Posterior only debridement and instrumentation in thoracolumbar spinal tuberculosis

Abstract

Introduction: Spinal tuberculosis is the most common form of skeletal tuberculosis with the dorsolubar region being the most commonly affected region. The most dreaded complication of spinal tuberculosis is tubercular paraplegia seen in around 40% of the cases. There has been controversy regarding the surgical treatment of the disease and also the approach to be used and the use of implants. In our study we have have operated 41 patients of thoracolumbar tuberculosis by posterior only debridement, implantation by pedicle screw and rods and fusion. Purpose: The purpose of this study is to assess the functional and neurological outcome of the patients of thoracolumbar tuberculosis treated by a posterior only approach. The inraoperative blood loss, bony fusion, neurological recovery and post operative blood loss was studied in all patients. Methods: Forty- One patients with thoracolumbar tuberculosis who underwent posterior approach in combination with debridement, interbody autografting and instrumentation were reviewed. The mean age group of the study was 44.0±12.3 years. All cases were followed up for 12–27 months. The groups were compared by parameters like blood loss, improvement in kyphosis, neurological recovery. Bony fusion was assessed by Bridwell criteria. Final functional outcome was assessed by Prolo scale. Results: The mean duration of hospital stay was 21.0±4.8 days. The average blood loss was 714.6±80.8 ml. The mean preoperative kyphotic angle was 23.8±4.2 degrees which improved to a mean of 8.1±2.7 degrees and at final followup were 12.3±3.9 degrees. Definitive fusion was seen in 90% of the cases. There was no deterioration of neurological symptoms in any of the patient. Conclusion: The posterior approach combined with debridement and instrumentation can be a better alternative than the classical anterior approach. A better correction of the deformity combined with a decreased blood loss and low morbidity is observed with the posterior approach.