Using anterior radical debridement with bone fusion and internal fixation to treat adjacent multi-vertebral tuberculosis

Objective To analyze the clinical effect of treating adjacent multi-vertebral tuberculosis by anterior radical debridement, titanium mesh bone fusion and internal fixation. Methods Twenty-four patients with adjacent multi-vertebral tuberculosis were treated by anterior radical debridement, titanium mesh bone fusion and internal fixation from April 2002 to May 2004. There were different types of tuberculosis symptoms in all the cases, including local pain and preoperative kyphosis deformity, and paraplegia in 6 cases. The preoperative kyphosis angle was 27.5°±3.5°. After intensive anti-tuberculosis medication for 2 to 4 weeks before operation, 24 patients were reconstructed with Ti-Mesh filled with autograft rib and anterior internal fixation. After operation, the anti-tuberculosis medication was continued for one year. Results All the patients were followed up for 1.5 to 2.5 years postoperatively, with the average of 1.9 years. Their focus was eliminated completely, all the wounds healed in the first stage. The postoperative kyphosis angle was 5°±2.5°. The average subsidence of Ti-Mesh was (3.5±0.5) mm at 8th weeks postoperation and the loss angle of kyphosis correction was 4.1°±1.0° at lastest follow-up. Ti-Mesh began to fuse 3 to 6 months after operation. No looseness and dislocation were found during follow-up period. 6 patients with paraplegia recovered completely after 6 months, and kyphosis was rectified. ESR of these patients reduced a month after operation and reached to normal level after 6 months. Conclusion Anterior radical debridement, titanium mesh bone fusion and internal fixation show good results in treatment of adjacent multi-vertebral tuberculosis. The large bone deficit in the spine after debridement can be successfully reconstructed and kyphosis can be rectified. As the result of a better stability of the spine, secondary paraplegia can be avoided, and there is no need for iliac bone harvest, so without any relative complications.