[Surgical treatment of previously treated thoracic and thoracolumbar spinal tuberculosis].

OBJECTIVE

To explore the surgical measurements and principles in the treatment of thoracic and thoracolumbar spinal tuberculosis.

METHODS

A total of 232 cases of previously treated thoracic or thoracolumbar spinal tuberculosis in recent 7 years were retrospective analyzed. Preoperative assessments were as follows: Cobb angles of kyphosis: < 30° (n = 65), 30 - 60° (n = 147) and > 60° (n = 20); Frankel B (n = 13), C (n = 12), D (n = 41) and E (n = 166). Forty-eight cases were performed with one-stage transpedicular screw system and anterolateral debridement by single incision, 184 cases with one-stage anterior approach (debridement, fusion and plate-screw fixation) routinely. The tissues and liquor paris debrided from focus were sent for pathology, Bacillus tuberculosis detection and culture, and drug sensitivity test. The patients were given anti-tuberculosis therapy according to the results of drug sensitivity test for 1 - 1.5 years. The follow-up parameters included relapse rate, fusion of bone graft, the status of neurological restoring and kyphosis correction.

RESULTS

All 232 cases recovered from perioperation and 230 cases achieved primary wound healing. Two cases undergoing single incision one-stage posterior instrumentation and anterolateral debridement were complicated with wound healing and sinus formation. There was delayed healed by changing dressings. The complications included intercostals neuralgia (n = 135) and pneumothorax or hydrothorax requiring no special measure (n = 13). The follow-up period ranged from 1.0 to 4.5 years old (mean: 2.6). There was no recurrence within the follow-up period and bone union was found in all cases. All 66 cases with neurological deficits recovered partially or totally. Kyphosis correction was achieved by 27.5° on average postoperatively and showed a mild loss of 4.2° on average during the follow-up period. All cases were confirmed pathologically as Bacillus tuberculosis infection. Bacillus tuberculosis was detected and cultured successfully in 107 cases (46.1%). Forty strains (37.4%) were drug resistant among which 8 strains (7.5%) was multi-drug resistant.

CONCLUSION

For the patients with thoracic and thoracolumbar spinal tuberculosis, directional chemotherapy, one-stage anterior approach with thorough debridement, auto-rib or Ti-mesh fusion and plate-screw fixation may be the first-line therapy.