ORIGINAL ARTICLE   

Journal of Neurosurgical Sciences 2017 October;61(5):473-80

DOI: 10.23736/S0390-5616.16.03333-6

Copyright © 2015 EDIZIONI MINERVA MEDICA

lingua: Inglese

The role of single-stage posterior debridement, interbody fusion with titanium mesh cages and short-segment instrumentation in thoracic and lumbar spinal tuberculosis

Xiongjie SHEN ¹, Hongzhe LIU ¹, Guoping WANG ¹, Xiaoyang PANG ², Chengke LUO ³, Hao ZENG ³, Zhengquan XU ³, Xiangyang LIU ¹, Xiyang WANG ³ ✉

¹ Department of Spine Surgery, Hunan Provincial People’s Hospital, Changsha, China; ² Department of Orthopedic Surgery, Xiangya Hospital of Central South University, Changsha, China; ³ Department of Spine Surgery, Xiangya Hospital of Central South University, Changsha, China

BACKGROUND: The aim of this paper was to retrospectively analyze the clinical efficacy and feasibility of thoracic and lumbar spinal tuberculosis treated by single-stage posterior debridement, interbody fusion with titanium mesh cages (TMC), and combined short-segment instrumentation.
METHODS: Fifteen patients with no more than two vertebral bodies involving thoracic and lumbar tuberculosis were collected from January 2006 to January 2010, performed by single-stage posterior debridement, interbody fusion with TMC and posterior short-segment fixation. The clinical efficacy was evaluated based on the data of the 10-point Visual Analogue Scale (VAS), neurological status, kyphosis angle, erythrocyte sedimentation rate, and C-reactive protein, which were collected at a certain time.
RESULTS: The average duration of surgery was 135 minutes. All the patients were followed up for a period ranging from 18 to 48 months (mean 28.9±6.44 months). The VAS score was improved from 8.47±1.13 (range 7-10) before surgery to 2.1±1.7 (range 0-2) after surgery. Correction of segmental kyphotic deformity was 24.2±6.59°. Neither the postoperative change of the position of titanium mesh cage nor any posterior instrumentation failure was recorded. The situation of 13 patients with incomplete neurologic lesions before surgery was improved after surgery.
CONCLUSIONS: Patients with thoracic and lumbar spinal tuberculosis can be successfully treated by posterior debridement, interbody fusion with TMC combining short-segment instrumentation. The presence of the TMC anteriorly at the site of tubercular spondylitis has no negative influence on the course of infection healing, and additionally they stabilize the affected segment maintaining sufficient sagittal profile.

KEY WORDS: Surgical mesh - Spinal tuberculosis - Debridement