Clinical Evaluation of Surgical Treatments for Ten Cases of Tuberculous Spondylitis.

Whee, Sung Mock; Eoh, Whan; Nam, Do Hyun; Lee, Jung Il; Kim, Jong Soo; Hong, Seung Chyul; Shin, Hyung Jin; Park, Kwan; Kim, Jong Hyun

Original Article

Journal of Korean Neurosurgical Society 2001;30(11): 1314-1319.

Sung Mock Whee, Whan Eoh, Do Hyun Nam, Jung Il Lee, Jong Soo Kim, Seung Chyul Hong, Hyung Jin Shin, Kwan Park, Jong Hyun Kim

Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.

ABSTRACT

OBJECTS: Because of the nonspecific nature of symptoms in tuberculous spondylitis, a delay in the diagnosis can result in progressive neurologic deficits. The authors evaluate the clinical and the radiological results of the 10 cases of surgically treated tuberculous spondylitis. CLINICAL MATERIALS AND METHODS: We retrospectively analyzed the medical records of 10 patients with tuberculous spondylitis who were treated between February 1996 and March 2000. Six patients were female, and four were male. Mean age was 43 years old, and mean follow-up period was 20.5 months. All patients were treated with 12 months of antituberculous medication postoperatively, and were followed by complete blood count, ESR, spine X-ray and MRI.
RESULTS
The lumbar spine was involved in 5 patients, the thoracic in 4, and the thoracolumbar in one. The infected vertebral bodies were 2.8 in average. The associated lesions were pulmonary tuberculosis in 3 cases, and renal tuberculosis in one. Five patients were treated by anterior debridement and fusion with bone graft using anterior instrumentation, 2 with anterior debridement and fusion with bone graft(Hong Kong procedure only), 1 with Hong Kong procedure with posterior spinal instrumentation, and 2 were managed with posterior debridement and posterior spinal instrumentation. All patients improved after operation, and the average kyphotic angle decreased postoperatively. Postoperatively, one patient had a fistula at the operative site.
CONCLUSION
The debridement and minimal level fusion of motion segment with instrument fixation is one of surgical option for tuberculous spondyltis to preserve the spine motion segment as much as possible. Spine instability and kyphosis were prevented by anterior and posterior spinal instrumentation. But, large number of cases and longer period follow-up study in future will be needed to confirm the long term results.

Key Words: Tuberculous spondylitis; Spinal instrumentation; Hong Kong procedure