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Design: This a retrospective study in single centre., Objective: The objective of this retrospective clinical study is to compare the long-term clinical efficacy of posterior long-segment and short-segment fixation with single-stage transpedicular debridement and fusion for the treatment of thoracolumbar spinal tuberculosis in adults., Methods: Sixty-six cases of thoracolumbar tuberculosis were treated by single-stage transpedicular debridement, bone graft fusion, and pedicle screw fixation. Thirty-five cases were under long-segment fixation (group A) and 31 cases were under short-segment fixation (group B). These patients were followed up for a minimum of five years. The clinical and radiographic results for these patients were analyzed and compared., Results: All 66 patients were completely cured during the follow-up. All patients had significant improvement of neurological condition and visual analogue scale pain scores at the final follow-up. The average operation duration and blood loss in group A were more than that in group B. Kyphosis Cobb angle of both groups was significantly corrected after surgical management. The correction rate of Cobb angle in group A was significantly higher than that in group B at the time of immediate post-operative period or the last follow-up (P < 0.05). The correction loss of group A was significantly less than that in group B (P < 0.05)., Conclusion: Both posterior long-segment and short-segment pedicle screw fixations for the treatment of thoracolumbar spinal tuberculosis have significant effects in the correction of kyphosis and the improvement of neurological function. Although the blood loss and operation time of long-segment fixation were more than that of short-segment fixation, long-segment fixation was superior to the short-segment fixation in the correction of kyphosis and the maintenance of spinal stability, especially in the prevention of long-term correction loss.

Aim: The aim of this retrospective clinical study is to evaluate the long-term outcomes for single-stage transpedicular debridement, posterior instrumentation and fusion in the management of thoracic and thoracolumbar spinal tuberculosis in adults., Methods: Fifty-nine adult patients with thoracic and thoracolumbar spinal tuberculosis underwent single-stage transpedicular debridement, posterior instrumentation and fusion. These patients were followed for a minimum of 5 years. Patients were assigned to one of two groups according to the infected anatomic segment. In the thoracic spinal tuberculosis group, there were 28 cases (17 males, 11 females) with a mean age of 38.9 years; in the thoracolumbar spinal tuberculosis group, there were 31 cases (19 males, 12 females) with a mean age of 40.3 years. All cases were evaluated clinically using the visual analog scale (VAS), Kirkaldy-Willis criteria and the American Spinal Injury Association (ASIA) impairment scale. Radiographs were performed for measuring the angle of kyphosis and scoliosis. Complications related to surgery were recorded., Results: All patients successfully resolved their infections, experienced one or more ASIA grades of improvement, and improved in their VAS pain scores at final follow-up. In both groups, patient-reported outcomes reached over 90% excellent or good results using Kirkaldy-Willis criteria. The loss of kyphotic angle correction was 2.6° in the thoracic spinal tuberculosis group and 3.2° in the thoracolumbar spinal tuberculosis group. No scoliosis was observed in either group. Fifty-eight (98.3%) cases achieved solid bony fusion. In the thoracolumbar spinal tuberculosis group, one patient experienced screw loosening, and another patient with nonunion and rod breakage underwent revision surgery., Conclusions: The technique of single-stage transpedicular debridement, posterior instrumentation and fusion is an effective method for the treatment of thoracic and thoracolumbar spinal tuberculosis in adults. Long-term postoperative clinical and radiological outcomes were satisfactory.

