Spinal tuberculosis: early surgical treatment combined with medical treatment

BACKGROUND: Spinal tuberculosis can produce kyphosis with neurological defi cit, despite antibiotic treatment. When there is no response to medical tre atment, the recommended procedure is debridement and interbody fusion with bone autograft. The biological characteristics of Mycobacterium tuberculosi s do not prevent osteosynthesis of the infected bone from being performed. PATIENTS AND METHOD: Five patients with spinal tuberculosis and neurologica l deficit underwent debridement, interbody fusion and anterior osteosynthes is in addition to medical treatment. In order to ensure stability, posterio r fusion was also performed in three patients. All 5 patients displayed wea kness and paralysis of their lower extremities, two patients suffered an L4 radiculopathy, one developed paraparesia and one was excluded due to a sho rt follow-up. Mean value of vertebral kyphosis was 22,8 degrees and mean fo llow-up was 3,1 years. RESULTS: No patient had septic loosening or progression of the disease. Cor rection of kyphosis was 104,5% postoperatively and 80,5% at the end of foll ow-up. All patients, apart from one with an L4 radiculopathy, exhibited neu rological recovery. CONCLUSIONS: Anterior instrumentation allows spinal decompression, septic f ocus debridement, deformity correction and autologous bone grafting. In sev ere kyphotic flattening, it is advisable to associate a limited posterior a rthrodesis. When pathological fractures appear or there is no response to a ntibiotic treatment, the combination of medical and surgical treatment impr oves patients' outcome.