Surgical treatment of thoracic and lumbar tuberculosis by anterior interbody fusion and posterior instrumentation.

OBJECTIVE To evaluate the efficacy and clinical outcome of simultaneous or sequential anterior and posterior surgical approaches in the management of spinal tuberculosis in the form of anterior extirpation of the tuberculous lesion, strut bone grafting of the defect produced and posterior instrumentation for spinal fixation. SUBJECTS AND METHODS Twenty-two patients who had tuberculosis of the thoracic and lumbar spine with moderate to severe localized kyphosis and variable degrees of neurological deficits were treated at Al Razi Hospital (Kuwait) in the period from 1998 to 2000 by anterior debridement and autogenous strut bone grafting with simultaneous or staged posterior spinal fixation using either USS or SOCON spinal instrumentation. Appropriate antituberculosis treatment was given to all patients for 9-12 months. The postoperative follow-up period was 18 months. RESULTS Of the 22 cases the average of preoperative kyphosis was 42 degrees. The average of immediate postoperative correction was 27 degrees. At the last follow-up the average correction was 24 degrees and the loss of correction did not exceed 3 degrees. Average fusion times were 5 months for one-segment fusions and 8 months for two-segment fusions. There was no recurrence of the disease in any of the cases. CONCLUSION Posterior instrumental stabilization and anterior interbody fusion were found to be effective in arresting the disease, correcting kyphotic deformity and maintaining correction until solid spinal fusion.