Surgical Treatment of Spinal Tuberculosis: An Orthopedic Service Experience

Abstract

Introduction: Tuberculosis is responsible for more than 40% of spine infections. While tuberculostatic chemotherapy remains the goldstandard treatment, surgical intervention is necessary only in specific cases. This paper reports the results of 33 patients with spine tuberculosis operated in our department in the last 15 years.
Objective: Evaluate retrospectively patients with spine tuberculosis operated in the last 15 years - from 1996 to 2011; evaluate the surgical options, infection resolution results, deformity correction, functional results and outcome in cases of neurological injury.
Material and Methods: Analysis of clinical and radiological assessments of patients diagnosed with spine tuberculosis and operated between 1996 and 2011. In this period 33 patients were operated with average age of 46.7 years; 17 patients had thoracic infection, 11 patients lumbar infection and 5 thoraco-lumbar infection. Paravertebral abscess was identified in 26 cases with intracanal extension in 16 patients. Nine patients had neurological injury. The anterior surgical approach was used in seven cases, the posterior approach in 11 and anterior-posterior approach was preferred in 15 occasions. Antituberculous chemotherapy was maintained on average for 14
months, with mean follow up of 24 months.
Results: The infection was eradicated in all patients. Bone fusion was found in average at 10.6 months follow-up. The anterior approach did not produce correction of the initial deformity, while the posterior approach allowed average correction of 12.7° and the anterior-posterior approach a mean correction of 8.7°. Five patients with neurological injury experienced improvement of 2 or 3 levels in ASIA score. We also report complications in two cases where superficial wound infection was diagnosed.
Discussion and Conclusion: Treatment with antituberculosis drugs is the first-line therapy in the treatment of tuberculous spondylodiscitis, while surgical treatment has specific indications. The surgical option, when indicated, allows deformity correction and bone fusion. The anterior-posterior or only posterior surgical approach is preferred in this context. The complication rate was not significant despite the introduction of osteosynthesis hardware.