Publication: Clinical outcomes of single stage posterior-only debridement and instrumentation in the management of spinal tuberculosis
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Date
2022
Authors
Tohkainathan, Thanabala
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Abstract
Introduction Spinal tuberculosis is the most common form of extra-pulmonary tuberculosis. Anti-tuberculous chemotherapy has been the standard treatment for spinal TB. However, surgical management is recommended to control the progression of kyphosis and improve the neurological impairment associated with this disease. Various surgical methods have been advocated. But the posterior approach surgery has gained popularity due to its reported low complication rate. In this study, we report the clinical outcomes of single stage posterior only approach for debridement and instrumentation for treatment of spinal tuberculosis. Methodology In this retrospective study, we analysed 27 patients with thoraco-lumbar TB treated in our centre from 2003 to 2019 with single‑stage posterior only debridement and instrumentation. Preoperative and postoperative kyphosis angle, ASIA neurological grading, C‑reactive protein (CRP), erythrocyte sedimentation rate (ESR) and visual analog scale (VAS) score were compared. Correction in kyphosis including loss of kyphosis angle, neurological recovery, resolution of infection and pain relief at one year follow‑up was assessed. The data was analysed using SPSS version 24. Numerical variables were presented as mean and standard deviation while categorical variables were presented as frequency and percentage. The numerical variables were assessed using skewness and kurtosis. Results 15 male and 12 female patients with mean age of 51 years were treated. All patients had two contiguous vertebral segment involvement. The preoperative average rise in ESR was 74.78 SD 23.68 mm/h which significantly dropped down to 25.46 SD 19.49 mm/h at one year follow-up. The average preoperative rise in CRP was 80.89 50.26 mg/L which returned to 16.55 10.01 at one year follow‑up. There was significant improvement of VAS from 6.96 ±1.29 preoperatively to 1.37 ± 0.57 at one year follow-up. Preoperatively, the mean kyphosis angle was 17.75 ± 10.49 and corrected postoperatively to 9.87 7.47 with an average correction of 7.88 6.99 (45.37%). At one year follow-up, the mean loss of correction was of 2.22 2.15(32.38%). No patients recorded any neurological deterioration with 100% neurological recovery observed at one year follow-up Conclusion The results of this study show improvements in kyphotic correction, neurological recovery, VAS score as well as resolution of infection.
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Keywords
Spine tuberculosis , Posterior-only approach