Surgery for spinal tuberculosis: a multi-center experience of 582 cases

J Spine Surg, 2015 · DOI: 10.3978/j.issn.2414-469X.2015.07.03 · Published: December 1, 2015

Simple Explanation

Tuberculosis (TB) of the spine is a common site of osseous TB, accounting for 50%-60% of cases. Spinal TB still occurs in both developed and developing countries. The treatment for spinal TB remains a difficult and challenging decision making process, given the lack of evidence and guidelines on the optimal treatment and management strategies. The objective of this study is to evaluate the efficacy and clinical outcomes of different treatment approaches of spinal TB, including decompression surgery, autogenous bone grafting and anti-TB chemotherapy.

Study Duration

January, 2003 to July, 2014

Participants

582 patients with TB of the cervical, thoracic and lumbar spine with moderate to severe cord compression

Evidence Level

Not specified

Key Findings

1
Neurological improvement occurred in all patients except for 2 cases (0.3%).
2
Preoperatively, a large proportion of patients (n=221, 38%) were classified as Class A on the ASIA neurological impairment scale. This was significantly reduced postoperatively to 0.4%.
3
For final outcomes, 70% of patients were rated as “excellent” upon follow-up, 15% of patients were rated as “fair”, 10% of patients were rated as “good” and 5% of patients were rated as “poor”.

Research Summary

A total of 582 patients with TB of the cervical, thoracic and lumbar spine with moderate to severe cord compression were studied. Variable degrees of neurological deficit with deformity were treated from January, 2003 to July, 2014. For patients with spinal TB anterior debridement, auto graft bone fusion, anterior or posterior fixation appears to be effective in arresting disease, correcting kyphotic deformity and maintaining correction until solid spinal fusion. Our prospective series demonstrates that surgical treatment of spinal TB and Pott’s disease is safe and effective, with good clinical and radiological outcomes.

Practical Implications

Effective Surgical Treatment

Surgical treatment combined with chemotherapy is a safe and effective approach for treatment of spinal TB infections, leading to neurological improvement in most patients.

Debridement and Stabilization

Surgery allows for thorough debridement, decompression of the spinal cord, and adequate spinal stabilization, contributing to improved patient outcomes.

Kyphosis Correction

Anterior debridement, auto graft bone fusion, and anterior or posterior fixation are effective in correcting kyphotic deformity and maintaining correction until solid spinal fusion.

Study Limitations

1
Lack of statistical comparison between anterior versus posterior surgical approaches for spinal TB
2
Did not demonstrate any significant differences in terms of operation duration, blood loss, body fusion, follow-up complications and neurological status between surgical approaches
3
The duration of anti-TB chemotherapy still remains a concern for the patient and clinician

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