Effect of One-stage Posterior Debridment,Primary Grafting and Internal Fixation for the Treatment of Upper Thoracic Tuberculosis Accompanied by Kyphosis

【Objective】To investigate the effect and feasibility of surgical management of upper thoracic tuberculosis by using debridment,primary bone grafting and internal fixation through one-stage posterior approach.【Methods】 Eight cases of upper thoracic tuberculosis had paraspinal abscess,abscess inside the vertebral canal and severe destructed vertebraes less than 3 segments.The kyphosis angle ranged from 26 to 76 degree before operation.ASIA score system was used to evaluate the neurological deficits.The results showed that there were 2 cases in A grade,4 cases in B grade and 2 cases in C grade preoperation.All cases were treated with primary debridement,decompression,interbody grafting and internal fixation by one-stage posterior approach.【Results】 All incisions were healed perfectly without recurrence.All cases with paraplegia obtained an average improvement of grade 1.88 by ASIA neurological classification.The immediate postoperative kyphotic deformity was 8 to 24 degrees and there was no significant loss of the correction at the latest follow up.The ESR decreased to normal level 3 months postoperatively.Solid fusion was achieved within 3 to 7 months,with 5 months in average.【Conclusion】 One-stage debridment,primary grafting and internal fixation from posterior approach is an effective method for treating upper thoracic tuberculosis accompanied by kyphosis while severe destructed vertebraes are less than 3.