Surgical Treatment of Thoracic Spinal Tuberculosis: A Multicenter Retrospective Study

The aim of the present multicenter, retrospective study was to assess the safety and effectiveness of different surgery strategies for the treatment of thoracic tuberculosis and to provide a reference for surgical treatment of thoracic tuberculosis.

This study reviewed 394 patients with thoracic tuberculosis who were treated in 6 institutions between January 2000 and January 2015. There were 208 men and 186 women with an average age of 34.92 ± 13.14 years (range 5-76 years). A total of 73 patients underwent one-stage anterior surgery (group A); 84 underwent an anterior combined posterior surgery (group B); and 237 underwent one-stage posterior surgery (group C). Clinical outcome, laboratory indexes, and radiologic results were analyzed to observe the advantage of posterior approach surgery.

All cases were followed up for about 26-60 months (average of 37 months). At the last follow-up, all patients reached bone fusion, pain relief, and neurologic recovery. There were significant differences before and after treatment in terms of the visual analog scale and Oswestry Disability Index scores (P < 0.05). Posterior approach significantly improved kyphosis (P < 0.05).

Posterior fixation is superior to anterior fixation in the correction of kyphosis and maintenance of spinal stability. One-stage posterior surgery can achieve the same efficacy as anterior-only or combined surgery, with less trauma, less blood loss, and shorter operative times. However, for wide lesions or paraspinal abscesses, severe bone destruction, and anterior and middle column defects that are too large after debridement to require long segment bone grafting, the anterior combined posterior approach is indispensable.