Anterior radical debridement and interbody bone grafting with onestage anterior or posterior instrumentation for treatments of thoracic and lumbar spinal tuberculosis

【Objective】 To evaluate the clinical outcomes of anterior radical debridement and interbody bone grafting with one-stage anterior or posterior instrumentation for the treatment of thoracic and lumbar tuberculosis.【Methods】68 cases of thoracic and lumbar tuberculosis were surgically treated by anterior radical debridement and autogenous ilium or titanium cage interbody bone grafting with one-stage anterior or posterior instrumentation from Jan.2001 to Feb.2006.They were followed up to determine the effectiveness of intervertebral bony fusion,corrections of spinal kyphosis and restorations of neurological deficit.【Results】 The follow-up period ranged from 1.5 years to 5 years(mean 36 months).Sinus tract formation occurred postoperatively only in 3 cases and healed after continuous dressing changes.These patients′ erythrocyte sedimentation rates(ESR) decreased to normal level after an average of 3.2 months after operation.Among all the 28 paraplegia patients,there were 27 patients whose feeling,motion and sphincter functions gradually recovered 24 hours to 3 months after operation and ASIA grades increased at least one grade at final follow-up.Only 1 patient did not recover at all and his ASIA grade did not increase at final follow-up.All the patients achieved complete intervertebral bony fusion for a mean of 4.8 months(ranged from 3 to 15 months) postoperatively.No internal fixation devices were loose,extracted or broken.Average Cobb angle of kyphotic deformity was 41.2° preoperatively and decreased to 13.6° in 1 week postoperatively.The angle maintained 15.8° at final follow-up and average loss of correction was only 2.2°.There were no recurrences in all the cases.【Conclusions】 The method of anterior radical debridement and interbody bone grafting with one-stage anterior or posterior instrumentation is effective for the treatment of thoracic and lumbar spinal tuberculosis.