Early surgical intervention for active thoracic spinal tuberculosis patients with paraparesis and paraplegia

Abstract Background To explore the therapeutic effect of early surgical intervention for active thoracic spinal tuberculosis (TB) patients with paraparesis and paraplegia. Methods Data on 118 active thoracic spinal TB patients with paraparesis and paraplegia who had undergone surgery at an early stage (within three weeks of paraparesis and paraplegia) from January 2008 to December 2014 were retrospectively analyzed. The operation duration, blood loss, perioperative complication rate, VAS score, ASIA grade and NASCIS score of neurological status rating, Erythrocyte Sedimentation Rate (ESR), C-reactive protein (CRP), kyphotic Cobb’s angle, and duration of bone graft fusion were analyzed to evaluate the therapeutic effects of surgery. Results The mean operating time was 194.2 minutes, and the mean blood loss was 871.2 ml. The perioperative complication rate was 5.9 %. The mean preoperative VAS score was 5.3, which significantly decreased to 3.2 after the operation and continued decreasing to 1.1 at follow up (P<0.05). All cases achieved an increase of at least one ASIA grade after operation. The rate of full neurological recovery for paraplegia (ASIA grade A and B) was 18.0 % and was significantly lower than the rate (100 %) for paraparesis (ASIA grade C and D) (P<0.05). On the NASCIS scale, the difference in the neurological improvement rate between paraplegia (22.2 % ± 14.1 % in sensation and 52.2 % ± 25.8 % in movement) and paraparesis (26.7 % ± 7.5 % in sensation and 59.4 % ± 7.3 % in movement) was remarkable (P<0.05). Mean preoperative ESR and CRP were 73.1 mm /h and 82.4 mg/L, respectively, which showed a significant increase after operation (P>0.05), then gradually decreased to 11.5 ± 1.8 mm/h and 2.6 ± 0.82 mg/L, respectively, at final follow up (P<0.05). The mean preoperative kyphotic Cobb’s angle was 21.9º, which significantly decreased to 6.5º after operation (P<0.05) while kyphotic correction was not lost during follow up (P>0.05). The mean duration of bone graft fusion was 8.6 ± 1.3 months. Conclusions Early surgical intervention may be beneficial for active thoracic spinal TB patients with paraparesis and paraplegia, with surgical intervention being more beneficial for recovery from paraparesis than paraplegia.

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Early Surgical Intervention for Active Thoracic Spinal Tuberculosis with Paraplegia

10.21203/rs.3.rs-48848/v1 ◽

2020 ◽

Author(s):

Weiwei Li ◽

Zheng Liu ◽

Xiao Xiao ◽

Zhenchao Xu ◽

Zhicheng Sun ◽

...

Keyword(s):

