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

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