One-stage combined anterior-posterior approach treatment of multiple cervicothoracic spinal tuberculosis with kyphosis

The purpose of this study was to investigate the clinical efficacy and feasibility of one-stage posterior fixation, anterior debridement, bone grafting and anterior fixation for multiple cervicothoracic spinal tuberculosis with kyphosis.

From December 2006 to June 2011, fifteen patients (seven males, eight females) suffering from cervicothoracic spinal tuberculosis with kyphosis were admitted. The pathologic change regions were as follows: two in the C6-C7 segment, two in the C6-T1 segment, one in the C6-T2 segment, three in the C7-T1 segment, two in the T1-T2 segment, two in the C7-T2 segment, one in the T1-T3 segment, and two in the T2-T3 segment. All patients were treated with one-stage surgical treatment by posterior fixation, anterior debridement, bone grafting, and anterior fixation. Then, the clinical efficacy was evaluated using statistical analysis based on the materials about the Cobb angle of kyphosis, Frankel grade and erythrocyte sedimentation rate (ESR), which were collected at certain times.

All patients ages ranged from 17 to 67 years (average, 40.9 years). Operation time ranged from 180 to 290 min (average, 226 minutes). Intra-operative blood loss ranged from 400 to 1000 ml (average, 650 ml). All patients were followed up for 18-46 months postoperatively (average, 27.7 months). The kyphosis angle was changed significantly between pre-operation and postoperation (P < 0.05), and there was no obvious loss at the last follow-up. The ESR recovered to normal within three months postoperatively in all patients (P < 0.05). Bone fusion was achieved within three to six months (average, 5.5 months). In the 15 cases, no postoperative severe complications occurred and neurologic function was improved in various degrees.

The outcomes of follow-up showed that the one-stage combined anterior-posterior approach can be an effective treatment method for multiple cervicothoracic spinal tuberculosis with kyphosis.