Study of functional outcomes of surgical treatment of tuberculosis of spine with debridement and spinal fixation

Abstract

Background: Spinal tubercular infection is the most common and dangerous form of skeletal tuberculosis. It constitutes 1/3 to 1/2 of all bone and joint tuberculosis. Even today tb spine is a life threatening condition inspite of advances in diagnostic procedure surgical techniques and effective tuberculostatic drugs. Delay in establishing diagnosis and surgically reliving the spinal cord compression can lead to progression of neurological deficit and spinal deformity thereby diminishing the likelihood of recovery. The goals of surgery in Pott's spine are adequate decompression, adequate debridement, maintenance and reinforcement of stability and correction and prevention of deformity. The aim of present study is to evaluate the clinical, radiological and functional outcome of surgical treatment of tuberculosis of spine. The aim of present study is to evaluate the clinical, radiological and functional outcome of surgical treatment of tuberculosis of spine. Materials and Methods: All patient with tubeculosis of spine treated surgically at NCH, Surat using various operative methods were evaluated during the hospital stay and the clinical, radiological and functional outcomes were assessed. Hematological investigation, Plain radiography, computerized tomography (CT), and magnetic resonance imaging (MRI) studies were conducted before surgery for all patients. Immediately post-surgery, routine lateral and anteroposterior radiographs were done to assess the extent of decompression and placement of graft and instrumentation. All patients were evaluated at 1, 3, 6, 9, and 12 months after surgery. At each followup evaluation, clinical examination, necessary hematological investigation and plain radiographic studies were obtained to determine the fusion status, development or progression of deformity after surgery, and instrumentation failure. Final fusion assessment done according to Bridwell criteria. Neurological deficit graded according to Frankel system. Pain assessed according to the following scale: Severe, moderate, mild, and no pain. Functional outcome assessed according to Prolo scale. Results: Mean age of the paients was 39 years with maximum numbers of the patients belonging to the age group of 20-40 years. 5 patients recovered from Frankel A TO Frankel grade D, 1 patient recovered from grade B to grade E, 3 patients recovered from grade C to grade E, 2 patients recovered from grade D to grade E and 5 patients has retained Frankel grade E. Mean preoperative kyphosis was 30.5” (12-44) preoperatively, which was corrected to mean of 18” in immediate post-operative radiographs and at final follow up mean kyphotic angle was 20”. 5 (30%) had excellent outcome, 8 (48%) had good outcome, 3 (18%) patients had fair outcome and no patient had poor outcome. Conclusion: Spinal tuberculosis heals with sequelae of spinal deformities with consequent long term biomechanical consequences. Even if biological control of disease is achieved, the biomechanical damage of the skeleton keeps on adding morbidities and reduction in the functional performance in future life. Paraplegia is the most crippling neurological complication of spinal TB. In developing countries like India, we still see a significant proportion of patients with spinal TB presenting late after onset of disease with advanced paraplegia. Destruction of the vertebral body by the tuberculous foci will induce kyphosis deformity by collapse of vertebral body. Surgical treatment may be necessary when risk of kyphotic deformity is higher. For successful results, anterior radical surgical debridement of the tuberculous focus and the replacement with a bone graft was essential for correction of kyphosis. Operative procedures provide adequate and fast removal of the disease process, added stability to the diseased part of the spine, with additional reconstructive procedure provide an ideal environment for healing and fusion to take place rapidly and abundantly and additionally reduces the further chances of neurological compromise.