Tuberculosis of dorsal and lumbar spine – Posterior decompression & posterior stabilization

Abstract

Introduction: Vertebral disease is the commonest form of skeletal tuberculosis, accounting for half of the cases. The most frequent sites of involvement are the thoracic and the thoracolumbar spine. Antituberculous chemotherapy remains the mainstay of treatment now that MRI allows early diagnosis. This conservative approach cannot, however, prevent the progression of a kyphotic deformity, and long-term rest is usually required to relieve severe back pain. These problems may be avoided by rigid internal stabilisation of the spine. Treatment options: Various methods have been described for spinal tuberculosis including 1) anterior decompression and fusion, 2) combined anterior and posterior fusion , 3) posterior decompression and fusion alone. Materials and methods: Prospective study done between April 2010 to August 2014. Eight patients had been operated with average age group of 60. Dorsal spine – 1 pt, Dorsolumbar – 5 pts, Lumbar – 2pts. Normal neurology but with kyphosis of 30 degree – 3 pts. ASIA grade B &C paralysis – 4 pts. Grade-A paralysis – 1 pt. Indications for surgery: Failure of conservative treatment and significant kyphotic deformity. Surgical Technique: Pedicle screw fixation done avoiding the infected vertebral segment and the screws were inserted in the adjacent vertebral bodies. Through transpedicular approach, body was approached poster laterally. Costotransversectomy and decompression was done for dorsal spine. If necessary root is sacrificed for better exposure. Next, the disc space was distracted and the infected end-plate, disc and soft tissue were meticulously debrided 1) Interbody fusion was done with bone graft, voids were filled with graft. Short segment stabilization was done with pedicle screw construction. 2) ATT was started. Follow up (Range from 8 months to 2 years) early mobilization from the bed with Taylor brace. Muscle strengthening exercises from 3rd week onwards. Bending after radiological healing. Results: Radiological and clinical improvement was noticed within one month in all patients. 10 degree of vertebral collapse was noticed in one patient. 2 patients – neurological recovery from B, to Grade D. 2 patients – Grade C recovered to Grade E. One patient with grade A didn’t show any improvement. Conclusion: Posterior decompression and stabilization in tuberculosis of dorsal, dorsolumbar and lumbar spine is a very useful alternate procedure. It is very safe surgery with good results, particularly in elderly individuals.