Evaluation of Transpedicular Surgical Decompression withLong Segment Stabilization in Thoracic and Thoracolumbar SpinalTuberculosis

Abstract

Pott’s disease is a common cause of neurological complications and kyphotic deformity.When deformity progressed that may lead to painful costo-pelvic impingement, respiratory distress, risk of paralysis of muscle of lower limb and consequent reduction in quality andlongevity oflife. The treatmentstrategy is to avoid neurological complication and achieve a near normal spine. In tuberculosis, spinal column may become unstable. Pathological fracture or dislocation of a diseased vertebral body may occur due to mechanical insult. Surgical decompression causefurther instability.The insertion of a metallic implant is to provide stability. Pedicle screw fixation in kyphotic correction in old Pott’s disease is a most suitable device.This prospective interventionalstudywas conducted in BanglabandhuSheikh Mujib Medical University (BSMMU) for aperiod of 60 monthsfrom July 2011, with at leasttwo years follow-up period. Twentycases (13 males and 7 females) of thoracolumbar spinal tuberculosis with neurological deficit were operated with a transpedicular decompression and screw fixation along with anti-tubercular drug treatment. All of these patients had varying degrees of neurological deficit and single level involvement with vertebral body destruction and mild kyphosis of 9–28 degrees. Long segment pedicle screw fixation, posterior decompression, and correction of kyphosis were performed in single stage.The mean age of patients was 50.9 and kyphosis improved from 17.85±1.37 degrees to 10.85±2.66 degrees (p=0.0206).Neurological recovery occurred in 18 patients (90%). Bony fusion was achieved in 67.5% cases. At 2-years follow-up mean visual analogue score (VAS) score improved from 5.5 to 0.75 (p=0.0031).So, posterior decompression and transpedicular stabilization with continued chemotherapy is a good treatment option for the management of the thoracic and thoracolumbar TB in patients with vertebral body destruction and <30degree kyphosis.