Single-stage Internal Fixation for Thoracolumbar Spinal Tuberculosis Using 4 Different Surgical Approaches

A retrospective study was conducted on 148 spinal tuberculosis (TB) patients (M:F, 92:56; mean age, 39.7±12.3; range, 16-74 y) treated with anterior debridement and bone graft fusion with nail and screw internal fixation (nails+screws group); posterior pedicle screw fixation (pedicle screw group); vertebral arch pedicle internal fixation through a posterior route (posterior arch fixation group); or posterior debridement, bone graft fusion, and vertebral arch pedicle internal fixation (arch fixation group).We investigated 4 variant surgical approaches for internal fixation of spinal TB.The effectiveness of single-stage surgical fixation for different degrees of spinal TB is a matter of debate.Operation time and bleeding volume were recorded. Complications, American Spinal Injury Association (ASIA) score, C-reactive protein, and erythrocyte sedimentation rate were examined preoperatively and 6 months after surgery.Overall, 78, 48, 16, and 6 patients underwent nails+screws, pedicle screws, arch fixation, and posterior arch fixation approaches, respectively. The mean operation times were 175.8±48.8, 308.5±76.7, 143.8±43.0, and 398.3±90.8, respectively (P<0.01). Mean blood transfusion volumes were 1227.1±988.2, 1771.7±794.7, 467.7±123.3, and 2833.3±1083.8 mL, respectively (P<0.01). Primary wound healing was achieved in 127 patients. No patients experienced spinal TB recurrence or failure of bone graft or fixation. All groups achieved significantly improved C-reactive protein and erythrocyte sedimentation rate, but significantly improved ASIA scores were only observed in the nails+screws and pedicle screw groups (P<0.01).Surgical approach limitations and advantages should be considered based on the position and severity of spinal TB infection to maximize functional outcomes and minimize surgical risks.