To study the outcomes of posterior decompression and fixation of tuberculosis of dorsolumbar spine

Abstract

Introduction: Spinal TB generally starts in the vertebral bodies and the intervertebral discs and is thus called “spondylodiscitis”. It is not only important due to the high prevalence but also because upto 30% of cases develop serious neurological sequelae from compression of the spinal cord, such as para paresis and paraplegia. Although clinical and radiological findings are clear in tuberculosis of the spine, making an early and definite diagnosis is not yet easy, because disease progression is slow and insidious. If there are no complications and if the lesion is limited to the vertebrae, anti-tubercular chemotherapy can treat tuberculosis​ ​. However, with proper indications, surgical procedures are superior in the prevention of neurological deterioration, maintenance of stability, prevention of deformity, early recovery and early mobilization. Tubercular kyphosis is an unstable lesion that tends to progress at least until there is a sound body fusion anteriorly. The wide lesions, abscess formations, sinuses, vertebral deformities and neurological deficits due to spinal tuberculosis should be treated surgically. To date, there are several surgical treatment methods in the literature. Nowadays, tuberculous spine treatment and management has greatly evolved. Aim: To study the results of only posterior decompression and fixation in dorsolumbar tuberculosis spine in view of neurological status, amount of fusion, amount of correction of kyphotic deformity and life style status over the period of time. Materials and Methods: 60 patients were taken in the study initially but out of them 10 did not come for regular follow up. So study consisted of 50 patients. All patients (n=50) who were included in the study had tuberculosis of spine at dorsal and/or lumbar with or without neurological deficit and with or without deformity.All of 50 patients were managed by only posterior decompression and fixation. We studied the cases for development of deformity at dorsal and lumbar spine treated by posterior decompression and fixation and their neurological status according to GERTZBEIN GRADING​​, rate of fusion according to BRIDWELL SCORE​, pain status by DENNIS PAIN SCALE​ and functional ability according to DENNIS WORK SCALE​ and final outcome was assessed according to ​SEYBOLD AND BAYLEY SCALE. Neurological function on admission was graded according to Frankle et al​. Results and Discussion: In the current series of 50 patient’s posterior instrumentation performed to decrease and stabilize the kyphotic unstable segment. Functional outcome was significantly better in posteriorly fixed group of patients with average score being 14.66 (good) according to Seybold and Bayley score. Better targeting of the disease focus with removal of disease focus, possible posterior reconstruction, rapid healing, added stability and better fusion, which all fulfilled by the posterior fixation and decompression and has the better functional outcome. Conclusion: From the present study, we concluded that functional outcome is better according to Seybold and Bayley Scale in form of pain relief, work performance, fusion and neurological outcome after posterior decompression and fixation.Posterior fixation is safe and helps in early mobilization and rehabilitation.