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Research article
Yunqi Wu
Xiangya Hospital Central South University
Corresponding Author
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Background Multi-segment tuberculosis of the thoracic spine in adults poses a therapeutic challenge due to the complexity of infection and the need for stabilization. Experience with a mid-to-long-term follow-up for management that uses a single-stage debridement through the posterior transforaminal approach coupled with stabilization that uses fusion and instrumentation is presented here.
Methods From January 2007 to October 2015, a total of 42 adult patients were diagnosed with tuberculosis of the thoracic spine that involved 3 or more levels; they underwent a single-stage procedure with posterior transforaminal debridement. The instrumentation, in addition, to interbody fusion was performed for all patients. All patients received the appropriate medical management for tuberculosis. The treatment response was recorded as an improvement on serial biochemical markers (ESR, CRP levels), pain scores, and the measurement of kyphotic angles and spine scores (ASIA, SF-36 scale).
Results At a mean follow-up of 73.5 + 9.6 months, all 42 patients were eligible for final evaluation. The reduction at 3 months and a return to physiological levels of biochemical markers as well as pain scores were noted in all patients at end of treatment. VAS and SF-36 scales were significantly improved compared with preoperative values. In total, 30 patients with a preoperative neurological deficit underwent the procedure and improvement in neurology was noted in all. The mean kyphotic angle loss of 1.7±1.1° was recorded at final the follow-up and bone fusion was observed at a mean of 10.6±2.1 months with no failure of instrumentation. There were no failures of graft lysis or implant breakages noted in this study.
Conclusions Our mid-to-long-term experience with the management of multilevel thoracic tuberculosis in adults demonstrated the ability to offer a single staged procedure for posterior debridement as well as fusion with instrumentation and this approach has shown promising results in this study.
Keywords
Debridement, Interbody fusion, Multilevel thoracic spinal tuberculosis, Posterior approach, Single-stage procedure
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This preprint is under consideration at BMC Surgery. A preprint is a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
Learn more about In Review
Research article
Yunqi Wu
Xiangya Hospital Central South University
Corresponding Author
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
Peer Review Timeline
CURRENT STATUS: Under Review
Version 1
Posted 20 Jan, 2021
No community comments so far
Editorial decision: Withdrawn by author
On 07 Mar, 2021
Editor assigned
On 11 Jan, 2021
Submission checks complete
On 11 Jan, 2021
Editor invited
On 11 Jan, 2021
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
License:
This work is licensed under a CC BY 4.0 License. Read Full License
Background Multi-segment tuberculosis of the thoracic spine in adults poses a therapeutic challenge due to the complexity of infection and the need for stabilization. Experience with a mid-to-long-term follow-up for management that uses a single-stage debridement through the posterior transforaminal approach coupled with stabilization that uses fusion and instrumentation is presented here.
Methods From January 2007 to October 2015, a total of 42 adult patients were diagnosed with tuberculosis of the thoracic spine that involved 3 or more levels; they underwent a single-stage procedure with posterior transforaminal debridement. The instrumentation, in addition, to interbody fusion was performed for all patients. All patients received the appropriate medical management for tuberculosis. The treatment response was recorded as an improvement on serial biochemical markers (ESR, CRP levels), pain scores, and the measurement of kyphotic angles and spine scores (ASIA, SF-36 scale).
Results At a mean follow-up of 73.5 + 9.6 months, all 42 patients were eligible for final evaluation. The reduction at 3 months and a return to physiological levels of biochemical markers as well as pain scores were noted in all patients at end of treatment. VAS and SF-36 scales were significantly improved compared with preoperative values. In total, 30 patients with a preoperative neurological deficit underwent the procedure and improvement in neurology was noted in all. The mean kyphotic angle loss of 1.7±1.1° was recorded at final the follow-up and bone fusion was observed at a mean of 10.6±2.1 months with no failure of instrumentation. There were no failures of graft lysis or implant breakages noted in this study.
Conclusions Our mid-to-long-term experience with the management of multilevel thoracic tuberculosis in adults demonstrated the ability to offer a single staged procedure for posterior debridement as well as fusion with instrumentation and this approach has shown promising results in this study.
Figure 1
Figure 2
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