Pedical fixation for thoraco-lumbar spinal tuberculosis

The Hong Kong method (radical debridement and anterior fusion) has dominated the field of treatment for thoracolumbar tuberculosis for a long time. However, recent reports have proved that anti-tuberculosis medication alone may also have good treatment results for this disease. In our department, we treat patents with anti-tuberculosis medication alone in case there is no evidence of segmental instability. When patients have thoracolumbar tuberculosis with clinical, as well as radiological evidence of spinal instability, transpedicular instrumentation is performed in addition. In our series, 15 patients underwent pedicle fixation for segmental instability due to thoracolumbar tuberculosis. Among them, twelve patients needed a concomitant neural decompression. Thirteen patients had good to excellent operative results. Pull-out of the implant was found in one patient. Persistent lower back pain was found in another patient. Both of these two patients had rather advanced tuberculous infection. In conclusion, transpedicular instrumentation is a good adjuvant for the treatment of early stage of thoracolumbar spinal tuberculosis with evidence of segmental instability.