Blood Loss ◽

Complication Rate ◽

Surgical Intervention ◽

Spinal Tuberculosis ◽

Thoracic Spinal ◽

Cobb’S Angle ◽

Perioperative Complication ◽

Early Surgical Intervention ◽

Thoracic Spinal Tuberculosis

Abstract Background: To explore the therapeutic effect of early surgical interventions for patients of active thoracic spinal tuberculosis (TB) with paraplegia. Methods: Data of 118 patients with active thoracic spinal TB and paraplegia who had undergone surgeries at an early stage (within three weeks of paraplegia) from January 2008 to December 2014 were retrospectively analyzed. The operation duration, blood loss, perioperative complication rate, VAS score, ASIA grade of neurological status, Erythrocyte Sedimentation Rate (ESR), C-reactive protein (CRP), kyphotic Cobb’s angle, and duration of bone graft fusion were analyzed to evaluate the therapeutic effects. Results: Mean operation time was 194.2 minutes, mean blood loss was 871.2 ml. The perioperative complication rate was 5.1%. Mean preoperative VAS score was 5.3, significantly decreased to 3.2 after operation, and continued decreasing to 1.1 at the follow up (P＜0.05). All cases achieved at least one grade elevation after operation, specifically, 2 cases of ASIA grade A rose to grade B, 10 cases of ASIA grade A rose to grade C, 2 cases of ASIA grade A rose to grade E; 9 cases of ASIA grade B rose to grade D, 38 cases of ASIA grade B rose to grade E; all 57 cases of ASIA grade C rose to ASIA grade E. The rate of full neurological recovery for complete paraplegia patients was 14.3%, significantly lower than the rate (91.3%) for incomplete paraplegia patients. Mean preoperative ESR and CRP were 73.1 mm /h and 82.4 mg/L, insignificantly increased after operation (P＞0.05), then gradually decreased to 11.5 ± 1.8 mm /h and 2.6 ± 0.82 mg/L at the final follow up, respectively (P＜0.05). The mean preoperative kyphotic Cobb’s angle was 21.9º, significantly decreased to 6.5º after operation (P＜0.05) and the kyphotic correction had not lost during the follow up (P＞0.05). Mean duration of bone graft fusion was 8.6±1.3 months Conclusion: Early surgical intervention may be beneficial for patients with active thoracic spinal TB with and paraplegia, with surgical intervention being more beneficial for incomplete paraplegic recovery compared with that of complete paraplegia.

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Early Surgical Intervention for Active Thoracic Spinal Tuberculosis with Paraparesis and Paraplegia

10.21203/rs.3.rs-48848/v2 ◽

2020 ◽

Author(s):

Weiwei Li ◽

Zheng Liu ◽

Xiao Xiao ◽

Zhenchao Xu ◽

Zhicheng Sun ◽

...

Keyword(s):

Blood Loss ◽

Complication Rate ◽

Surgical Intervention ◽

Spinal Tuberculosis ◽

Thoracic Spinal ◽

Cobb’S Angle ◽

Perioperative Complication ◽

Early Surgical Intervention ◽

Thoracic Spinal Tuberculosis

Abstract Background: To explore the therapeutic effect of early surgical interventions for patients of active thoracic spinal tuberculosis (TB) with paraparesis and paraplegia.Methods: Data of 118 patients with active thoracic spinal TB and paraparesis and paraplegia who had undergone surgeries at an early stage (within three weeks of paraparesis and paraplegia) from January 2008 to December 2014 were retrospectively analyzed. The operation duration, blood loss, perioperative complication rate, VAS score, ASIA grade of neurological status, Erythrocyte Sedimentation Rate (ESR), C-reactive protein (CRP), kyphotic Cobb’s angle, and duration of bone graft fusion were analyzed to evaluate the therapeutic effects.Results: Mean operation time was 194.2 minutes, mean blood loss was 871.2 ml. The perioperative complication rate was 5.1%. Mean preoperative VAS score was 5.3, significantly decreased to 3.2 after operation, and continued decreasing to 1.1 at the follow up (P＜0.05). All cases achieved at least one grade elevation after operation, specifically, 2 cases of ASIA grade A rose to grade B, 10 cases of ASIA grade A rose to grade C, 2 cases of ASIA grade A rose to grade E; 9 cases of ASIA grade B rose to grade D, 38 cases of ASIA grade B rose to grade E; all 57 cases of ASIA grade C rose to ASIA grade E. The rate of full neurological recovery for patients with paraplegia was 14.3%, significantly lower than the rate (91.3%) for patients with paraparesis. Mean preoperative ESR and CRP were 73.1 mm /h and 82.4 mg/L, insignificantly increased after operation (P＞0.05), then gradually decreased to 11.5 ± 1.8 mm /h and 2.6 ± 0.82 mg/L at the final follow up, respectively (P＜0.05). The mean preoperative kyphotic Cobb’s angle was 21.9º, significantly decreased to 6.5º after operation (P＜0.05) and the kyphotic correction had not lost during the follow up (P＞0.05). Mean duration of bone graft fusion was 8.6±1.3 monthsConclusion: Early surgical intervention may be beneficial for patients with active thoracic spinal TB and paraparesis or paraplegia, with surgical intervention being more beneficial for paraparesis recovery compared with paraplegia recovery.

