Abstract
Introduction
The incidence of tuberculosis has rapidly increased in the last decade. The aim of this work is to compare the results of iliac crest and rib grafts and to assess the role of short segment posterior instrumentation in patients with multiple level affections.
Materials and Methods
The results of 48 patients with multiple level resistant tuberculous spondylodiscitis surgically treated were retrospectively reviewed. Patients were followed-up for an average of 6.5y. The average age was 47y and 27 patients had an associated neurologic deficit. The disease affected two levels (36 patients) and three levels (12 patients). All had anterior debridement and bone grafting by iliac crest autograft in 26 patients (Group 1) and rib autograft in 22 patients (Group 2); followed simultaneously by posterior short segment instrumentation.
Results
Postoperatively, the kyphotic deformity was corrected from an average of 41 degrees to an average of 5 degrees (Group 1) and from an average of 47 degrees to an average of 6 degrees (Group 2). At the last follow up, both groups had a similar fusion rate (95% and 96% respectively) and loss of correction (averaged 2.4 degrees and 2.1 degrees respectively). Group 1 patients had 7 donor site complications. All patients except one had an improvement in their neurologic status.
Conclusions
Radical anterior debridement of multiple level spondylodiscitis eradicated the infection; short segment posterior instrumentation applied immediate stability, allowed adequate graft uptake and long term correction of the kyphotic deformities.