Transpedicular Decompression/Debridement and Posterior Spinal Fusion With Instrumentation for Single-Level Thoracic Spinal Tuberculosis With Myelopathy-Is Anterior Column Reconstruction Necessary?

Spine Deform. May-Jun 2018;6(3):282-289. doi: 10.1016/j.jspd.2017.09.051.


Objectives: The purpose of this study is to study the safety and efficacy of single-stage transpedicular decompression/debridement and instrumented posterior spinal fusion for single-level thoracic spinal tuberculosis with myelopathy without anterior column reconstruction.

Summary of background data: Existing literature has many reports of transpedicular decompression/debridement and instrumented posterior spinal fusion with anterior column reconstruction. The quoted loss of correction is around 2°, but there is no strong evidence analyzing the loss of kyphosis correction, assessment of fusion in the same, without anterior column reconstruction.

Study design: Retrospective study.

Methods: Study consisted of 57 patients of single-level thoracic tuberculosis with myelopathy from a single center who fulfilled the selection criteria. All underwent pedicle screw-rod instrumentation (2 up and 2 down), bilateral transpedicular decompression/debridement of granulation tissue/abscess, followed by instrumented posterior spinal fusion with local bone/B-tri-calcium phosphate. Patients were analyzed clinically (ASIA scoring) and radiologically by radiographs for kyphosis correction and CT scans at 2 years (for assessment of fusion). The grade of destruction was correlated with loss of kyphosis correction and neurologic improvement.

Results: There are 43 female and 14 male patients with a mean age of 46.7 years (18.4-74.2), mean follow-up of 3.4 years (2.1-8.4). The mean pre-op Cobb angle is 26.4° and mean correction obtained is 12.6° (47.8%). The mean loss of kyphosis after 2 years' follow-up is 3.6° (13.6%). The mean American Spinal Injury Association (ASIA) grade improvement after surgery is 1.05 (p = .001). There is no correlation observed between neurologic recovery and grade of destruction (R = -0.11). There is no correlation between the improvement in kyphosis and neurologic recovery (R = -0.05). Two-year postoperative CT scan showed solid interbody (55 patients) and posterior fusion (57 patients).

Conclusion: Significant neurologic recovery, kyphosis correction, and posterior/interbody bony fusion can be obtained by transpedicular decompression/debridement and instrumented posterior spinal fusion (without anterior reconstruction) with maintained correction at 2 years.

Keywords: Anterior reconstruction; Myelopathy; Posterior spinal fusion; Single staged transpedicular fixation; Spinal tuberculosis; Transpedicular decompression.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Debridement
  • Decompression, Surgical
  • Female
  • Humans
  • Male
  • Middle Aged
  • Retrospective Studies
  • Spinal Cord Diseases / etiology
  • Spinal Cord Diseases / surgery*
  • Spinal Fusion / instrumentation
  • Spinal Fusion / methods*
  • Spinal Fusion / statistics & numerical data
  • Thoracic Vertebrae / surgery*
  • Tuberculosis, Spinal / complications
  • Tuberculosis, Spinal / surgery*
  • Young Adult