One stage anterior debridement and titanium mesh instrumentation for thoracic and thoracolumbar tuberculosis

Objective:To evaluate the effect of one stage anterior debridement and titanium mesh instrumentation for thoracic and thoracolumbar tuberculosis.Method:31 cases of thoracic and thoracolumbar tuberculosis undergoing anterior debridement and decompression,interbody fusion with titanium mesh instrumentation from April 2003 to March 2007 were reviewed retrospetively.The were 17 males and 14 females with the age ranging from 21 to 72 years,of these,5 were older than 65 years.Thoracic tuberculosis was noted in 13 cases and thoracolumbar tuberculosis in 18 cases.Among them,6 cases had 1 vertebra involved,21 cases had 2 vertebrae and 4 cases had 3 vertebrae involved with no jumping lesions.All patients presented with local pain and 13 patients presented with paralysis,the average VAS score was 7.4±0.5.According to Frankel grade system,4 cases were grade A,3 were grade B,2 were grade C and 4 were grade D.The average preoperative Cobb angle was 25.3°±8.2° with 9 patients' preoperative Cobb angle larger than 30°,13 cases had posterior wall of involved vertebrae penetrated while 18 cases remained integrity.The surgical outcome was evaluated retrospectively.Result:The average surgical time was 3h,and the mean blood loss was 400ml.All incisions healed primarily,one patient was complicated with pleural effusion which was cured by thoracentesis.No pulmonary infection or respiratory failure was noted.All patients had symptoms relieved and all recovered to ambulate at 2 weeks after operation.All 31 cases were followed up from 24 to 72 months with an average of 41 months.No instrument failure were noted either and all patients got solid bony union with the average fusion time of 4.3 months(range,3-6 months).The average correction rate of the kyphosis deformity was(77.1±15.1)%(preoperative Cobb angle 15.3°±5.2°,postoperative Cobb angle 3.5°±2.1°) with an average loss of correction of 1.5°± 1.0° at follow-up.The mean VAS score improved from 7.4±0.5 to 2.0±1.2.The Frankel scale of 13 patients with paraplegia improved at least one grade.Conclusion:One stage anterior debridement and titanium mesh instrumentation for thoracic and thoracolumbar tuberculosis can ensure good correction of the kyphosis deformity,completely decompression as well as stability reconstruction,which have a good prognosis.