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Efficacy Analysis of One-stage Posterior-only Surgical Treatment for Thoracic Spinal Tuberculosis in the T4-6 Segments with Minimum 5-year Follow-up

10.21203/rs.3.rs-769455/v1 ◽

2021 ◽

Author(s):

Yi Zhan ◽

Xin Kang ◽

Wenjie Gao ◽

Xinliang Zhang ◽

Lingbo Kong ◽

...

Keyword(s):

Surgical Treatment ◽

Cobb Angle ◽

Clinical Efficacy ◽

Spinal Tuberculosis ◽

Surgical Trauma ◽

Posterior Surgery ◽

One Stage ◽

Thoracic Spinal ◽

Thoracic Spinal Tuberculosis

Abstract In recent years, with the in-depth research on spinal tuberculosis, posterior surgery alone has been praised highly by more and more surgeons due to the better correction of kyphosis, better maintenance of spinal physiological curvature, smaller surgical trauma and fewer surgical complications. However, there is currently lack of relevant reports about the efficacy of posterior surgery alone in the treatment of tuberculosis in the T4-6 segments. This study aimed to evaluate the clinical study efficacy and feasibility of one-stage posterior-only surgical treatment for thoracic spinal tuberculosis in the T4-6 segments. 67 patients with tuberculosis in T4-6 segments who underwent one-stage posterior-only surgery were included in this study. The clinical efficacy was evaluated using statistical analysis based on the data about erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), Oswestry Dability Index (ODI) score, Visual Analogue Scale (VAS) score and Cobb angle before surgery, after surgery and at the last follow-up. All patients completed fusion during the follow-up period of 6–9 months. ESR and CRP were returned to normal for all patients at 6 months follow-up. In the meanwhile, among the 27 patients combined with neurological impairment, neurological functions of 22 cases (81.48%) recovered completely at the last follow-up (P < 0.05). Cobb angle of the kyphosis was improved from preoperative 34.8 ± 10.9° to postoperative 9.6 ± 2.8°, maintaining at 11.3 ± 3.2° at the last follow-up, The ODI and VAS scores were improved by 77.10% and 81.70%, respectively. This 5-year follow-up study shows that better clinical efficacy can be achieved for tuberculosis in T4-6 segments using one-stage posterior-only approach by costotransverse debridement in combination with bone graft and internal fixation. The posterior surgical method cannot only effectively accomplish debridement, obtain satisfactory clinical results, but also well correct kyphotic deformity and maintain it.

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The efficacy of single posterior debridement, bone grafting, and instrumentation for the treatment of thoracic spinal tuberculosis

10.21203/rs.3.rs-19393/v1 ◽

2020 ◽

Author(s):

Jiao Zhou ◽

Quanyi Li ◽

Yongchun Zhou ◽

Qichun Song

Keyword(s):

