Percutaneous pedicle screw fixation in caries spine – Does early MIS fixation has advantage over conservative?

Abstract

Objective: We performed this study to investigate the role of fixation by percutaneous pedicle screw fixation (PPSF) in spondylodiscitis secondary to TB origin for pain relief and rapid early mobilization of the patient.Material and Methods: Thirty-two cases of tuberculous spondylodiscitis were managed from March 2017 to 2019. Clinical assessment, radiological evaluation, and laboratory studies with over a year follow-up after PPSF without decompression. Visual analog scale (VAS score) and Oswestry disability indices (ODI scale, Hindi version) were used for outcome measure.Results: Female-to-male ratio was 19:13. The average follow-up was 14 months ± 6 days and the duration for fusion was around 6 months. The mean duration of hospital stay was 4.006 ± 1.17 days. The average blood loss was 27.18 ml ± 17.71. The mean surgical time was 121.25 ± 14.59 min. ATT was continued for 12–18 months. C-reactive protein (CRP), erythrocyte sedimentation rate (ESR) pain scores (visual analog scale), and ODI were lower at 3 months and at final follow up. No failure of instrumentation or decline in neurological condition was reported after operative intervention.Conclusion: Primary treatment of TB spine has been chemotherapy with limited indications for surgery. Severe pain in the presence of spondylodiscitis without neurological deficit or deformity projects as an unclear situation and a temporary surgical fixation gives stability to prevent unexpected neurological injury and promote early healing with faster rehabilitation in contrast to strict bed rest and external bracing.