Anterior instrumentation in tuberculous spondylitis: is it effective and safe?

Radical anterior débridement and strut grafting is the gold standard in the surgical treatment of tuberculosis spondylitis. For many years anterior instrumentation was avoided due to concerns about infection until recently. We investigated the effectiveness and safety of anterior instrumentation for different sites of involvement, number of involved levels, and different age groups in 100 consecutive patients (mean age, 44.3 +/- 12.4). We measured preoperative, postoperative, and final kyphotic deformities radiographically and looked for the presence of fusion. Patients had a minimum followup of 3 years (average, 4.5 years; range, 3-6 years). Addition of anterior instrumentation was effective in the correction of kyphotic deformity (19.8 degrees +/- 7.3 degrees) and facilitated solid fusion, with an average loss of 1.6 degrees +/- 1.8 degrees. Of the 44 patients with neurologic symptoms, 40 (90.9%) achieved full and four (9.1%) achieved partial recovery. There were no apparent pseudarthroses and implant failures. All patients demonstrated clinical healing of tuberculosis without recurrence and reactivation. All domains of the SRS-22 questionnaire showed improvements at the last followup. Anterior instrumentation represents a safe and effective method for the treatment of tuberculosis spondylitis, and it may be the ideal stabilization method thanks to less segment fusion, single approach, and obviating the need for external immobilization.