Bone Grafting ◽

Spinal Tuberculosis ◽

Clinical Manifestations ◽

Adult Patients ◽

Thoracic Spinal ◽

Imaging Results ◽

Single Posterior Approach ◽

Posterior Debridement ◽

Thoracic Spinal Tuberculosis

Abstract Background: The aim of this study was to investigate the clinical efficacy of single posterior debridement, bone grafting, and instrumentation for the treatment of thoracic spinal tuberculosis of adult patients. Methods: A retrospective analysis was conducted on 88 adult patients with thoracic spinal tuberculosis between June 2013 and September 2017. All patients were treated with single posterior debridement, bone grafting and instrumentation. The clinical manifestations and laboratory and imaging results of the approach were subsequently analysed. Results: All patients were followed up for 40.6 ± 4.1 m (range, 36–48 m). Bony fusion was achieved in all bone grafts. The VAS scores, ESR, and CRP levels 6 weeks after operation and at the final follow-up were significantly lower than the preoperative levels (P<0.05). The postoperative and final-follow-up kyphosis angles were both significantly smaller than the pre-operative kyphosis angles (P<0.05). The postoperative angle correction rate reached 81.5%, and the postoperative angle loss only reached 4.1%. At the last follow-up, ASIA improvement was significant compared with the preoperative levels (P<0.05). Conclusion: The single posterior approach can achieve satisfactory clinical outcomes in the treatment of thoracic spinal tuberculosis.

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Comparison of anterior transthoracic debridement and fusion with posterior transpedicular debridement and fusion in the treatment of mid-thoracic spinal tuberculosis in adults

BMC Musculoskeletal Disorders ◽

10.1186/s12891-019-2945-x ◽

2019 ◽

Vol 20 (1) ◽

Cited By ~ 2

Author(s):

Weiwei Li ◽

Zheng Liu ◽

Xiao Xiao ◽

Zhen Zhang ◽

Xiyang Wang

Keyword(s):

Blood Loss ◽

Spinal Tuberculosis ◽

Operation Time ◽

Kyphosis Angle ◽

Vas Score ◽

Thoracic Spinal ◽

Sf 36 ◽

Group A ◽

Group B ◽

Thoracic Spinal Tuberculosis

Abstract Background The surgical procedures for mid-thoracic spinal tuberculosis mainly include anterior transthoracic debridement and fusion and posterior transpedicular debridement and fusion. Until now, the surgical choice is still controversial. This study aims to compare the clinical efficacy of anterior transthoracic debridement and fusion with posterior transpedicular debridement and fusion in the treatment of mid-thoracic (T5–9) spinal tuberculosis in adult patients. Methods Eighty-seven cases with mid-thoracic spinal tuberculosis were treated with anterior transthoracic debridement and fusion (Group A, n = 39) and posterior transpedicular debridement and fusion (Group B, n = 48) from January 2007 to June 2014. Parameters including the operation time, blood loss, time of ESR and CRP decreasing to the normal level, time of abscess disappearance, time of bone graft fusion, rate of surgical complications, Visual Analog Scale (VAS) score, kyphosis angle and SF-36 scale were compared between two groups to evaluate their therapeutic effects. Results All patients were followed up for 5–10 years with the mean of 6.2 ± 1.1 years. No significant differences were observed regarding the gender composition ratio, age, course of disease, number of lesion segments, and preoperative indexes of ESR, CRP, VAS score, kyphosis angle and SF-36 scale between the two groups. Besides, no significant differences were observed regarding VAS score, kyphosis angle and SF-36 scale between the two groups in the 5th postoperative year (P > 0.05). However, the operation time (158.2 ± 10.7 min vs. 183.7 ± 14.1 min), blood loss (517.9 ± 76.5 ml vs.714.6 ± 57.4 ml), time of ESR (2.3 ± 1.1 months vs.3.1 ± 1.4 months) and CRP (1.1 ± 0.3 months vs.1.2 ± 0.6 months) decreasing to the normal level, time of abscess disappearance (2.7 ± 1.6 months vs.4.9 ± 1.9 months), and time of bone graft fusion (6.6 ± 0.8 months vs.8.0 ± 9.6 months) in Group A were less than those in Group B (P < 0.05). Conclusions Both anterior transthoracic debridement and fusion and posterior transpedicular debridement and fusion have a low risk of surgical complications and provide good quality of life for the patients with mid-thoracic (T5–9) spinal tuberculosis followed up in the mid-term. Moreover, the anterior procedure leads to early resolution of the disease and faster fusion.

