The role of costotransverse radical debridement, fusion and postural drainage in the surgical treatment of multisegmental thoracic spinal tuberculosis: a minimum 5-year follow-up.

ABSTRACT

PURPOSE: We present a retrospective study of patients with multilevel contiguous tuberculous spondylitis of thoracic region that underwent single-stage posterolateral debridement and fusion and following posterior instrumentation. METHODS: From June 2000 to March 2009, 870 consecutive spinal tubercular patients including 36 patients who were diagnosed and treated as multilevel contiguous thoracic spinal tuberculosis in our institution. Apart from five patients being treated conservatively, the 31 cases received surgery by single-stage posterolateral debridement, fusion, following posterior instrumentation and postural drainage. The patients were evaluated based on the Frankel scoring system, kyphotic Cobb angle, and visual analog scale (VAS) pain score. RESULTS: The mean duration of postoperative follow-up was 79.2 ± 9.9 months (range 62-98 months). Neither mortalities nor any major complications were found. Solid bony fusion was achieved in all patients. No patients with neurological deficit deteriorated postoperatively. According to Frankel scoring system, 7 cases were rated as Grade D, 24 cases as Grade E at last follow-up. The average preoperative Cobb's angle was 32° (range 21°-39°). The average early postoperative Cobb's angle was 23° (range 15°-32°). The mean latest postoperative Cobb's angle was 26° (range 20°-32°), with a small loss of correction at last follow-up. Pre-op VAS was 8.8 ± 0.7 (range 7-10) and final follow-up was 1.8 ± 1.1. There was a significant difference of VAS between preoperation and the final follow-up. CONCLUSIONS: One-stage surgical treatment for multilevel contiguous spinal tuberculosis by posterolateral debridement, fusion, posterior instrumentation can be an effective and feasible treatment method.