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  • Spinal Tuberculosis: Role of Surgery

    Final Number:
    1004

    Authors:
    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 .

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