Results of surgical treatment of tuberculosis of the dorsolumbar spine

ABSTRACT

The aim of this work is to study the results of surgical debridement JL ML and posterior instrumentation in treating cases of Pott's disease of the dorso lumbar spine complicated by cold abscess, kyphosis and / or paraplegia . This study included 18 cases of Pott's disease. The age of the patients ranged 29-70 years [mean = 52.1], 12 were males and 6 were females [ratio =21]. Twelve patients were immuno-compromised; 8 due to diabetes mellitus and 4 due to chronic renal failure. Patients presented with pain, kyphosis and constitutional manifestations [night fever, sweating, anorexia, loss of weight]. Motor paralysis of the lower limbs was present in 10 patients [2 patients with type B, 3 with type C and 5 with type D according to Frankel grading]. In 17 cases, 2 contiguous vertebrae were affected; 2 in the mid dorsal spine, 11 in the lower dorsal and 4 in the lower lumbar. In only one case, 4 adjacent vertebrae were affected [DV. 7, 8, 9, 10]. MRI examination showed cold abscess formation in all cases. The kyphotic angle ranged 11-38° [mean = 26.9°]. CT guided needle biopsy was done to confirm the diagnosis. It was successful in 14 patients [77.8%] and failed in 4 patients where open biopsy was taken at the time of surgery. All cases were treated surgically through a posterior approach.Costotransversectomy, debridement, grafting and posterior pedicular screw rod fixation using ISO LA system was carried out. Patients were followed up for 20-44 months [mean= 32.6]. The infection was controlled in all cases. The kyphotic angle was partially corrected as it ranged 5-18° [mean = 12.1°] post operatively. Motor paralysis improved completely in 9 patients [90%] and partially in one patient [10%].surgical treatment is effective in controlling infection, kyphosis and improving paralysis