Modified single-stage transpedicular decompression, debridement, and posterior instrumentation in treatment of thoracic tuberculosis

Objective: To investigate the effectiveness and feasibility of modified single-stage transpedicular decompression, debridement, and posterior instrumentation in treatment of thoracic tuberculosis.

Methods: Between January 2005 and December 2009, 22 cases of thoracic tuberculosis were treated with modified single-stage transpedicular decompression, debridement, and posterior instrumentation. There were 12 males and 10 females with an average age of 39.4 years (range, 22-52 years). The mean disease duration was 1.2 years (range, 3 months to 10 years). The involved vertebral bodies were T5-12, including 2 segments in 17 cases and 3 segments in 5 cases. The kyphosis Cobb angle was (31.2 +/- 14.5) degrees before operation. According to Frankel score system for neurological deficits, 2 cases were classified as grade A, 1 case as grade B, 8 cases as grade C, 5 cases as grade D, 1 case as grade E, and 5 cases had no neurological deficits before operation.

Results: All incisions healed by first intention. All patients were followed up 22.2 months on average (range, 12-65 months). Pain in low back was relieved in varying degrees 2 weeks after operation. Fusion was achieved in the bone implant area at 3 months after operation. According to Frankel score system, 1 case was rated as grade B, 2 cases as grade C, 4 cases as grade D, 7 cases as grade E, and 8 cases had no neurological deficits at last follow-up. The kyphosis Cobb angle was (16.2 +/- 3.6) degrees, showing significant difference when compared with the value before operation (t = 5.952, P = 0.001). No loosening, emersion, breakage of internal fixation or pneumothorax occurred 1 year after operation.

Conclusions: Single-stage transpedicular decompression and posterior instrumentation is an effective and safe method in treatment of thoracic tuberculosis.