Posterior Transpedicular Decompression and Pedicle Screw Fixation for Early Stage Thoracic, Thoracolumbar and Lumbar Tuberculosis

Abstract

IntroductionAnterior decompression and fixation has been long considered as the gold standard for treatment of tuberculosis of spine. Recently the posterior approach surgery has gained popularity, based on the principle of adequate debridement and stable xation with much lower complication rates. This retrospective study aims at evaluating the role of a posterior transpedicular decompression and pedicle screw fixation for early stage thoracic, thoracolumbar and lumbar tuberculosis. Material and MethodsRetrospective study of 55 patients treated with posterior transpedicular decompression and pedicle screw fixation for tuberculosis of spine between Jan 2009 to May 2014 and had a minimum of 18 months follow up were included in the study. Their functional outcome (VAS score), neurological outcome (ASIA grading) and radiological outcome (xray and MRI) were assessed. Patients with kyphotic angle > 30 degrees, more than 3 contiguous discal involvement and multifocal lesions were excluded from the study. ResultsThoracic spine was involved in 29, thoracolumbar in 16 and lumbar in 10 patients. Mean follow up was of 30.6 months. Mean age of patients was 47.2 years. Most common indication for surgery was instability pain. VAS score improved from an average of 9.2 to 2.4 in post operative period and 3.2 at follow up. Neurological improvement was seen in all patients with neurological deficits preoperatively. Mean kyphosis angle was 20.6 ± 4.8 degrees and was corrected postoperatively to 7.4 ± 3.2 degrees (>50%). At the latest follow-up there was mean loss of correction of 3.4 degrees resulting in 6.5 degrees of final correction. Bony fusion was achieved in 78% patients with no patient having any clinical signs of psuedoarthrosis. ConclusionPosterior transpedicular decompression and pedicle screw fixation accompanied by chemotherapy, has shown an improvement in the functional outcome and the neurological status in most of the patients with good maintenance of spinal alignment without the need of an anterior decompression and fusion. Hence this can be considered as a relatively simple surgical option for early stage tuberculosis of spine.