Experience with spinal instrumentation for tuberculosis spine at PMCH Nawabshah

Spinal column is the common site of skeletal tuberculosis. Anteriorly there are three varieties: Paradiscal, Centrosomatic and Anterior Longitudinal. Extra-osseous involvement causes paravertebral abscess, epidural abscess or involvement of ligaments. The purpose of this study is to identify the frequency, presenting features, diagnostic tests and outcome of decompression and stabilization of tuberculous spondylitis. This study was conducted in Peoples Medical College, Nawabshah. All cases of spinal tuberculosis treated surgically were included. Admission criteria for these patients were advanced form of spinal tuberculosis, presenting with progressive deformity, neurological deficit, intractable pain, large paraspinal abscess or posterior element involvement. Over a period of 5 years, we had operated upon 248 cases of tuberculous spondylitis. Females dominated [1.91 times]. Bulk of series belonged to younger age group less than 40 years. Majorities of them had pain, neurological deficit and gibbus deformity. Surgery was performed to decompress the cord, apply a bony strut graft and stabilize with instrumentation. Thoracic region was commonly involved. Anterior approach was preferred because most of times anterior elements were involved. Webb Morley instrumentation system was used in majority of cases from D4 to L4. At the end of 6 months postoperatively pain relief was observed in 94.9% and neurological [motor] improvement in 92.2% cases. In this series we have observed that in our part of the world tuberculosis of spine is commonly seen in females and younger age group. Anterior decompression and stabilization is helpful in segmental rigid fixation of spine, pain relief deformity correction and early neurological recovery

Osteolytic torcular lesion

Torcular lesion encroach supratentorial and infratentorial compartments saddling or invading the big sinuses leading to torrential bleeding, which may need repair with venous or arterial graft. A case is, hereby, reported that presented with headache and an occipital swelling. CT scan showed torcular osteolytic tumor extending out beneath the scalp and into the posterior cranial fossa and causing fourth ventricular blockage. It needed two-stage surgery for complete excision. All the big venous sinuses near the lesion were protected. The dural gap was filled with fascia lata graft. Histopathology report revealed as malignant tumor of bony origin