Treatment of Spinal Tuberculosis of GATA Type III: Primary Posterior Debridement Combined with Osteotomy Parallel to the Endplates for Reconstruction

Abstract

To evaluate the curative effect of one-stage posterior debridement and osteotomy parallel to the endplates for reconstruction, deformity correction, and tuberculosis control on treating the spinal tuberculosis of graded GATA III. From July of 2012 to December of 2017, there were 36 cases from the Second Hospital of Shanxi Medical University with thoracic and lumbar tuberculosis graded GATA III, in which we used osteotomy parallel to the endplates and reconstruction for treatment,16 for males and 20 for females. The local Cobb angles of kyphosis of all patients are greater than or equal to 20.The age varied from 28 months to 72 years with an average of 38.8 years. There were 15 cases of thoracic segment, 12 cases of thoracolumbar segment (T-11-L-2), 9 cases of lumbar segment. Preoperative results of ASIA were 3 cases of grade C,5 cases of grade D and 28 cases of grade E with an average kyphosis Cobb angle of 37.21 +/- 3.28. The visual analogue scale(VAS) scores preoperatively were 0-8 points (averaged 5.58 +/- 1.66 points). All the patients had paraspinal abscesses. After completing the preoperative examinations and evaluations, the osteotomy parallel to the endplates and reconstruction were executed. We made a statistical analysis of the Cobb angles, visual analogue scale(VAS) scores, erythrocyte sedimentation rate (ESR), C-reaction protein(CRP), and ASIA grades before and after the surgery. The following-up time varied from 12 to 24 months, with an average of 18 months. The VAS score improved from 5.58 +/- 1.66 before the surgery to 3.25 +/- 0.92 one month after the surgery and 2.12 +/- 0.73 at the last follow-up. The Cobb angles decreased from 37.21 degrees +/- 3.28 degrees before the surgery to 5.72 degrees +/- 2.66 degrees one month later and 5.99 degrees +/- 1.92 degrees at the last follow-up. The ESR decreased from 55.34 +/- 1.72 mm/1 h before the surgery to 28.22 +/- 3.76 mm/1 h one month later and 11.54 +/- 0.46 mm/1 h at the last follow-up. The CRP decreased from 35.22 +/- 2.46 mg/L before to 12.67 +/- 2.82 mg/L and 4.50 +/- 2.11 mg/L at the last follow-up. The results of the last ASIA grades were 1 case of grade D and 35 cases of grade E. The one-stage posterior debridement and osteotomy parallel to the endplates for patients with spinal tuberculosis of graded GATA III are not only beneficial to spinal reconstruction, but also obtain ideal reconstuction effects.