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Comparison of single posterior debridement, bone grafting, and instrumentation with single anterior debridement, bone grafting, and instrumentation in treatment of thoracic spinal tuberculosis

10.21203/rs.2.15859/v1 ◽

2019 ◽

Author(s):

Yongchun Zhou ◽

Weiwei Li ◽

Liqun Gong ◽

Jiao Zhou ◽

Jing Luo

Keyword(s):

Bone Grafting ◽

Spinal Tuberculosis ◽

Operation Time ◽

Anterior Debridement ◽

Thoracic Spinal ◽

Group A ◽

Group B ◽

Posterior Debridement ◽

Thoracic Spinal Tuberculosis

Abstract Objective To explore the clinical effect of single posterior debridement, bone grafting, and instrumentation and single anterior debridement, bone grafting and instrumentation in the treatment of thoracic spinal tuberculosis of adult patients. Methods: A retrospective analysis was made by involving 38 adult patients with thoracic spinal tuberculosis from between June 2013 and December 2015. Of the 38 patients, 21 patients were categorized in single anterior approach group and underwent single posterior debridement, bone grafting, and instrumentation (Group A). The remaining 17 patients were classified in single posterior approaches group (Group B), which received single posterior debridement, bone grafting and instrumentation. Clinical manifestations, laboratory and imaging results of the two groups were analyzed subsequently. Results: All patients were followed up for 23.9 ± 3.8 m (range, 19–36 m). Bony fusion was achieved in all bone grafts. The operation time and intraoperative blood loss in group B were significantly less than those in group A (P<0.05). The VAS scores, ESR, and CRP levels 6 weeks after operation and at the final follow-up were significantly lower than the preoperative levels (P<0.05). At the last follow-up, ASIA improvement no significant difference between groups (P>0.05). Furthermore, the postoperative and final-follow-up kyphosis angles in group B were both significantly smaller than those in group A (P<0.05). Group A had a postoperative angle correction rate smaller than group B, and its postoperative angle loss was greater than group B’s (P<0.05). Conclusion: Single posterior debridement, bone grafting, and instrumentation can achieve similar curative effect as single anterior debridement, bone grafting and instrumentation in the treatment of thoracic spinal tuberculosis, but also accompanied by additional advantages of shorter operation time and less bleeding .

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The efficacy of single posterior debridement, bone grafting and instrumentation for the treatment of thoracic spinal tuberculosis

Scientific Reports ◽

10.1038/s41598-021-83178-0 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Zhi Yi ◽

Qichun Song ◽

Jiao Zhou ◽

Yongchun Zhou

Keyword(s):

Bone Grafting ◽

Spinal Injury ◽

Spinal Tuberculosis ◽

Clinical Manifestations ◽

Adult Patients ◽

Thoracic Vertebrae ◽

Thoracic Spinal ◽

Posterior Debridement ◽

Thoracic Spinal Tuberculosis

AbstractThe aim of this study was to investigate the clinical efficacy of single posterior debridement, bone grafting and instrumentation for the treatment of thoracic spinal tuberculosis in adult patients. A retrospective analysis was conducted between June 2013 and September 2017of 88 adult patients with thoracic spinal tuberculosis. All patients were treated with single posterior debridement, bone grafting and instrumentation. The clinical manifestations and laboratory and imageological results were subsequently analysed. All patients were followed for 40.6 ± 4.1 months (range, 36–48 m). Bony fusion was achieved in all bone grafts of thoracic vertebrae. The visual analogue scale scores, erythrocyte sedimentation rate and C-reactive protein levels 6 weeks after surgery and at the final follow up were significantly lower than the preoperative levels (P < 0.05). The postoperative and final follow up kyphosis angles were both significantly smaller than the preoperative kyphosis angles (P < 0.05). The postoperative angle correction rate reached 81.5% and the postoperative angle loss reached only 4.1%. At the last follow up, American Spinal Injury Association improvement was significant, compared with the preoperative levels (P < 0.05). The single posterior approach can achieve satisfactory clinical outcomes in the treatment of thoracic spinal tuberculosis.

