Anterior debridement may not be necessary in the treatment of tuberculous spondylitis of the thoracic and lumbar spine in adults A RETROSPECTIVE STUDY

作者：Wang S T^*; Ma H L; Lin C P; Chou P H; Liu C L; Yu W K; Chang M C

来源：Bone & Joint Journal, 2016, 98B(6): 834-839.

DOI：10.1302/0301-620X.98B6.36472

Aim
Many aspects of the surgical treatment of patients with tuberculosis (TB) of the spine, including the use of instrumentation and the types of graft, remain controversial. Our aim was to report the outcome of a single-stage posterior procedure, with or without posterior decompression, in this group of patients.
Patients and Methods
Between 2001 and 2010, 51 patients with a mean age of 62.5 years (39 to 86) underwent long posterior instrumentation and short posterior or posterolateral fusion for TB of the thoracic and lumbar spines, followed by anti-TB chemotherapy for 12 months. No anterior debridement of the necrotic tissue was undertaken. Posterior decompression with laminectomy was carried out for the 30 patients with a neurological deficit.
Results
The mean kyphotic angle improved from 26.1 degrees (-1.8 degrees to 62 degrees) to 15.2 degrees (-25 degrees to 51 degrees) immediately after the operation. At a mean follow-up of 68.8 months (30 to 144) the mean kyphotic angle was 16.9 degrees (-22 degrees to 54 degrees), with a mean loss of correction of 1.6 degrees (0 degrees to 10 degrees). There was a mean improvement in neurological status of 1.2 Frankel grades in those with a neurological deficit. Bony union was achieved in all patients, without recurrent infection.
Conclusions
Long posterior instrumentation with short posterior or posterolateral fusion is effective in the treatment of TB spine. It controls infection, corrects the kyphosis, and maintains correction and neurological improvement over time.

• 出版日期2016-6