Follow-up of 146 spinal tuberculosis patients operated through an anterior approach

Summary From 1978 to 1995, 146 patients with spine tuberculosis were operated through an anterior approach. The mean age of the patients was 42, ranging from 18 to 74. Preoperative neurological deficit was present in 26% of cases. Paraplegia was present in 9 cases and paresis in 29 cases. The TB process was localized in cervical 2%, thoracic 64%, thoracolumbar 15%, lumbar 17% and lumbosacral in 2%. In 96% of the cases two vertebrae were affected with kyphosis and angulation (20–40° in 40%, 40–50° in 36% and over 50° in 24%). All patients had angulation and collapse of vertebral body more than a 1/4 of its height. There are no anamnestic data about smokers and non-smokers. Surgery consisted of anterior approach (thoracotomy, thoracophrenolumbotomy, lumbotomy), excision of the focus, decompression of spinal canal, solid interbody fusion with autogenous grafts (rib autograft in 62%, iliac crest in 18%, vascularised rib in 16%and fibula in 4%) and biopsy. All patients with neurological deficit improved after this type of treatment. Follow-up was possible in 110 patients. On follow-up after completion of treatment-operation, cast and drug, during 8 months none of the patients showed recurrence of disease, increase of deformity or any neurological deficit. Follow-up period was from 14 months up to 9 years. The authors believe that the anterior approach offers several advantages: wide exposure of the lesion, excellent opportunity for decompression and adequate solid body fusion with autografts.