Evaluation of efficacy and clinical outcomes of posterior surgical approach and posterior instrumentation in the management of tuberculosis of spine

Abstract

Introduction: Pott’s disease or Pott's disease is a form of tuberculosis that occurs outside the lungs whereby disease is seen in the vertebrae. Tuberculosis can affect various tissues apart from the lungs including the spine, a kind of tuberculous arthritis of the inter-vertebral joints and it is usually termed as extra-pulmonary tuberculosis. The disease involving the spine is named after Percivall Pott (1714–1788), a British surgeon. The lower thoracic and upper lumbar vertebrae are the areas of the spine most often affected. Materials and methods: 12 patients with active spinal tuberculosis with severe kyphosis, neurological deficits and radiologically evident disease were included. Aim was to evaluate the efficacy and clinical outcomes of posterior surgical approach and posterior instrumentation in the management of tuberculosis of spine. Results: Total 12 patients were included 6 males and 6 females with average age being 37.2 years.3 patients had history of tuberculosis in the past. Two patients had pleural effusion; one patient had tuberculosis of the elbow. The average number of vertebra involved is 1.8 (range 1-3 vertebra). 10 cases had cold abscess with tubercular debris (wet lesion).And two cases were dry lesions. Graft consolidation and functional outcome was excellent in most of cases and good in remaining cases. Conclusion: The posterior approach to Thoraco lumbar spine has many advantages and it doesn’t have complications associated with the other approaches. Our results show that single stage circumspinal decompression + anterior spinal fusion + posterior Moss-Miami instrumentation + posterior spinal fusion through posterior approach is an alternative treatment for Thoraco lumbar spinal tuberculosis. It is a minimum surgical intervention that has minimum morbidity compared to other approaches and encourages neurological recovery, good correction and prevention of progressive kyphosis.