Single posterior approach for circumferential debridement and anterior reconstruction using fibular allograft in patients with skipped multifocal spinal tuberculosis.

Abstract

Skipped multifocal spinal tuberculosis (TB) is an atypical presentation of spinal TB. Surgical treatment for these unusual cases remains a challenge for spine surgeons. In our institute, we used single-stage circumferential debridement and anterior reconstruction with fibular allograft followed by posterior instrumentation through posterior-only approach for these patients. This study aimed to determine the efficacy and feasibility of this technique. Twelve patients with skipped multifocal spinal TB who received our treatment method from January 2012 to June 2020 were enrolled in this study. The visual analog score (VAS), laboratory data, comorbidities, complications, and neurologic status based on Frankel scale were recorded. The patients' clinical conditions were evaluated based on modified Brodsky's criteria and Oswestry Disability Index (ODI). All the patients were infection free at the end of the treatment. The average VAS score was 7.5 (range, 7-8) before surgery and decreased to 2.1 (range, 1-3) one year postoperatively. No one experienced any severe complications such as neurologic deterioration, fixation failure, or bone graft dislodgement. Out of the three patients requiring debridement surgery, two had wound infection and one had seroma formation. The ODI score improved from 76.8 (range, 70-84) preoperatively to 25.5 (range, 22-28) one year after surgery. All patients achieved good or excellent outcome based on modified Brodsky's criteria one year postoperatively. In our study, the patients could achieve a good clinical outcome. This technique could be an alternative for patients with skipped spinal TB.