Evaluation of Surgical Decompression by Laminectomy and Fusion by Strut Graft 3 with Stabilization by Pedicle Screw and Rod in Lumbar Spinal Tuberculosis

Abstract

Potts disease is a common cause of neurological complications and kyphotic deformity in our country. When deformity progressed that may leads to painful costo-pelvic impingement, respiratory distress, risk of paralysis of muscle of lower limb and consequent reduction in quality, longevity of life. The treatment strategy is to avoid neurological complication and achieve a near normal spine. In TB, spinal column may become unstable. Pathological fracture/dislocation of a diseased vertebral body may occur due to mechanical insult. Surgical decompression cause further instability. The insertion of a metallic implant is to provide stability. Pedicle screw fixation in kyphotic correction in old polls disease is a most suitable device. This prospective interventional study was done on BSMMU for the period of 60 months with minimum follow up period of 2 years. 20 cases (13 males and 7 females) of lumbar spinal tuberculosis with neurological deficit were operated with a transpedicular decompression and screw fixation along with anti-tubercular drug treatment. All of these patients had varying degrees of neurological deficit and single level involvement with vertebral body destruction and mild kyphosis of 5-15 degrees. Long segment pedicle screw fixation, posterior decompression, and correction of kyphosis were performed in single stage. The mean age of patients was 50.9 and kyphosis improved from 10.4+,2.9 degrees to 4.0±1.2 degrees Neurological recovery occurred in 18 patients (90%). Bony fusion was achieved in 67.5% cases. At 2-years follow-up mean VAS score improved from 5.5 to 0.75. So posterior decompression and transpedicular stabilization with continued chemotherapy is a good treatment option for the management of the lumbar TB in patients with vertebral body destruction.