The role of anterior spinal instrumentation and allograft fibula for the treatment of Pott disease

Study Design. The authors retrospectively reviewed 28 patients with multilevel Pott disease who underwent anterior radical debridement, decompression, and fusion with anterior spinal instrumentation and fibular allograft replacement. Objectives. To assess the efficacy of allograft fibular fusion and anterior spinal stabilization as an alternative treatment of spinal tuberculosis. Summary of Background Data. The results of anterior surgery in preventing late or early spinal deformity from Pott disease have been closely related to the status of the segmental stability and graft materials, especially in cases of multisegmental involvement. The use of allograft and anterior spinal instrumentation in tuberculous spondylitis remains controversial because of the risk of persistence and recurrence of infection in the presence of devitalized bone graft, which may also be prone to poor incorporation. Methods. Between 1993 and 1998, a total of 28 patients with Pott disease (two or more segments involved) underwent anterior debridement, allograft fusion, and stabilization. The patients were given antituberculosis treatment in the postoperative period according to a standardized protocol. The authors retrospectively analyzed their experience in tuberculous spondylitis, with particular attention to method, allograft incorporation, and anterior spinal instrumentation. Incorporation of the allograft was evaluated by either static or dynamic (flexion/extension) radiographs. Results. None of the patients used external support in the postoperative period. A minimum of 3 years' follow-up was achieved in 26 patients. The overall fusion rate was 96%. There were no graft problems. Two patients died in the early postoperative period as a result of multiorgan failure. One patient suffered from an instrumentation failure. No other complications were observed. The segmental correction was maintained successfully in all of the patients. The mean correction loss was 6degrees. Conclusions. The use of anterior spinal stabilization accompanied with a structural allograft fibula is effective after proper radical debridement for interbody fusion, deformity correction, and maintenance in cases of multisegment involved Pott disease.