Purpose: To investigate the clinical efficacy and feasibility of surgical treatment for thoracic spinal tuberculosis with neurological deficit by one-stage posterior instrumentation, proper transpedicular debridement, without anterior instrumentation and without anterior or posterior bone graft.
Methods: A total of 19 cases with thoracic tuberculosis, neurological deficit and bone destruction (without severe kyphosis) admitted to the hospital from May 2005 to January 2010 were treated by internal fixation, transpedicular debridement without bone graft via the isolated posterior approach. Operating time, blood loss, complications, neurological function, deformity correction, pain relief, and inter-body fusion were investigated.
Results: The average mean operating time was 168.9 ± 21.1 min. The average blood loss during operation was 655.8 ± 82.8 ml. All patients were followed for 28-46 months post-operation (average, 36.8 ± 5.8 months). All patients had significant postoperative improvement in ASIA classification scores and VAS scores. The thoracic kyphotic angle was significantly decreased to 11.6°-20.2° after operation (average, 15.6° ± 2.2°), and the angle was 12.3°-21.6° (average, 16.4° ± 2.2°) at final follow-up. No severe complications or spinal cord injury occurred. The erythrocyte sedimentation rate and C-reactive protein recovered to normal within 3 months after operation in all patients. All patients have got spontaneous bony fusion within 6-9 months after surgery.
Conclusions: One-stage posterior instrumentation, transpedicular debridement without bone graft can be an effective and feasible treatment method for selected thoracic spinal tuberculosis.