A Comparative Study of anterior Interbody Fusion with and without Anterior Instrumentation in Multi-level Tuberculosis of Thoraco-Lumbar Spine

Cho, Duck Yun; Kim, Eung Ha; Koh, Eun Sung; Cho, Kye Nam

Abstract

The anterior decompression and anterior interbody fusion have been the choice of surgical treatment for spinal tuberculosis since 1960. But, multi-level spinal tuberculosis involved more than three vertebrae resulted in large post-debridement defect and spinal instability. So, failure of the graft was very common & postoperative maintenance of the kyphotic angle correction was very difficult. In part of such cases as multi-level spinal tuberculosis, we performed supplementary anterior instrumentation in a single-stage procedure. The authors analyzed total 39 surgical cases of multi-level tuberculosis of the thoracolumbar spine from January 1985 to June 1992. The patients treated only with a strut graft were designated as group I(n=23) and the patients added by anterior instrumentation as group II(n=16). Mean age of 39 cases was 33.1 years, and mean follow-up period was 31.6 months. The purpose of this study was to compare the postoperative results of group I with those of group II by measuring the angular kyphosis on serial lateral roentgenograms, and to provide an aid in selecting method of surgery before treatment of multi-level spinal tuberculosis with high risk of progression of kyphosis. The results were as follows: 1. There were 16 cases of thoracolumbar, 14 cases of thoracic, 9 cases of lower lumbar lesions, and numbers of vertebrae involved were 4.2 in mean. 2. By standard Cobb lateral measurement, mean preoperative angle of segmental kyphosis was 32.5° in group I, and 45.1° in group II, and group II proved as more kyphotic. After operation, mean angle of segmental kyphosis was 24.7° in group I and 32.4° in group II. 3. On final F/U, mean angle of segmental kyphos was 32.7° in group I, and 37.3° in group II, and final loss of correction was 8.0° in group I, 4.9° in group II. 4. There were 8 patients(34.8%) of graft-related complications in Group I, and 2(12.5%) in group II. And graft failure in group I resulted in severe loss of correction of segmental kyphosis, but graft failure in group II did not, through graft protection by anterior instrumentation. 5. There were 3 patients(18.8%) of implant-related problems in group II; two during and one after union. In these former two cases, bony union was obtained without loss of correction by prolonged application of brace. No cases of group II was associated with persistence or recurrence of infection after instrumentation. In our opinion, anterior interbody fusion and combined anterior instrumentation can be effective and safe one of methods in surgical treatment for multi-level tuberculosis of the spine which has been considered as the most important determinant of the result by its extensive vertebral involvement with resulting large post-debridement defect to be struted.