Single stage combined posterior instrumentation and anterior debridement for tuberculosis of thoracic and lumbar spine with paralysis

Objective:To evaluate the efficacy of the single stage procedure combined posterior instrumentation and anterior debridement for treatment of spinal tuberculosis in patients with neurological deficit.Methods:From January 2005 to December 2008,23 patients of spinal tuberculosis combined with paralysis were enrolled in this study.All patients included 13 males and 10 females,and the average age was 32.4 years(range from 9 to 56 years).There were 14 cases located at thoracic region,3 cases at thoracolumbar region,5 cases located at lumbar region;They all had different degree of kyphosis.According to the Frankel's scoring system,there were 5 patients with Frankel Grade B,7 with Grade C,and 11 with Grade D.Sphincter disturbance was observed in 4 patients and 9 patients had nerve root irritation.All patients underwent single stage posterior instrumentation,postlateral bone grafting,and anterior debridement,decompression and fusion.Results:The average follow-up duration was 27 months(ranged from 12 to 60 months).The mean duration of the combined posterior and anterior single session surgery was 285 minutes(ranged from 240 to 360 minutes),and the mean blood loss was 950 ml(ranged from 600 to 1500 ml).All incisions were healed up primarily,and kyphosis correction was good enough.Neurologic deficits were improved by 1.1 level according to Frankel grade system.All 9 patients with nerve root irritation completely released.There was no complication in perioperative and follow-up duration.All patients showed evidence of successful bone fusion.No recurrence of the tuberculous infection at final follow-up.Conclusion:This single stage posterior instrumentation and anterior debridement,fusion spinal surgery was helpful in curing the spinal tuberculosis,correcting the kyphosis and providing solid fusion.