Posterior debridement, bony graft and instrumentation for upper thoracic tuberculosis

English Keywords:Upper thoracic vertebrae  Spinal tuberculosis  Interbody bone graft  Internal fixation  Posterior approach

English Abstract:

  【Abstract】 Objectives: To investigate the effect and feasibility of posterior debridement, bony graft and instrumentation for upper thoracic tuberculosis. Methods: 14 cases suffering from upper thoracic tuberculosis were admitted to our hospital from May 2006 to April 2011. There were 6 males and 8 females, with an average age of 37 years(range, 18 to 67 years). Based on preoperative ASIA score, there were 1 grade A, 2 grade B, 5 grade C, 3 grade D, and 3 grade D. The kyphosis angel of diseased segments was 26° to 55°(mean, 37°). The involved segments included: T1 to T2 in 1 case, T2 to T3 in 4, T3 to T4 in 5, T4 in 2，and T4 to T5 in 2, and the involved vertebrae were less than two. The defects were limited in local, no abscess was noted in all cases. All cases underwent posterior debridement, bony graft and instrumentation. Results: The operation time ranged from 140min to 270min, 195min in average. The blood loss ranged from 300 to 2500ml, 850ml in average. The follow-up was 6 to 48 months, 18 months in average. 2 cases were complicated with CSF leakage, there was extradural hematoma in 1 case and delayed union of wound in 1 case. Sinus tract, cerebrospinal meningitis and recurrence of tuberculosis were not noted. No instrumental failure was noted. ASIA score improved by 1.14 grades in average. The ESR recovered to normal 6 months after operation in all patients. Solid fusion was achieved within 3 to 8 months, with an average of 5 months. The mean kyphosis angle was 10°(range, 6° to 18°) after operation， with an average correction rate of 73.0%. At final follow-up, the average loss of correction was 2°. Conclusions: Posterior debridement, bony graft and instrumentation is reliable and safe for upper thoracic tuberculosis with localized defect.