Extensive thoracolumbar spinal tuberculosis treated with two-stage surgery using a minimally invasive posterior instrumentation

We report the case of extensive thoracolumbar tuberculosis involving eight vertebral bodies, and successful treatment by two-stage surgical procedure using a minimally invasive posterior instrumentation. There have been few reports about widespread spinal tuberculosis in recent years. However tuberculosis is on the rise in the developed countries. This can be attributred to the increase in HIV and immigration from countries where tuberculosis is common. The patient was a 32-year-old female from one of the developing countries with spinal tuberculosis of T7-L2. The delay until diagnosis was about one year. Medical and conservative treatment for eighteen months was not effective to her illness. Two-stage surgical treatment (first: anterior debridement and bone graft; second: minimally invasive posterior instrumentation) was performed. Anterior debridement was adequately performed through the right side thoracotomy at two site, and two weeks after the surgery, posterior instrumentation without additional arthrodesis was performed using a minimally invasive approach. Antituberculous chemotherapy was continued for three months after surgery. Three years after the surgeries, the patient is now completely asymptomatic and has not had a recurrence. The infected anterior site healed and bony fusion was successfully achieved without kyphotic progression.