Background: There are quite a few controversies on the surgical management of single-segment thoracic spinal tuberculosis with neurological deficits (STSTND). In this study, the clinical efficacy and feasibility of one-stage posterior-only transpedicular debridement, interbody fusion, and posterior instrumentation for treating STSTND in adults were retrospectively evaluated., Methods: Thirty-four cases with STSTND underwent one-stage posterior-only transpedicular debridement, interbody fusion and posterior instrumentation at the same institution from January 2003 to January 2013. Follow-up time was 34.4 ± 10.2 months (range, 18-48 months), and kyphosis angle was 34.1 ± 12.3°. The American Spinal Injury Association (ASIA) classification of spinal cord injury was employed to evaluate neurological deficits, while visual analogue scale (VAS) was employed to assess the degree of pain. Erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) were used to evaluate the activity of tuberculosis (TB)., Results: All 34 patients with spinal tuberculosis (ST) were completely cured, and there was no recurrence of TB. Postoperative kyphosis angle was 8.2 ± 1.8°, and there was no significant loss of correction during the final follow-up. Solid fusion was achieved and pain was relieved in all cases. Neurological condition in all patients improved after surgery., Conclusions: One-stage posterior-only transpedicular debridement, interbody fusion, and posterior fixation followed by chemotherapy seems to be adequate for obtaining satisfactory healing of single-segment thoracic spinal tuberculosis with neurological deficits. Careful patient selection is critical to the successful outcome with this technique.

Purpose: To evaluate the efficacy and safety of single-stage posterior debridement, compact bone grafting and posterior single-segment fixation for the treatment of mono-segmental lumbar tuberculosis., Methods: We enrolled 32 patients with mono-segmental lumbar tuberculosis from January 2005 to April 2011. The severity of damage to the vertebral bodies is not more than 2/3 height. All the patients were treated by single-stage posterior debridement, compact bone grafting and posterior single-segment fixation., Results: Patients were followed 21-63 months (43.5±9.5 months). The average Cobb angle decreased to 5.3±3.0° postoperatively from 22.1±6.1° preoperatively. Meanwhile, average 1.8±1.0° loss was observed at last visit. Fusion occurred at 3-9 months (mean 5.1 months). All patients with preoperative neurologic deficit recovered in different degree. 1 with grade B recovered to grade D; 2 with grade C recovered to grade E; 18 with grade D recovered to grade E. No mortality occurred. One patient experienced anti-tuberculosis drug-induced liver dysfunction which was managed successfully with modified anti-TB treatment and hepato-protective treatment. The Oswestry Disability Index decreased from 40.1±4.0 preoperatively to 13.7±3.1 postoperatively., Conclusions: Single-stage posterior debridement, compact bone grafting and posterior single-segment fixation is an effective method for the treatment of mono-segmental lumbar tuberculosis., (Copyright © 2015 Elsevier Ltd. All rights reserved.)

Purpose: To investigate the clinical efficacy and feasibility of one-stage surgical treatment for thoracic spinal tuberculosis with adjacent segments lesion by internal fixation, transpedicular debridement, and combined interbody and posterior fusion via a posterior-only approach., Materials and Methods: Twenty-one patients (thirteen males, eight females) with thoracic tuberculosis whose lesions were confined to two adjacent segments were studied retrospectively. All patients were treated with one-stage surgical treatment by internal fixation, transpedicular debridement, and combined interbody and posterior fusion via a posterior-only approach. The American Spinal Injury Association (ASIA) impairment scale was used to assess neurological function. Thoracic Cobb angle was used to assess thoracic kyphosis. Operating time, blood loss, complications, neurological function, deformity correction and interbody fusion were investigated., Results: Average mean operating time was 231.4 ± 31.9 min, and evaluated blood loss during operation was 880.2 ± 112.7 ml. All patients were followed up for 22-41 months postoperatively (average 29.8 ± 5.4 months). All patients had significant postoperative improvement in ASIA classification scores. The thoracic kyphotic angles were significantly decreased to 9°-25° postoperatively (average 16.7° ± 4.4°), and at final follow-up were 10°-27°(average 17.7° ± 4.4°). No severe complications or spinal cord injury occurred. The erythrocyte sedimentation rate recovered to normal within 3 months postoperatively in all patients. All patients got bony fusion within 6-9 months after surgery., Conclusions: One-stage transpedicular debridement, posterior instrumentation and combined interbody and posterior fusion via a posterior-only approach can be an effective and feasible treatment method for thoracic spinal tuberculosis.

