Revision surgery for spinal tuberculosis with secondary deformity after treatment with debridement, instrumentation, and fusion.

PURPOSE: To discuss the cause and clinical efficacy of revision surgery for secondary deformity after treatment of spinal tuberculosis with debridement, instrumentation, and fusion.

METHODS

From September 2007 to March 2013, 15 patients with postoperative secondary deformity after treatment of spinal tuberculosis were enrolled. Constitutional symptoms, laboratory findings, and radiographic evidence were used to evaluate the secondary deformity conditions and diagnose the recurrence of spinal tuberculosis. All patients underwent revision surgery. The clinical and radiographic data from before and after previous surgery, before and after revision surgery, and after a minimum follow-up of 9 months were retrospectively reviewed.

RESULTS

Among 15 cases of secondary deformity, there were 8 recurrences of spinal tuberculosis. Anterior instrumentation was used in 9 patients, and posterior instrumentation in 6. Regarding previous surgery, the mean number of involved segments was 2 vertebral bodies; a mean of 4 vertebral bodies were fused; the mean preoperative scoliosis of 14.5° was corrected to 6.5° (52.08 % correction); the mean preoperative kyphosis of 56.4° was corrected to 28.9° (44.8 % correction). Before revision surgery, the mean kyphotic angle increased to 58.6° and the mean scoliosis angle increased to 19.6°. New deformity occurred at the primary levels in 11 patients and at the level adjacent to fused segments in 4. After revision surgery, a mean of 8 vertebral bodies were fused; at final follow-up, the mean kyphotic angle was corrected to 26.7° and the mean scoliosis angle was corrected to 2.4°. No neurologic complications were observed during or after revision surgery. No complications with instrumentation and recurrence of spinal tuberculosis were found at final follow-up.

CONCLUSIONS

Recurrence of spinal tuberculosis, incorrect choice of internal fixation strategy, unsuitable fused segments, and poor achievement of sagittal and coronal balance after surgery may lead to secondary deformity postoperatively. Good clinical outcomes were obtained by revision surgery to extend the fused segments, albeit with decreased spinal range of motion.