Reconstruction and Stabilisation in Tuberculous Spondylitis

• (a, b - All India Institute of Medical Sciences)

Introduction: The main stay of management of spinal tuberculosis in developing countries has been antituberculous chemotherapy with bracings. Late complications like kyphosis, late neurological defecits have been problems commonly encountered. The purpose of this study is to assess the role of global fusion with instrumentation in spinal tuberculosis.

Methodology: Out of 124 patients of tuberculosis of thoracic and lumbar spine, 34 were operated at our Institute between January 1998 & December 2001. The indications of surgery were neurological defecits; gross instability, kyphosis, translated segments and suspicion of multi-drug resistance. Surgical procedure - posterior approach; stabilisation with pedicular screw - rod short construct; transforminal decompression of cord with debridement of diseased vertebrae, vertical titaneum mesh cage (Moss type) filled with cancellous bone graft placed in the debrided vertebral defect. Pre- and post-operative standard antituberculous chemotherapy cover given.

Results: 34 patients of ages 12 to 58 years; 10 patients with kyphosis (range 30º to 110º ); 18 patients with significant neurological defecits ranging from root compression to complete paraplegia, follow up 9 months to 40 months - average 28.6 months. Kyphosis correction 72 to 86% ; significant neurological improvement in all but one case. Complications encountered - sinking/displacement of cage 2, transient neuralgia-2, superficial skin necrosis-1, death (pulmonary embolism)-1.

Discussion: Debridement of diseased vertebra followed by placement of cancellous bone filled cage, supports and facilitates interbody fusion. Good fusion mass seen radiologically bridging the vertebrae anteriorly within 3 months in majority of patients. Restoration and reconstruction of sagital profile, facilitation of healing process of the infection and overall better morbidity of patients thus treated were major advantages.

• If noted, the author indicates something of value received. The codes are identified as: a-research or institutional support; b-miscellaneous funding; c-stock or stock options; d-royalties; e-other financial or material support.