Our results of single stage, debri̇dement, decompression, fusion and posterior instrumentation in vertebra tuberculosis

Aim: Nowadays vertebral tuberculosis has anterior, posterior and combined surgical treatment methods, single-stage surgery from posterior is more preferred due to less comorbidity compared to anterior interventions. The aim of this study was to examine the clinical and radiological results of patients who underwent single-stage debridement, decompression, fusion and posterior instrumentation in vertebral tuberculosis. Materials and Methods: Twelve patients who underwent surgery for vertebral tuberculosis between 2014 and 2019 in Dicle University Medical Faculty Orthopedics and Traumatology Department were retrospectively analyzed. Preop radiography, MRI, CT, laboratory (CRP and ESR), tuberculosis history, functional and neurological conditions of the patients were questioned.Kyphosis angle in the post op radiography and final control radiographs and post op CRP, ESR and pathology results were evaluated. Neurological status of the patients were evaluated according to the Frankel scale, and their functional results were evaluated with VAS and Oswestry scales. Results: In our study, 8 (66.7%) were female and 4 (33.3%) were male. The mean age was 46.17 ± 15.9 (15-6) years and the mean follow-up was 34.92 (15-75) months. Average hospital stay was 8.25 days. Vertebral involvement localizations of our patients were 2 (16.7%) lumbar, 2 (16.7%), thoraco-lumbar junction and 8 (66.7%) thoracic. We did not have a patient with a previous history of tuberculosis, except one. The pre op crp values of 12 patients were 1.39 mg / lt, and our measurements in early post op were 13.49 mg / lt. The mean crp values of the patients at the 12th week are 2.08 mg / lt. Pre op sedimentation averages were measured as 32.83 mm / hour. Post-operative 3rd Month mean sedimentation values were measured as 30.08 mm / hour. The mean pre-op kyphosis angle of 10 patients with thoracic and thoraco-lumbar involvement was calculated as 25.8°. The mean of early post op kyphosis angles of the same patients was calculated as 13.8. In the last graphs taken in the follow-up of the patients, an average of 16.9° was found. The comparison between the pre-op and post-op, post-op and post-kyphosis angles of our patients was found statistically significant and was calculated as 0.005. The mean Pre Op VAS score (out of 10) of our patients was 7.67, and the mean post op VAS score was 3.25. A statistically significant difference was found in the comparison of Vas score to pre-op and post-op (P <0.002). In our study, the last follow-up functional results of patients were evaluated with the Oswestry scale and calculated as 27.33. Conclusions: In vertebral tuberculosis, single-stage debridement decompression titanium cage, fusion and posterior instrumentation application is a reliable method, and the complication and hospital stay rates are lower than other surgical applications.It is a treatment modality that can be preferred to other surgical methods with its advantages such as controlling the infection area, maintaining the sagittal balance and maintaining the continuityof the correction, and improving the functional results in a short time. Keywords: Vertebral tuberculosis, single stage posterior intervention, titanium mesh, cage, posterior instrumentation