One stage anterior and posterior fusion and fixation for the treatment of multiple-level tuberculosis of the upper thoracic spine

Objective To evaluate the efficacy and clinical outcome of one stage anterior and pos-terior fusion and posterior fixation for the treatment of multi-level tuberculosis of the upper thoracic spine. Methods Between March 2000 and August 2003, 20 patients with multiple-level tuberculosis of the upper thoracic spine with kyphotic deformity (Cobb angle 44°±3.2°) and variable degrees of paraplegia (19 cases) were treated surgically. There were 9 males and 11 females with an average of 35.2 years (18-56 years). The location of lesions were T2-5 in 4, T3-5 in 8, T3-6 in 5, T3-7 in 2, and T2-7 in 1. The levels of the lesion were 9 cases for 3 vertebrae, 8 cases for 4, 2 cases for 5 and 1 case for 6. The surgical procedures were one stage anterior debridement, anterior and posterior fusion with autograft and posterior fixation utilizing hook-screw-rod system. All patients were given appropriate chemotherapy for 12-24 months. Results All the incisions were healed without sinus formation or recurrence. Both ESR and CRP were decreased to normal level within 1 to 3 months postoperatively. The mean follow up for this group of patients was 24 months (12-43 months). The average of immediate postoperative correction of kyphotic deformity was 19°±6.5° and there was no sig-nificant loss of the correction (P0.05) at the latest follow up. All the cases achieved solid fusion within 12 months. Nineteen cases with incomplete paraplegia obtained an average improvement of 1.26 grades by Frankel neurological classification. The major complications in this group included one case with temporary deterioration of neurological function. Another case with pulmonary atelectasis on the operation side, but cured with appropriate treatment. Conclusion One stage surgical treatment for multiple-level tuberculosis of the upper thoracic spine by combined anterior and posterior spine fusion with posterior instrumentation is feasible and effective without major complications. Early surgical intervention should be emphasized for the treatment of progressive tuberculosis of the upper thoracic spine.