Wednesday, September 26, 2018 7:35 AM–9:00 AM ePosters

Abstract

BACKGROUND CONTEXT Neural compression in tuberculosis spine is anterior and ideally requires anterior decompression. Posterior or posterolateral decompression avoids approach related morbidity of Anterior decompression but has the disadvantage of further destabilizing the spinal column. Tuberculosis of the spine is further compounded by osteopenia necessitating longer constructs for stabilization. Thus, posterior instrumentation in tuberculosis of the spine traditionally involved fixation of multiple segments. PURPOSE Authors devised the technique of sparing as much of the lamina with the intention of reducing the implant density or number of instrumented vertbrae while achieving desirable decompression. Sparing the healthy posterior elements while decompressing the cord is optimally required while planning the surgery. Lamina sparing approach not only gives the desired decompression but destabilizes the spinal column to lesser extent. By sparing midline structures like part of lamina, spinous process and supraspinous or interspinous ligaments the need for long posterior constructs may be obviated. STUDY DESIGN/SETTING Prospective cohort study. PATIENT SAMPLE Twenty-two patients suffering from active spinal tuberculosis. OUTCOME MEASURES Blood loss, duration, number of vertebrae instrumented against number of vertebrae affected. Radiological outcome: correction of deformity as measured with Cobb angle. Neurological outcome: Frankel grade. Functional outcome: Oswestry Disability Index (ODI) and VAS score. METHODS A total of 22 consecutive patients operated at single centre by a single surgeon were included in the study. Inclusion criteria: patients with active spinal tuberculosis, patients developing neurological deficit or deficit progressing, deficit persisting during course of conservative treatment (3–4 weeks), patients with mechanical instability of spine. RESULTS A total of 8 males, 14 females with an average age of 34.2 (range 4–69 years). A total of 12 patients had dorsal, 6 lumbar and 4 thoracolumbar spine involvement. A total of 14 had single level disease while 4 multifocal contagious and 4 multifocal non contagious. Indication of surgery was neurological deficit (n=14) and instability (n=8). Average preoperative Cobb angle was 27.5° (8°–50°) and postoperative Cobb angle was 15.5°(36° to −2°). Average Kyphosis correction was 16° (0°–40°). Average blood loss was 547.89 mL (130–1200 mL). Duration of surgery was 4.07 hours (1–6 hours). Average number of vertebrae involved was 2.9 while average number of vertebrae instrumented was 3.5. A total of 14 Patients presented with sensory or motor or both deficit (Grade A=1,B=3,C=1,D=9). Recovery occurred in 13 Patients and 1 remained status quo. Average preoperative ODI was 74.35 (32–100) and at 18 months 17.5 (0–60). preoperative VAS was 7.15 (6–9) and at 18 months 1 (0–4). Complications: two patients had infection, one each dural tear and loosening of screws. CONCLUSIONS Lamina sparing decompression in spinal tuberculosis gives good decompression which translates clinically by improvement in neurological and functional outcome. On the other hand, preserving the posterior midline structures allows shorter instrumentation.