Surgical treatment of recrudescent thoracic or thoracolumbar spinal tuberculosis after posterior fixation

Objective:To explore the surgical measurements and curative effects in the treatment of recrudescent thoracic or thoracolumbar spinal tuberculosis treated by posterior fixation.Method:Fifteen cases of recrudescent thoracic or thoracolumbar spinal tuberculosis treated with posterior fixation in recent 3 years were analyzed retrospectively.Six cases were because of non-remission or aggravation of neurological deficits and worse tubercular toxic symptom.According to the Frankel grading,B grade for 3 cases,C for 1,D for 2.Nine cases presented sinuses.The anti-tuberculosis therapy was used for those patients according to the adjusted plans for 2-8 weeks before re-operation.Five cases were performed dislodgment of transpedicular screw system and routinely surgical treatment by anterior approach(debridement,fusion with rib or Ti-mesh,and plate-screw fixation) in one stage,1 case of 72 years old underwent debridement,Ti-mesh implantation and bone grafting directly without removal of the transpedicular screw systems.Nine cases received sinuses excision,debridement and dislodgment of transpedicular screw system at first time,then the standard anterior approaches were performed on the patients 2 weeks after healing of incision.The patients were given anti-tuberculosis therapy for 1-1.5 years according to the results of drug sensitivity test.The relapse rate,fusion of the bone graft,the status of neurological restoring were all observed in the follow-up.Result:All 15 cases recovered from perioperation.All incisions healed primarily.Seven cases were complicated with intercostal neuralgia.Bacillus tuberculosis infection in all cases were confirmed by pathology.Bacillus tuberculosis was detected and cultured successfully in 8 cases(57.1%).Four strains were drug resistant and in which 1 strain was multi-drug resistant.The time of follow-up ranged from 3 to 32 months(mean,18 months).Six of 15 cases with the neurological deficits recovered partially or completely.No relapse occurred within follow-up period and bone union was found in cases followed up more than 1 year.Conclusion:To the recrudescent thoracic or thoracolumbar spinal tuberculosis treated with posterior fixation,thorough debridement by anterior approach based on directional chemotherapy may be a good choice.