Selecting a surgical approach for incurable tuberculous thoracolumbar kyphosis and analyzing its clinical efficacy

Abstract

Background: Incurable spinal tuberculosis is extremely uncommon, its treatment is challenging and still controversial. We aimed to investigate the efficacy of posterior and combined posterior-anterior surgical approaches for incurable tuberculous thoracolumbar kyphosis. Materials and methods: We retrospectively analyzed 63 cases of incurable tuberculous thoracolumbar kyphosis. The mild group was treated with posterior surgery alone, and the severe group was treated with the combined posterior-anterior surgery. The surgical efficacy was evaluated based on the clinical symptoms, Cobb angle correction rate, SVA, operative time, intraoperative bleeding, and surgical complications. Symptoms and function were assessed using the American Spinal Injury Association (ASIA) spinal cord injury classification, the visual analogue scale (VAS), the Oswestry dysfunction index (ODI), and the Kirkaldy-Willis functional score. The degree of implant fusion was evaluated according to the Eck fusion grading scale. Results: The preoperative Cobb angles were 59.4°±12.6° and 102.9°±16.6°, and the improved postoperative Cobb angles were 19.9°±6.2° and 28.5°±9.6° for the mild and severe groups, with correction rates of 65.5%±12.0% and 72.0%±9.5%, respectively. The Cobb angle losses were 3.1°±1.4° and 4.2°±1.7° at the last follow-up for the mild and severe groups, respectively. The preoperative SVA were 27.6±10.7 mm and 39.1±18.6 mm, which postoperatively improved to 20.6±9.0 mm and 26.4±12.1 mm in the mild and severe groups, respectively. All patients had an ASIA classification of E, except two patients in the severe group with a classification of D at the time of the final follow-up. All patients with bone grafting achieved grade I fusion. The Kirkaldy-Willis functional scores were 89.7% and 85.3% for the mild and severe groups, respectively, except for two case (1 mild and 1 severe group)with broken rods. no tuberculosis recurrence, internal fixation loosening, breakage, and obvious loss of correction were found during the follow-up period. Conclusion: Simple posterior surgery can achieve the desired clinical outcomes in patients with mild non-curative tuberculous thoracolumbar kyphosis. However, in severe patients with accumulated multiple segments, combined posterior-anterior surgery is required for satisfactory deformity correction, complete lesion removal, and significant bone grafting support, making it a safe and reliable treatment method. Level of evidence: IV