Posterior-only Approach Surgery for Fixation and Decompression of Thoracolumbar Spinal Tuberculosis

Abstract

A retrospective case study series. To evaluate the results of posterior decompression and transpedicular screw fixation in 18 cases of thoracolumbar spinal tuberculosis with neurological deficit. Spinal tuberculosis has been managed with various modalities of treatment ranging from only antitubercular drugs to radical procedures such as anterior or combined approach surgeries. However, although the former method of treatment sometimes is met with unacceptable kyphosis, the later is considered to be too drastic. In the present study, authors have shown the results of posterior decompression and pedicle screw fixation in selected cases of Pott paraplegia. The cases (12 males and 6 females) were operated with a posterior decompression and transpedicular screw fixation in a single stage along with antitubercular drug treatment. All of these patients had varying degrees of neurological deficit (4 with Frankel grade A, 8 Frankel B, 4 Frankel C, and 2 Frankel D) and single level involvement with <50% vertebral body destruction and mild kyphosis of 8-27 degrees. Short-segment pedicle screw fixation, posterior decompression, and correction of kyphosis were performed in single stage. Kyphosis improved from preoperative value of 17.7±5.8 degrees to 9.4±4.6 degrees postoperatively. At a follow-up period of 24-46 months, final kyphosis correction was maintained at 11.6±5.4 degrees. Bony fusion was achieved in 55.5% cases. Neurological recovery occurred in 17 patients (94.4%). All patients became pain free, with final visual analogue score 0-2. The procedure in safe and has satisfactory results in early active cases of Pott paraplegia with less destruction of vertebral bodies.