Surgical Outcome and Strategy in the Treatment of Thoracic Spinal Tuberculosis

Objective To investigate surgical strategy and outcome for thoracic tuberculosis. Methods Data of 36 patients,who had undergone surgical treatment for thoracic spinal tuberculosis from May 2005 to May 2009,were retrospectively analyzed. There were 18 cases of male and 18 cases of female; age 17 ~ 60 years old with an average of 32. 2 years. The lesion level was T1 ~ 12,including two levels in 23 cases,three levels in 7 cases,four levels in 6 cases. All patients had varying degrees of kyphosis,kyphosis angle 10° ~ 110°,an average of 21°. Twenty-two patients with neurological deficits. Three antaomical regions were defined: cervicothoracic junction( C7~ T2); middle thoracic spine( T3 ~5) and subaxial thoracic spine( T6 ~ 12).The patients with thoracic tuberculosis were treated by 5 different surgical procedures( anterior cervicothoracic,anterior radical debridement by extrapleural approach,anterior radical debridement by transthoracic approach,posterolateral decompression,posterior). The tuberculous lesion region was completely resected,autologous iliac or rib graft was harvested to complete interbody fusion,and an instrumentation was used to reconstruct the stability of the affected segments. Results All patients were followed up for 18 ~ 48 months postoperatively,with the average of 26 months. All patients'. Erythrocyte sedimentation rate gradually returned to normal after 1 to 3 month. The deformity was corrected to posterior correct angle to 0° ~ 60°,an average of14°36 patients with preoperative kyphosis. Twenty-two patients with neurological deficits showed obvious improvement. Conclusion For patients with thoracic tuberculosis,the surgical methods should be chosen according to the anatomical region and degree of the lesion.