Results of Posterior and Posterolateral Decompression, Pedicle Screws fixation and Fusion for Dorso-Lumbar Koch’s Spine

Author(s): Dr. Himanshu Tailor and Dr. Vikram Jasoliya

Abstract: Introduction: Tuberculosis is ubiquitous in distribution. Globally, nearly 30 million people suffer from tuberculosis. Spinal tuberculosis (50%) is the most common form of skeletal tuberculosis. In the thoracic and lumbar region, morbidity and complications associated with anterior surgery (Thoracotomy, Retroperitoneal) are very significant. A combined anterior debridement and posterior instrumentation helps to overcome stability related drawbacks of anterior approach alone. Aims & Objectives: The aim of this prospective study is to analyse the clinic-radiological outcome of posterior and posterolateral decompression, stabilization with pedicle screws and fusion for tuberculosis of dorsal and lumbar spine done in tertiary care institution from July 2013 to June 2016. Method:The Inclusion criteria was age group of 12 to 70 years of age, mild to moderate amount of cold abscess with No improvement with conservative treatment and worsening of neurological deficit. Patients less than 12 years of age, huge cold abscess, severe kyphotic deformity with internal gibbus and patients not fit for anesthesia were excluded from the study. Results: Before surgery, 9 patients were classified as Frankel grade C, 3 patients each with grade B, D and E & 2 patient with grade A. After surgery, all patients with grade C improved to one grade. Out of 3 patients with grade B, one improved to grade C and other improved to grade D. Of the patients with grade D, one improved to grade E and the other remained with grade D. One patient with grade A has not recovered. One patient developed superficial wound infection which healed by conservative methods and extended antibiotic therapy. Two of our patients developed implant failure. By the time they came for follow up, bony consolidation seen in the follow up x-ray and hence implant exit done. Conclusion: The posterior/posterolateral approach (extracavitary approach) gives a reasonable access to the lateral and anterior aspects of the cord for an equally good decompression of the cord, avoids problems of prolonged recumbency, provides better functional outcome and significantly better kyphosis correction.

DOI: https://doi.org/10.22271/ortho.2019.v5.i1g.68