Objective: To evaluate the clinical outcomes of anterior radical debridement and autologous ilium or titanium cage interbody autografting with one-stage instrumentation anteriorly or posteriorly for the treatment of thoracic and lumbar tuberculosis.
Methods: Sixty-eight cases of thoracic and lumbar tuberculosis were surgically treated with anterior radical debridement and autologous ilium or titanium cage interbody autografting with one-stage instrumentation anteriorly or posteriorly from Jan 2001 to Feb 2006. Thirty-nine were male and 29 were female age ranged from 28 to 76 years, (average 36.8 years. The course of illness was from 3 months to 1.5 years average 8 months). Fifty-five of them underwent anterior instrumentations, and the remaining underwent posterior instrumentations. All patients were followed up to determine the stages of intervertebral bony fusion and the corrections of spinal kyphosis and the restoration of neurological deficit
Results: The follow-up period ranged from 1.5 years to 5 years (mean 36 months). Sinus formation occurred in 3 cases and healed after continuous dressing changes. The ESR of these patients decreased to normal levels after an average of 3.2 months postoperatively. The functions of feeling, motion and sphincter in 27 cases among all 28 paraplegia cases gradually recovered 24 h to 3 months postoperatively and ASIA grades increased at least one grade at the final follow-up. Only 1 case did not recover at all and ASIA grade did not increase at the final follow-up. Intervertebral bony fusions were all achieved for a mean of 4.8 months (ranged from 3 to 15 months) postoperatively. No internal fixation devices were loose, extracted or broken. Average Cobb angle of kyphotic deformities was 41.2 degree preoperatively and decreased to 13.6 degree at 1 week postoperatively. The average correction was 27.6 degree. The average Cobb angle was 15.8 degree at the final follow-up and the average loss of correction was only 2.2 degree. There were no recurrences in all cases.
Conclusion: The method of anterior radical debridement and interbody grafting with one-stage instrumentation anteriorly or posteriorly was effective for the treatment of thoracic and lumbar spinal tuberculosis.