ABSTRACT

Aim:

The aim of the study is to evaluate the results of the surgical treatment of the tuberculosis of the spine which can cause serious complications.

Patients and Methods:

Between 1999 and 2006, 27 patients with a diagnosis of spine tuberculosis which were surgically treated and had a long term follow-up were evaluated. The complaints of the patients, prediagnostic time interval, physical examination, surgical techniques and results of long term follow-up were evaluated.

Results:

Our study group included 12 men and 15 women with a mean age of 53.9 (27- 76). Fourteen patients had thoracic involvement and 13 had lumbar involvement. The major symptom was localized pain and pain was compatible with the involvement level. Weight loss, weakness, fever, night sweats were accompanying as the chronic findings of the disease. In physical examination local tenderness, muscle spasm and loss of range of motion were obvious. None of the patients had severe neurological deficit. Four patients (14.8 %) had loss of power and hypoesthesia. The mean time interval of the symptoms until the definitive diagnosis was 176.3 (10-360) days. As a surgical treatment modality, 5 patients (18.5 %) had anterior debridement and anterior fusion with autogeneous strut grafts, 22 (82.5 %) patients had anterior debridement+fusion and posterior instrumentation and fusion was applied. Depending our long term follow-up, we observed no mortality, 2 (7.4 %) patients had recurrences with inguinal and paravertebral fistulas.

Conclusions:

Late diagnosis, ineffective medical treatment protocols and progressive neurologic deficits make a necessity for surgical procedures in spine tuberculosis patients. Anterior radical debridement and fusion is regarded as the gold standard therapy for single level involved cases, but for multiple level spine tuberculosis patients, adding posterior instrumentation to anterior debridement and fusion, helps to improve stabilization and early mobilization and decreases the amount of correction loss.