Abstract
Introduction
Tuberculosis is a common problem specially in under developed countries. Tuberculosis of the vertebral column constitutes nearly 50% of all lesions of osteoarticular tuberculosis. The commonest site for the disease is in the peridiscal region. Treatment option usually is anti tuberculous chemotherapy but in some patients usually with severe pain and involving neurology, instability, large abcess, surgery is recommended. To our knowledge there is not a single publication in literature in which standalone titanium cage and bone graft without anterior plating is used in the treatment of TBS. The aim of this study is to evaluate the efficacy of standalone titanium mesh cages in TB cervical spine.
Material and Methods
A retrospective study of 47 patients with cervical tuberculous spondylitis (TBS) was performed at Ghurki trust teaching hospital. This study approved by the Institutional Review board and the ethics committee, included 47 patients with TBS of cervical spine who gave their informed consent to be included in the research. All patients had radical debridement, decompression, anterior coloumn reconstruction and instrumentation with standalone titanium cage without anterior plating filled with autologous iliac bone graft. The diagnosis of TBS was based on clinical correlation including night fever, loss of weight, fatigue and neck pain, laboratory investigations including ESR, CRP and tuberculin test were done in all patients. Visual analogue score (VAS) and frankel scoring system was used to score pain severity and grade neurological status. ATT was started preoperatively. The radiographic assessment included preoperative standard anteroposterior and lateral views. Cobbs methos was used to measure the sagittal profile.
Results
61.6% patients fell in age group 3–35 years and 28.4% fell in group 36–70 years of age. 26 were men and 21 were women. Out of all patients 26 had pre op frankel grade E and 4pts had grade D and 10 pts had grade C and 2 pts had grade B and five pts had grade A preoperatively. