One-stage surgical management for children with spinal tuberculosis by anterior decompression and posterior instrumentation

The goal of this study was to assess the efficacy of one-stage surgical management for children with spinal tuberculosis by anterior decompression, bone grafting, posterior instrumentation, and fusion. Between January 2002 and December 2006, 15 cases with spinal tuberculosis were treated with one-stage posterior internal fixation and anterior debridement. All cases were followed-up for an average of 30.3 months (range 12–48 months). The average neurological recovery in the patients was 0.93 grades on the scale of Frankel et al. (Paraplegia 7:179–192, 1969). The average preoperative kyphosis was 36° (range 19–59°), and the average postoperative kyphosis was 23° (range 15–38°) at final follow-up. At final follow-up, minimal progression of kyphosis was seen, with an average kyphosis of 27° (range 16–40°). An average loss of correction of 4° was seen at final follow-up. One-stage surgical management for children with spinal tuberculosis by anterior decompression, bone grafting, posterior instrumentation, and fusion was feasible and effective

The results of simultaneous posterior–anterior–posterior surgery in multilevel tuberculosis spondylitis associated with severe kyphosis

We retrospectively studied the cases with tuberculous spondylitis of thoracolumbar region with two or more levels of involvement that underwent posterior instrumentation and fusion and anterior fusion with titanium mesh following anterior decompression using simultaneous successive posterior–anterior–posterior surgery. Among all patients with tuberculous spondylitis accompanied by medium or severe kyphosis, 20 patients who underwent simultaneous successive decompression, fusion and instrumentation with posterior–anterior–posterior surgery between 1999 and 2004 were included in the study. Patients were evaluated for fusion formation and neurological and functional status. Kyphosis angles were measured at early and long-term follow-up. Antituberculosis chemotherapy was initiated in all patients and continued for 9 months; initially as quadruple therapy for 3 months, and then as triple therapy. Average follow-up period was 52.7 months (range 37–94). Solid fusion was achieved in all patients. All patients returned to their previous occupation; 75% (15 subjects) with mild pain or no pain and 15% (3 subjects) with major limitations. There were 11 patients with neurological deficit, 9 of these achieved complete neurological recoveries. Regarding kyphosis angle, an average 35.1° correction (84.8%) was obtained in postoperative period (p < 0.001) and there was no significant correction loss during the follow-up period (p < 0.05). There were no grafts or instrumentation-related stabilization problems. In subjects with tuberculous spondylitis with involvements at two or more levels accompanied by medium and severe kyphosis, decompression, fusion and instrumentation by simultaneous successive posterior–anterior–posterior surgery is an effective and safe management method for effective kyphosis correction with high fusion rates