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Debridement and Bone Graft Fusion via the Lateral Extracavitary Approach Combined with Lateral and Posterior Screw-Rod Fixation in Treatment of Thoracic Spinal Tuberculosis: A Retrospective Study of 38 Cases

10.21203/rs.3.rs-138928/v1 ◽

2021 ◽

Author(s):

Jianwei Zhou ◽

Shaoping Li ◽

Xiaoli Guan ◽

Shuanhu Lei ◽

Yuliang Wang

Keyword(s):

Blood Loss ◽

Bone Graft ◽

Spinal Injury ◽

Spinal Tuberculosis ◽

Fixation Method ◽

Parietal Pleura ◽

Thoracic Spinal ◽

Cord Injury ◽

Surgical Duration

Abstract BackgroundThoracic spinal tuberculosis is still common, and surgical treatment can rapidly relieve pain, correct deformity, reduce bone loss and prevent further damage to neurological function. We have practiced an efficient and safe surgical method.MethodsFrom January 2013 to April 2019, 38 patients with thoracic spinal TB were included in our study. Debridement and bone grafting were performed via the lateral extracavitary approach, combined with two different fixation method. Data from these cases were analyzed retrospectively.ResultsThe average surgical duration was 297.0±68.4 min, average intraoperative blood loss was 702.6±252.0 ml, postoperative hospital stay was 11.1±3.6 d, and C-reaction protein (CRP) and erythrocyte sedimentation rate (ESR) of all the patients decreased to normal levels at the last follow-up. The average Visual Analog Scale (VAS) score was 7.5±1.6 preoperatively and 0.6±0.8 at the last follow-up, which was significantly reduced compared with that before surgery. The average kyphosis correction was 6.3±4.7° and the angle loss was 1.4±1.6°. Neurological functions of all cases were significantly improved According to the American Spinal Injury Association (ASIA) classification. Solid fusion was observed in all cases at the last follow-up. One patient presented sinus tract formation at the incision site and the other two patients had rupture of the parietal pleura intraoperatively. No severe complications such as spinal cord injury or great vessel injury were found in all patients.ConclusionsDebridement and bone graft fusion via the posterolateral extracavitary approach combined with two fixation methods can both achieve high efficacy in the treatment of thoracic spinal TB. Lateral single screw-rod fixation is more suitable for patients with single-segment lower thoracic lesions and high stability, with less blood loss and shorter surgical duration. Posterior pedicle screw fixation has higher strength, and is more suitable for patients with multi-segment lesions, poor stability and complex conditions.

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Single posterior debridement, interbody fusion, and fixation on patients with continuous multivertebral lumbar spine tuberculosis (CMLSTB)

BMC Musculoskeletal Disorders ◽

10.1186/s12891-020-03628-0 ◽

2020 ◽

Vol 21 (1) ◽

Author(s):

Weihong Long ◽

Liqun Gong ◽

Yaqing Cui ◽

Jie Qi ◽

Dapeng Duan ◽

...

Keyword(s):

