We retrospectively reviewed 12 patients with
spinal tuberculosis of the thoracic and lumbar spine who had radical débridement, anterior
decompression, interbody
arthrodesis with an anterior interbody
titanium cage, and autologous bone grafts, combined with a standardized perioperative antituberculous regimen. Their mean age was 55.1 years and they were observed for a mean of 65.3 months. Indications for surgery included
epidural abscess, structural destruction with instability, progressive
kyphosis, and/or neurologic deterioration. Kyphotic
deformity was corrected from a mean of 24.6 degrees (range, 15 degrees-32 degrees) to a mean of 10 degrees (range, 4 degrees-18 degrees). Tuberculous
infection was controlled and bony fusion was achieved in all patients. No recurrence of
infection or construct failure was recorded. All patients were safely mobilized within the first postoperative week;
back pain fully resolved in eight patients and improved in the remaining four. We conclude that radical débridement followed by anterior stabilization with a
titanium cage and
bone grafting is a reasonable alternative for tuberculous
spondylitis requiring surgical treatment. It enables accurate and lasting
deformity correction and provides adequate stability to allow
early mobilization. The presence of a
titanium cage in an area of mycobacterial
infection did not preclude infection control or lead to recurrence.
LEVEL OF EVIDENCE: Therapeutic study. Level IV (case series). Please see Guidelines for Authors for a complete description of levels of evidence.