Evidence & Methods
Surgical intervention for tuberculosis of the thoracic spine often includes radical debridement, fusion, and anterior/posterior instrumentation. The authors of this study assessed outcomes with anterior surgery alone using modern instrumentation.
In this case series report, the authors found fusion rates, kyphosis correction, and functional outcomes to be favorable. No local recurrences of infection were noted.
While the usual limitations of a case series should be noted, there is enough background information on the surgical treatment of tuberculosis to lend reasonable support to the authors' findings.
—The Editors
Tuberculosis continues to be the leading cause of death from infectious disease in the world, and it is causing more widespread concern than ever before [1]. Spinal tuberculosis, the most common pattern of extrapulmonary tuberculosis, also has increased rapidly around the world in recent years, especially in the undeveloped and developing countries [2]. Patients with spinal tuberculosis often have evident collapse of vertebrae because of tuberculous destruction resulting in kyphosis and neurologic deficits. Developments in antituberculous agents are the most important achievements in the management of tuberculosis, and most of the patients with spinal tuberculosis can be successfully treated with effective medication [3], [4]. However, there may be treatment failure because of unresponsiveness or noncompliance with antituberculous chemotherapy. Surgical intervention is sometimes indicated for the patients with severe pain from an expanding abscess, neurologic deterioration from spinal cord compression, sequestered bone and disc, progressive kyphotic deformity, and instability. The goals of surgery are to eradicate the infection and prevent or treat neurologic deficits or spinal deformity [5].
Anterior radical debridement and spinal fusion have been advocated [6] and now widely applied to patients with spinal tuberculosis. A series of controlled clinical trials have been made by the Medical Research Council of the United Kingdom in multiple centers to compare various modes of treatment. The results reported at the 5-, 10-, and 15-year follow-ups [7], [8], [9] indicated that, although a favorable outcome rate of 87% was obtained in all three groups, radical debridement plus anterior spinal fusion was superior to drug treatment or simple anterior debridement, especially when solid fusion and deformity correction are considered [10].
Because anterior radical debridement may further deteriorate biomechanical stability of the spine, anterior grafting with posterior instrumentation has been recommended for stabilization of the involved motion segments and prevention of deformity progression [11], [12]. Supplementary posterior instrumentation and fusion, either simultaneous or staged, as an adjunct to anterior fusion in patients with spinal tuberculosis, particularly when deformity correction is necessary, have greatly improved the outcome [13]. However, the combined procedure was associated with increased operating time, greater blood loss, more postoperative complications, and longer hospital stay [14], [15], although it proved to be a well-documented technique.
We, therefore, report here a group of 42 cases with the exudative stage of thoracic spinal tuberculosis treated by the one-stage anterior radical debridement, decompression and autogenous rib grafts, and instrumentation. The purpose of this study was to determine the efficacy of anterior instrumentation after radical debridement and autogenous bone grafting in patients with spinal tuberculosis over a 4-year period at a single department.