Lumbar Spine ◽

Interbody Fusion ◽

Operation Time ◽

Cure Rate ◽

Spine Tuberculosis ◽

Cobb’S Angle ◽

Perioperative Complication ◽

The Mean ◽

Posterior Debridement

Abstract Background Patients with continuous multi-vertebral lumbar spine tuberculosis (CMLSTB) were subjected to single posterior debridement, interbody fusion, and fixation to explore their clinical outcomes. Methods Sixty-seven CMLSTB patients who underwent single posterior debridement interbody fusion and fixation between January 2008 to December 2017 were studied. The operation time, blood loss, perioperative complication rate, cure rate, Visual Analog Scale (VAS), Oswetry disability index (ODI), Japanese Orthopedic Association (JOA), Erythrocyte Sedimentation Rate (ESR), C-reactive protein (CRP), kyphotic Cobb’s angle and time of interbody fusion were analyzed to understand their therapeutic effects on CMLSTB patients. Results The patients were followed up for 20–48 months, with a mean of 24.3 months. The mean operation time was 215.5 min (range, 120–280 min), whereas 818.0 ml of blood was lost (range, 400–1500 ml) with a perioperative complication rate of 6.0% and a cure rate of 95.5%. During the last phase of follow-up, the mean preoperative VAS score (5.7) and ODI (72.0%) decreased significantly to 1.4 (t = 31.4, P<0.01) and 8.4% (t = 48.4, P<0.01), respectively. Alternatively, the mean preoperative ESR and CRP (74.7 mm /h and 69.3 mg/L, respectively) decreased to average values (tESR = 39.7, PESR<0.001; tCRP = 50.2, PCRP<0.001), while the JOA score (13.9) significantly increased to 23.0 (t = − 11.6, P<0.01). The preoperative kyphotic Cobb’s angle (20.5°) decreased to 4.8° after the operation (t = 14.0, P<0.01); however, the kyphotic correction remained intact at the time of follow-up (t = − 0.476, P = 0.635). Furthermore, the mean of interbody fusion time was identified to be 8.8 months (range, 6–16 months). Conclusion Single posterior debridement, interbody fusion, and fixation may be one of the surgical choices for the treatment of CMLSTB patients.

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Efficacy analysis of one-stage posterior-only surgical treatment for thoracic spinal tuberculosis in the T4–6 segments with minimum 5-year follow-up

Scientific Reports ◽

10.1038/s41598-021-04138-2 ◽

2022 ◽

Vol 12 (1) ◽

Author(s):

Yi Zhan ◽

Xin Kang ◽

Wenjie Gao ◽

Xinliang Zhang ◽

Lingbo Kong ◽

...

Keyword(s):

Surgical Treatment ◽

Cobb Angle ◽

Clinical Efficacy ◽

Spinal Tuberculosis ◽

Surgical Trauma ◽

Posterior Surgery ◽

One Stage ◽

Thoracic Spinal ◽

Thoracic Spinal Tuberculosis

AbstractIn recent years, with the in-depth research on spinal tuberculosis, posterior surgery alone has been praised highly by more and more surgeons due to the better correction of kyphosis, better maintenance of spinal physiological curvature, smaller surgical trauma and fewer surgical complications. However, there is currently lack of relevant reports about the efficacy of posterior surgery alone in the treatment of tuberculosis in the T4–6 segments. This study aimed to evaluate the clinical study efficacy and feasibility of one-stage posterior-only surgical treatment for thoracic spinal tuberculosis in the T4–6 segments. 67 patients with tuberculosis in T4–6 segments who underwent one-stage posterior-only surgery were included in this study. The clinical efficacy was evaluated using statistical analysis based on the data about erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), Oswestry Dability Index (ODI) score, Visual Analogue Scale (VAS) score and Cobb angle before surgery, after surgery and at the last follow-up. All patients completed fusion during the follow-up period of 6–9 months. ESR and CRP were returned to normal for all patients at 6 months follow-up. In the meanwhile, among the 27 patients combined with neurological impairment, neurological functions of 22 cases (81.48%) recovered completely at the last follow-up (P < 0.05). Cobb angle of the kyphosis was improved from preoperative 34.8 ± 10.9° to postoperative 9.6 ± 2.8°, maintaining at 11.3 ± 3.2° at the last follow-up, The ODI and VAS scores were improved by 77.10% and 81.70%, respectively. This 5-year follow-up study shows that better clinical efficacy can be achieved for tuberculosis in T4–6 segments using one-stage posterior-only approach by costotransverse debridement in combination with bone graft and internal fixation. The posterior surgical method cannot only effectively accomplish debridement, obtain satisfactory clinical results, but also well correct kyphotic deformity and maintain it.

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