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The Transpedicular Approach in the Management of Thoracic Spine Tuberculosis: A Short-Term Follow Up Study

Chacko, Ari G., MCh*; Moorthy, Ranjith K., MCh; Chandy, Mathew J., MCh

doi: 10.1097/01.brs.0000137063.64650.e1
Surgery
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Study Design. A retrospective descriptive assessment of the clinical and radiologic outcomes of 11 patients who underwent transpedicular decompression for thoracic spine tuberculosis.

Objectives. To study the neurologic and radiologic outcomes in patients who underwent transpedicular decompression for thoracic spine tuberculosis.

Summary of Background Data. Several approaches have been used in the management of thoracic spine tuberculosis to achieve the goals of decompression of the cord followed by immobilization and antituberculous therapy. These range from conservative regimens of computed tomography-guided biopsy followed by bed rest and drug therapy to radical surgeries that involve extensive debridement of the vertebral body followed by instrumentation. The authors report their experience with a “middle path” regimen of transpedicular decompression followed by external immobilization and antituberculous therapy.

Methods. The charts of 11 patients were reviewed retrospectively for clinical outcome, and kyphotic angle was measured on the follow-up radiographs to ascertain progression of kyphosis.

Results. There was no worsening of the neurologic status in any patient, and 10 of the 11 patients returned to functional activity. There was no significant progression of kyphosis.

Conclusions. Our results show that the transpedicular approach is a viable and safe surgical option for ventral decompression in thoracic spine tuberculosis, followed by chemotherapy for 18 months and immobilization in an alkathene shell for 3 months.

The clinical and radiologic outcomes were reviewed retrospectively in 11 patients with thoracic spine tuberculosis who underwent transpedicular decompression followed by external immobilization and antituberculous therapy. Nine of the 11 patients resumed functional activity at a median follow-up period of 10.4 months. The progression in the kyphosis was not clinically significant.

From the *Section of Neurosurgery, Department of Neurological Sciences, Christian Medical College Hospital, Vellore 632004, India.

Acknowledgment date: June 9, 2003. First revision date: August 30, 2003. Second revision date: November 30, 2003. Acceptance date: December 3, 2003.

The manuscript submitted does not contain information about medical device(s)/drug(s).

No funds were received in support of this work. No benefits in any form have been or will be received from a commercial party related directly or indirectly to the subject of this manuscript.

Address correspondence and reprint requests to Professor Ari G. Chacko, Section of Neurosurgery, Dept. of Neurological Sciences, Christian Medical College & Hospital, Vellore 632004, Tamilnadu, India. E-mail: agchacko@cmcvellore.ac.in

© 2004 Lippincott Williams & Wilkins, Inc.