Tuberculosis of the thoracic spine - A classification based on the selection of surgical strategies

In spinal tuberculosis MRI can clearly demonstrate combinations of anterior and posterior lesions as well as pedicular involvement. We propose a class ification system, using information provided by MRI, to help to plan the ap propriate surgical treatment for patients with thoracic spinal tuberculosis . We describe a series of 47 patients, divided into four groups, based on t he surgical protocol used in the management. Group A consisted of patients with anterior lesions which were stable with no kyphotic deformity, and wer e treated with anterior debridement and strut grafting. Group B comprised p atients with global lesions, kyphosis and instability who were treated with posterior instrumentation using a closed-loop rectangle with sublaminar wi res, and by anterior strut grafting. Group C were patients with anterior or global lesions as in the previous groups, but who were at a high risk for transthoracic surgery because of medical and possible anaesthetic complicat ions. These patients had a global decompression of the cord posteriorly, th e anterior portion of the cord being approached through a transpedicular ro ute. Posterior instrumentation was with a closed-loop rectangle held by sub laminar wires. Group D comprised patients with isolated posterior lesions w hich required posterior decompression only. An understanding of the extent of vertebral destruction can be obtained fro m MRI studies. This information can be used to plan appropriate surgery.