In gratitude of the loyal support of our members, the CNS is offering complimentary 2021 Annual Meeting registration to all members! Learn more.

  • Spinal Tuberculosis: Role of Surgery

    Final Number:

    Khaled Abdeen

    Study Design:
    Clinical Trial

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2012 Annual Meeting

    Introduction: Study design : Twenty five patients with spinal tuberculosis [10 cervical and 15 dorsolumbar] presenting with a 2-6 months history of neurologic deficits were managed surgically . Chemotherapy was instituted 2 weeks before surgery and for 9 months thereafter and follow up was for 12-36 months [mean 15 months] . Objective : to assess the impact of different surgical modalities on neurological outcomes ,bony fusion and spinal stability .

    Methods: Methods : In the cervical group: 9 patients were treated by an anterior cervical approach for decompression followed by fixation by iliac bone graft and cervical plating ,one patient with C3 tuberculosis was managed by single stage- combined anterior decompression and fusion by iliac bone graft followed by posterior occipitocervical fixation by a Ransford Loop . In the dorsolumbar group: 7 cases were managed by posterior instrumentation [5 cases segmental fixation by transpedicular screws and 2 by Hartshill rectangle with sublaminar wires , 6 by an anterior approach , and another two by circumferential fusion in one session .

    Results: Results : All patients had an improved neurologic outcome with solid fusion within 6 months . In the cervical group ,there was an improvement in the Nurick grade from a preoperative mean of 2.5 to 0.3 at the last follow up .In the dorsolumbar group ,the kyphosis angle improved in all patients from 36 to 17 degrees .

    Conclusions: Conclusions : Early surgical intervention ,either posterior rigid fixation ,anterior interbody fusion or circumferential fusion plus chemotherapy helps in arresting the disease providing satisfactory stabilization and kyphosis correction . No additional risks related to the use of an implant even when large quantities of caseating material were present.

    Patient Care: combined chemotherapy for 9 months and spinal fixation leads to sucessful outcome

    Learning Objectives: role of surgery in spinal tuberculosis , instrumentation can be done in porescence of infection provided that chemotherapy course given

    References: [1 ] Fang D, Leong J , Fang H .Tuberculosis of the upper cervical spine .J Bone Joint Surg [Br] .1983 ;65 :47-50 . [2] Govender S , Charles R : Tuberculosis of the cervical spine .Neuro Orthopedic 1991;11:101-107 . [3] Hsu L ,Leong J . Tuberculosis of the lower cervical spine [C2 –C7 ] :A report on 40 cases. J Bone Joint Surg 1984 ,66 B : 1-5 . [4] Trovlos J ,Toit G Du .Spinal tuberculosis : Beware of the posterior elements .J Bone Joint Surg. 1990 ;72-B :772 . [5] Jain AK ,Kumar S,Tuli SM .Tuberculosis of spine [C1-D4] .Spinal Cord 1999 ,37[5] :362- 369 . [6] Medical Research Council Working Party on Tuberculosis of the Spine . A controlled trialof anterior spinal fusion and debridement in surgical management of tuberculosis of the spine in patients on standard chemotherapy . A study in Hong –Kong B J Surg 1974 , 611 :853 –66 . [7 ] Derry DC : Pott’s disease in ancient Egypt .Med Pres Circ . 1938 ;197 :196-199 . [8] Fanci AS ,Braunwarld E ,Isselbacher KJ ,et al .eds :Harrison ‘s principles of internal medicine ,14 th ed .New York : Mc Graw –Hill ,1998:1007- 1008 .

We use cookies to improve the performance of our site, to analyze the traffic to our site, and to personalize your experience of the site. You can control cookies through your browser settings. Please find more information on the cookies used on our site. Privacy Policy