Role of Single Stage Posterior Pedicle Screw Fixation and Transpedicular Decompression with Chemotherapy, in Treatment of Thoracic, Thoracolumbar, and Lumbar Spinal Tuberculosis

Abstract

Introduction Tuberculosis of spine being an anterior disease, anterior decompression, and fixation has been long considered as the gold standard. Recently, the posterior approach surgery has gained popularity, based on the principle of adequate debridement and stable fixation with much lower complication rates. This retrospective study aims at evaluating the role of a posterior stabilization with transpedicular posterior alone decompression for tuberculosis of spine. Patients and Methods A total of 55 patients surgically treated with posterior pedicle screw fixation and transpedicular decompression along with chemotherapy for tuberculosis of spine between January 2009 and May 2013 and had a minimum of 12 months' follow-up were included in the study. Their functional outcome (VAS score), neurological outcome (ASIA grading) and radiological outcome (X-ray and MRI) were assessed. Patients with kyphotic angle > 30 degrees, more than three contiguous discal involvement and multifocal lesions were excluded from the study. Results Mean age of patients was 47.2 years. Thoracic spine was involved in 29, thoracolumbar in 16, and lumbar in 10 patients. Mean follow-up was of 23.2 months. Most common indication for surgery was instability pain. VAS score improved from an average of 9.2 to 2.4 in postoperative 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 a mean loss of correction of 3.1 degrees resulting in 6.1 degrees of final correction. Bony fusion was achieved in 73% patients with no patient having any clinical signs of pseudoarthrosis. Conclusion Posterior stabilization and transpedicular decompression have shown an improvement in the functional outcome and the neurological status in most of the patients without the need of an anterior decompression and fusion. Good maintenance of spinal alignment and fusion along with resolution of the inflammatory process on MRI can be satisfactorily attained through posterior stabilization and transpedicular decompression when accompanied by chemotherapy. However, further follow-up is necessary to monitor for possible disease recurrence or implant failure.