Background
Thoracic spinal tuberculosis is still common, and surgical treatment can rapidly relieve pain, correct deformity, reduce bone loss and prevent further damage to neurological function. We have practiced an efficient and safe surgical method.
Methods
From January 2013 to April 2019, 38 patients with thoracic spinal TB were included in our study. Debridement and bone grafting were performed via the lateral extracavitary approach, combined with two different fixation method. Data from these cases were analyzed retrospectively.
Results
The average surgical duration was 297.0±68.4 min, average intraoperative blood loss was 702.6±252.0 ml, postoperative hospital stay was 11.1±3.6 d, and C-reaction protein (CRP) and erythrocyte sedimentation rate (ESR) of all the patients decreased to normal levels at the last follow-up. The average Visual Analog Scale (VAS) score was 7.5±1.6 preoperatively and 0.6±0.8 at the last follow-up, which was significantly reduced compared with that before surgery. The average kyphosis correction was 6.3±4.7° and the angle loss was 1.4±1.6°. Neurological functions of all cases were significantly improved According to the American Spinal Injury Association (ASIA) classification. Solid fusion was observed in all cases at the last follow-up. One patient presented sinus tract formation at the incision site and the other two patients had rupture of the parietal pleura intraoperatively. No severe complications such as spinal cord injury or great vessel injury were found in all patients.
Conclusions
Debridement and bone graft fusion via the posterolateral extracavitary approach combined with two fixation methods can both achieve high efficacy in the treatment of thoracic spinal TB. Lateral single screw-rod fixation is more suitable for patients with single-segment lower thoracic lesions and high stability, with less blood loss and shorter surgical duration. Posterior pedicle screw fixation has higher strength, and is more suitable for patients with multi-segment lesions, poor stability and complex conditions.