Treatment strategy in tuberculous spondylitis: Long-term follow-up results of 55 patients

Abstract

Objectives: We evaluated our treatment algorithm used in adult patients with tuberculous spondylitis together with lon-term treatment results. Methods: The study included 55 adult patients (26 males. 29 females; mean age 50 years; range 23 to 71 years) with tuberculosis spondylitis. The patients underwent four different treatment methods including non-operative treatment (NO, 6 patients), posterior debridement. fusion and instrumentation (PDFI, 21 patients). anterior debridement, instrumentation and fusion (ADIF, 21 patients). and finally, urgent radical debridement (RD, 11 patients) due to financial limitations of the patients. All the patients received antituberculous therapy for 12 months. On presentation. 17 patients (30.9%) had neurologic deficits (ADIF, 6 patients RD, 11 patients). Neurologic assessment was made according to the Frankel grading system. The results were evaluated with respect to kyphosis, sagittal balance. neurologic recovery, and patient satisfaction. The mean follow-up period was 95.3 months (range 66 to 114 months). Results: Radiographically, Successful bone fusion was achieved in all the patients. Following treatment. all surgically treated groups exhibited decreases in the kyphotic angle. The mean correction was significantly greater in ADIF (17.5 degrees) and PDFI (12.1 degrees) groups compared to the RD group (4.9 degrees) (p<0.05). Final increases in the kyphotic angle were 0.7 degrees. 1.2 degrees, 1.4 degrees, and 1.6 degrees in NO, PDFI, ADIF and RD groups. respectively. The mean sagittal deviations in the first postoperative month were +2 mm, +11 mm. +12 mm, and +14 mm in NO, PDFI, ADIF, and RD groups, respectively, which remained unchanged till the end of follow-up. Complete neurologic recovery was obtained in all but one patient. All the patients expressed satisfaction with the treatment. No recurrences or reactivation of disease were observed. Conclusion: This study showed that, with appropriate patient selection, the results of NO, PDFI, and ADIF were satisfactory and comparable.