Choice of debridement methods for one-stage posterior approach surgery for multilevel spinal tuberculosis: osteotomized debridement versus traditional curetted debridement

This study aimed to compare osteotomized debridement with traditional curetted debridement in multilevel thoracolumbar tuberculosis (TB). Patients with multilevel thoracolumbar tuberculosis who underwent surgery in our hospital from February 2015 to September 2023 were retrospectively analyzed. According to the debridement method, the patients were divided into posterior traditional debridement and bone grafting and internal fixation (group A) and posterior complete vertebrectomy and bone grafting and internal fixation (group B). Surgery-related information, laboratory test results, VAS score, ODI score, JOA score, incidence of complications, recurrence rate, fusion time, and progression of kyphotic deformity were compared between the two groups. A total of 93 patients were included, including 45 patients in group A and 48 patients in group B. The postoperative follow-up time was 12–72 months, with an average of 39.81 ± 16.46 months. All patients had significant improvement in local thoracolumbar pain and spinal cord function after surgery. The operation time and intraoperative blood loss in group B were less than those in group A ( P < 0.05). C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) returned to the normal range shorter in group B than in group A ( P < 0.05). All patients’ postoperative VAS scores, JOA scores, and ODI scores were significantly improved, and there was no significant difference between the two groups ( P > 0.05). The incidence of postoperative complications in group B was higher than that in group A ( P < 0.05). The recurrence rate in group B (2.1%) was numerically lower than that in group A (6.7%), although the difference did not reach statistical significance ( P > 0.05). Bone graft fusion time was shorter in group B than in group A ( P < 0.05). The degree of long-term kyphotic correction angle loss was higher in group A than in group B, which was statistically significant ( P < 0.05). Compared with traditional bone conserving lesion removal methods. Thorough long-segment debridement of the diseased vertebral body for multilevel spinal tuberculosis has potential advantages in operation time, blood loss, complications, fusion time, and maintenance of correction angle.