Treatment of thoracolumbar tuberculosis by transforaminal endoscopic debridement combined with allograft and percutaneous internal fixation

Objective To discuss the feasibility, the advantages and disadvantages, the clinical efficacy and the indications of minimally invasive transforaminal endoscopic debridement combined with allograft and posterial percutaneous internal fixation for thoracolumbar spinal tuberculosis. Methods All of 22 patients with thoracolumbar tuberculosis treated in our department from January 2012 to December 2013 were retrospectively reviewed. There are 11 male and female cases separately, with an average age of 54.1 ±10.2 years and with an average disease duration of 5.3 ± 1.9 months. Endoscopic lesion removal and allograft bone grafting combined with posterial percutaneous immobilization were performed on all these cases. The data of these patients were complete, and all patients had been followed up for more than 36 months. The clinical and radiographic results were recorded and analyzed. Results In this group, 22 patients were followed-up for 41.9±2.5 months(36-48 months). The spinal kyphosis was not improved 3 months after surgery (t=0.3546, P=0.7029), but the amount of blood loss (30.5±7.9 ml) was less in the operation, the amount of postoperative analgesics(0.3±0.1 g) was low and the bed time(1.5±0.3 days) was short. No recurrence and no internal fixation failure was found after long term follow-up. Good clinical outcomes were achieved with the fusion rate reached above grade 2 in all patients(95.5%) except one. The neuralgia was relieved, and the spinal cord injury was recovered to ASIA E. The VAS score and SF-36 score which were recorded 1 month and 3 months after operative were all improved significantly compared with those before operation, and patients’ life quality in the early period after operation was excellent. The incidence of complications was low (9.0%) , and the patients were satisfied with the treatment process. Conclusion It may be a potential way to treat spinal tuberculosis with minimally invasive transforaminal endoscopic debridement combined with allograft and percutaneous internal fixation, which could be a powerful supplement to other therapeutic measures, and is worthy of further research and development. Key words: Thoracic vertebrae; Lumbar vertebrae; Tuberculosis, spinal; Endoscopy; Spinal fusion