Long-term outcome of anterior decompression and instrumentation in tuberculosis of spine

Abstract

Background: Treatment of tuberculosis of spine has various modalities ranging from medical to various surgical forms including just drainage of pus to only decompression and decompression with instrumentation. The goals of surgery include radical debridement of the infective focus. In some cases, when surgery causes mechanical spinal instability, the question arises whether the risk of recurrent infection outweighs the benefits of spinal instrumentation and stabilization. Instrumentation helps in preventing progression of kyphosis and helps in maintaining the achieved correction. Materials and Methods: Forty-three cases of both sexes with spinal tuberculosis treated with anterior decompression with instrumentation were reviewed retrospectively. Patients with medically managed disease and those who did not receive instrumentation were eliminated from this review. The mean age of patients was 42.3 years (20–72). The mean follow-up duration was 31.6 months (72 to 12 months). Results: Result was analyzed clinically and radiologically in the form of neurological improvement, correction of kyphosis, and maintenance of correction. All patients with wet lesion showed neurological improvement and showed no or very minimal progression of kyphosis. The mean preoperative kyphosis was 27.2° (50 to 16). The mean postoperative kyphosis was 9.0° (20 to 0) and the mean kyphosis at follow-up was 10.3°. None of the patients showed hardware failure, deep infection, and wound infection, and no patient required hardware revision. Conclusion: Instrumentation of the spine is safe and has an important role in stabilization of the tuberculosis of the spine. Despite the presence of active infection, instrumentation after radical debridement will not increase the risk of recurrent infection. In fact, greater benefit can be achieved through spinal stabilization, which can even promote accelerated healing and avoids progression of kyphosis. Level of Evidence: 2