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Posterior-only Approach Surgery for Fixation and Decompression of Thoracolumbar Spinal Tuberculosis: A Retrospective Study

Sahoo, Madan M. MS (Ortho)*; Mahapatra, Sudhir K. MS (Ortho), MBBS; Sethi, Gopal C. MS (Ortho)*; Dash, Sunil K. MS (Ortho)

Journal of Spinal Disorders & Techniques: October 2012 - Volume 25 - Issue 7 - p E217–E223
doi: 10.1097/BSD.0b013e31826a088e
ORIGINAL ARTICLES
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Study Design: A retrospective case study series.

Objective: To evaluate the results of posterior decompression and transpedicular screw fixation in 18 cases of thoracolumbar spinal tuberculosis with neurological deficit.

Summary of Back Ground Data: Spinal tuberculosis has been managed with various modalities of treatment ranging from only antitubercular drugs to radical procedures such as anterior or combined approach surgeries. However, although the former method of treatment sometimes is met with unacceptable kyphosis, the later is considered to be too drastic. In the present study, authors have shown the results of posterior decompression and pedicle screw fixation in selected cases of Pott paraplegia.

Methods: The cases (12 males and 6 females) were operated with a posterior decompression and transpedicular screw fixation in a single stage along with antitubercular drug treatment. All of these patients had varying degrees of neurological deficit (4 with Frankel grade A, 8 Frankel B, 4 Frankel C, and 2 Frankel D) and single level involvement with <50% vertebral body destruction and mild kyphosis of 8–27 degrees. Short-segment pedicle screw fixation, posterior decompression, and correction of kyphosis were performed in single stage.

Results: Kyphosis improved from preoperative value of 17.7±5.8 degrees to 9.4±4.6 degrees postoperatively. At a follow-up period of 24–46 months, final kyphosis correction was maintained at 11.6±5.4 degrees. Bony fusion was achieved in 55.5% cases. Neurological recovery occurred in 17 patients (94.4%). All patients became pain free, with final visual analogue score 0-2.

Conclusions: The procedure in safe and has satisfactory results in early active cases of Pott paraplegia with less destruction of vertebral bodies.

*Department of Orthopedics, VSS Medical College, Burla-Sambalpur

Department of Orthopedics at SCB Medical College, Cuttack, Orissa

Present address: Sudhir Kumar Mahapatra, MS (Ortho), MBBS, Lady Harding Medical College, New Delhi, India.

Present address: Sunil Kumar Dash, MS (Ortho), Hi-Tech Medical College, Bhubaneswar, Orissa, India.

The authors declare no conflict of interest.

Reprints: Sudhir K. Mahapatra, MS (Ortho), MBBS, c/o-Pabitra Mohan Mahapatra, At/post - Phasi, District- Ganjam, Orissa, 761038 India (e-mail: dr.sudhir.2k@gmail.com).

Received February 21, 2012

Accepted July 3, 2012

© 2012 Lippincott Williams & Wilkins, Inc.