Anterior instrumentation for the treatment of spinal tuberculosis

Background Kyphosis and neurological impairment are the major residual prob lems of spinal tuberculosis after the microorganism has been eradicated wit h use of appropriate medications. Spinal instrumentation is needed to suppo rt anterior strut grafts in patients who have kyphosis that affects more th an two levels. Most surgeons use posterior instrumentation. Anterior instru mentation, despite its advantages, has not been widely accepted, partly bec ause of concerns about introducing foreign material into infected tissue. T he purpose of the current study was to address those concerns. Methods: Twenty-two patients who had tuberculosis of the spine with moderat e-to-severe localized kyphosis and sixteen patients who had more than two i nvolved levels had stabilization with anterior instrumentation. Antitubercu lous medication was used postoperatively according to a standardized regime n, The patients were followed to determine if there was any recurrence of t he disease and if the correction had been maintained. Results: The twenty-two patients who had involvement of one or two levels h ad an average correction of the deformity of 64 percent (range, 58 to 90 pe rcent), and the sixteen patients who had more than two levels of involvemen t had an average correction of 81 percent (range, 75 to 97 percent). The co rrection was maintained in twenty-one patients, the maximum loss was 3 degr ees in sixteen, and one patient died on the second postoperative day. There was no recurrence of the disease. Conclusions: We believe that anterior instrumentation is more effective tha n posterior instrumentation for reducing the deformity and stabilizing the vertebral column in patients who have kyphosis related to tuberculosis of t he spine.