One-Stage Surgical Treatment for Consecutive Multisegment Thoracic Spinal Tuberculosis with Kyphosis by Posterior-Only Debridement, Interbody Fusion, and Instrumentation

OBJECTIVE: To evaluate the clinical efficacy and feasibility of one-stage surgical treatment for consecutive multisegment thoracic spinal tuberculosis with kyphosis by posterior-only debridement, interbody fusion, and instrumentation. METHODS: Sixty-two patients who underwent posterior debridement, interbody fusion, and instrumentation were reviewed for radiographic fusion, region kyphosis, neurologic status, and clinical outcomes. Thoracic Cobb's angle and Frankel grading system were used to assess kyphosis and neurologic improvements, respectively. Operation time, blood loss, erythrocyte sedimentation rate, C-reactive protein, visual analogue scale score, and postoperative complications were recorded to evaluate efficacy and feasibility. RESULTS: The surgery duration was 234.5 +/- 91.3 minutes, with blood loss of 761.3 +/- 598.5 mL. The levels of erythrocyte sedimentation rate and C-reactive protein in all patients decreased gradually to normal within 3 months after the surgery. Kyphosis angle was corrected from 16.9 +/- 10.9 degrees preoperatively to 10.4 +/- 6.3 degrees postoperatively (P < 0.001, t = 5.2) and remained at 12.0 +/- 6.6 degrees at final follow-up (P < 0.001, t = 4.6). Twenty-seven patients obtained neurologic improvement by 1-3 grades. The average visual analogue scale score decreased from preoperative 3.7 +/- 1.0 to postoperative 0.7 +/- 0.9 (P < 0.001, t = 16.4), and then to 0.5 +/- 0.3 at final follow-up (P < 0.001, t = 21.5). All patients achieved bony fusion. Recurrence of tuberculosis was not found in all patients. CONCLUSIONS: One-stage posterior surgery of debridement, interbody fusion and instrumentation could serve as an efficient way to cure patients with consecutive multisegment thoracic spinal tuberculosis.