Purpose The purpose of this study was to present our
experience in treating dorso-lumbar tuberculosis by one-stage
posterior circumferential fusion and to compare this group
with a historical group treated by anterior debridement
followed by postero-lateral fusion and stabilization.
Methods Between 2003 and 2008, 32 patients with active
spinal tuberculosis were treated by one-stage posterior
circumferential fusion and prospectively followed for a
minimum of two years. Pain severity was measured using
Visual Analogue Scale (VAS). Neurological assessment
was done using the Frankel scale. The operative data,
clinical, radiological, and functional outcomes were also
compared to a similar group of 25 patients treated with
anterior debridement and fusion, followed 10–14 days later
by posterior stabilization and postero-lateral fusion.
Results The mean operative time and duration of hospital
stay were significantly longer in the two-stage group. The
mean estimated blood loss was also larger, though
insignificantly, in the two-stage group. The incidence of
complications was significantly lower in the one-stage
group. At final follow-up, all 34 patients with pre-operative
neurological deficits showed at least one Frankel grade of
neurological improvement, all 57 patients showed significant
improvement of their VAS back pain score, the mean kyphotic
angle has significantly improved, all patients achieved solid
fusion and 43 (75.4%) patients returned to their pre-disease
activity level or work.
Conclusion Instrumented circumferential fusion, whether in
one or two stages, is an effective treatment for dorso-lumbar
tuberculosis. One-stage surgery, however, is advantageous
because it has lower complication rate, shorter hospital stay,
less operative time and blood loss.