Purpose: Retrospective analysis of the clinical efficacy and feasibility of patients with thoracolumbar spinal tuberculosis with psoas abscesses treated by one-stage posterior transforaminal lumbar debridement, interbody fusion, posterior instrumentation, and postural drainage., Method: A total of 18 patients with thoracolumbar tuberculosis (TB), between February 2007 and February 2011, underwent one-stage posterior transforaminal lumbar debridement, interbody fusion, posterior instrumentation, and postural drainage. And the clinical efficacy was evaluated based on surgery duration time, the blood loss, the postural drainage of time, neurological status that was recorded by American Spinal Injury Association (ASIA) Impairment Scale, the fate of bone graft fusion, kyphosis angle, erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP), which were collected at certain time., Results: The average follow-up period was 34 months (range 18-48 months). 18 patients suffered from seriously neurological deficits pre-operatively, of which 16 patients returned to normal at final follow-up. The surgery duration time was 197 ± 37.9 min, and the blood loss was 815 ± 348.5 ml. The postural drainage of time was 7.2 ± 2.7 days. The psoas abscesses disappeared in all cases, within the time range of 6-9 months (mean 7.4 ± 1.2 months). All patients of the grafted bones were thoroughly fused, with a fusion time ranging from 4 to 12 months (mean 7.8 months). Kyphosis angle was 44.32 ± 7.26° on average pre-operative and returned to 11.72 ± 2.85° at 6 weeks after operation; kyphosis angle was 13.10 ± 2.39° at final follow-up. The values of ESR and CRP were significant declined at 6 weeks post-operative, and returned to normal levels at final follow-up., Conclusion: With standardized anti-TB chemotherapy, thoracolumbar spinal tuberculosis with psoas abscesses could be effectively treated by one-stage posterior transforaminal lumbar debridement, interbody fusion, posterior instrumentation, and postural drainage.

Background: There is limited evidence to guide treatment for pediatric cervical spinal tuberculosis with kyphosis (PCSTK). This study retrospectively evaluates the safety, feasibility and efficacy of 360-degree arthrodesis combined with anterior debridement and decompression for treating PCSTK, while simultaneously emphasizing the role of posterior fixation for the correction and maintenance of the kyphosis angle. Methods: From May 2006 to December 2012, a total of 12 children with PCSTK underwent 360-degree cervical spinal arthrodesis followed by debridement of focus and decompression of the spinal cord. Data on the angle of kyphosis correction, visual analogue scale scores of pain, the American Spinal Injury Association scoring system of nerve function scores, erythrocyte sedimentation rate (ESR) and body weight were collected at certain periods. Clinical efficacy was evaluated by statistical analysis based on collected data. Results: Average follow-up period was 34.3 ± 8.6 months. No postoperative complications related to the instrumentation occurred, and neurologic function improved in various degrees. Preoperative kyphosis angle was 41.4 ± 5.2°, and significantly decreased to -4.9 ± 4.9° after surgery. The correction of kyphosis and loss of correction were 47.1 ± 4.9° and 0.6 ± 1.4°, respectively. Average pretreatment ESR was 49.8 ± 13.2 mm/h, which normalized (8.5 ± 0.6 mm/h) within three months in all patients. Average preoperative visual analogue scale was 6.6 ± 1.6, which decreased to 2.3 ± 1.4 postoperatively and 0.3 ± 0.5 during the final follow-up. Mean preoperative body weight was 25.9 ± 5.1 kg, and body weight was 33.5 ± 4.8 kg at the third month of post-operation. Bone healing was achieved in all patients after a mean period of 5.4 months. Conclusions: 360-degree arthrodesis combined with anterior debridement and decompression is a safe and effective method for the treatment of PCSTK. For the correction and maintenance of the kyphosis angle, additional posterior fixation is recommended. [ABSTRACT FROM AUTHOR]