. The average postoperative Frankel grade improvement was 1.2. The preoperative median value of the extent of listhesis was 26.2%, which fell to zero at the final follow-up (Z=−3.296, P=0.001). Pre- and postoperative median spinal stenosis rates were 45.9% and 8.4%, respectively (Z=−3.296, P=0.001). The preoperative neurologic level was positively correlated with the listhesis distance before surgery (rs=0.770, P=0.001). Postoperatively, the spinal stenosis rate was positively correlated with listhesis distance (rs=0.691, P=0.006). The correlation between neurologic level and age or spinal stenosis rate was not significant. The standardized coefficient of listhesis distance was greater than that of spinal stenosis rate in our multiple linear regression analysis model. No implant failure or recurrence of tuberculosis occurred. ConclusionTreatment of this rare pathology aims to restore good spinal alignment, radical debridement, and permanent stability. A reasonable surgical strategy may be the combination of posterior reduction, anterior debridement, and supportive graft fusion. This strategy can safely and effectively achieve all of the therapeutic goals in one step.