Spinal tuberculosis – A short series of complex multi-level anterior cage reconstructions

From a global perspective the epicenter of tuberculosis is in sub Saharan Africa. While largely a pulmonary disease up to 10% of tuberculosis is skeletal. In this skeletal cohort the spinal column is the more frequently involved bony structure and accounts for 50% of cases. Spinal tuberculosis is largely an effectively managed medical disease however in certain cases spinal surgeons must intervene to manage progressive neurology despite anti-tuberculous medical treatment, instability, and progressive deformity. The mid- to lower thoracic spine is the most common area involved and the costotransversectomy remains, to date, the work horse surgical procedure. Once significant acute kyphotic angulation, or anterior compression, predominates the attending spinal surgeon must have the skill set to directly debride and reconstruct the anterior column. The unique anatomy of the lumbar spine demands familiarity with a completely different skill set. Here the anterolateral retroperitoneal approach, lateral trans-psoas approach, anterior approach, and the posterolateral trans-pedicular approach are the standard surgical corridors utilized. We present a case series of four patients with multi-level spinal tuberculosis, instability, and deformity. In all patients we went anteriorly and performed a multi-level corpectomy necessitating a multi-level anterior cage re-construction. Our case series serves to illustrate several typical examples of the extensive form of the disease and the complex multi-cage reconstructions that can be performed in experienced hands.