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A novel classification of osteotomized debridement based on the range of focus in treating active thoracolumbar tuberculosis: a multicenter study

  • Orthopaedic Surgery
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript



Osteotomized debridement (OD) is increasingly used in the treatment of active thoracolumbar tuberculosis (TB). So far, no nomenclature has been established to describe the patterns of OD, and thus the surgical outcomes cannot be directly analyzed and compared among the patients treated with different extents of OD. The purpose of this study was to establish a reliable classification of OD for further study of spinal TB.

Materials and Methods

This was a multicenter retrospective study. The proposed classification included 6 grades of OD based on sagittal range of vertebral body destruction: grade 0 involves single-level intervertebral disc and adjacent superficial endplates; grade 1 involves adjacent endplates and vertebral bodies, but no pedicle is involved; grade 2 involves adjacent endplates, vertebral bodies, and a lower or upper pedicle; grade 3 involves adjacent endplates, vertebral bodies, and both of lower and upper pedicles; grade 4 involves an entire vertebral body and an adjacent lower or upper pedicle; grade 5 involves two continuous entire vertebral bodies. Two hundred and five patients with active thoracolumbar TB who underwent OD surgery were included, and all ODs were classified. The reliability of this classification was evaluated twice by 10 readers, and Fleiss kappa coefficients were calculated.


In the 205 patients, 208 ODs were performed. Grade 2 OD was the commonest type (98/208, 47.1%), followed by grade 1 (50/208, 24.0%), grade 3 (26/208, 12.5%), grade 0 (20/208, 9.6%), grade 4 (8/208, 3.8%), and grade 5 (6/208, 2.9%). The average accuracy of the two readings was 86.2% and 90.1%, respectively. The intra-rater reliability for the classification was “almost perfect agreement” with a Fleiss kappa coefficient average of 0.92. The inter-rater reliability was “almost perfect agreement” with a coefficient average of 0.89 for two readings.


This classification proved to be intuitive and reliable. The graded OD provides a platform for preoperative evaluation and allows comparative analysis of clinical outcomes in different extents of OD.

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This work was funded by National Natural Science Foundation of China (No.81860473, 81460405), Key project of Natural Science Foundation of Jiangxi Provincial (No. 20202ACB206004), Major Discipline Academic and Technical Leaders Training Program of Jiangxi Province (No. 20204BCJ22026) and the Program of Health Commission of Jiangxi Province (No.20191029).

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KC and SM contributed to the study conception and design. Material preparation, data collection and analysis were performed by ZZ, ZG, WW, YW and RZ. The first draft of the manuscript was written by SM and ZZ and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

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Correspondence to Kai Cao.

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The data does not compromise anonymity or confidentiality or breach local data protection laws, and it is approved for publication by The First Affiliated Hospital of Nanchang University, General Hospital of Ningxia Medical University, The Second Affiliated Hospital of Kunming Medical University, and The Second Affiliated Hospital of Nanchang University.

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Ma, S., Zhou, Z., Ge, Z. et al. A novel classification of osteotomized debridement based on the range of focus in treating active thoracolumbar tuberculosis: a multicenter study. Arch Orthop Trauma Surg 143, 5565–5574 (2023).

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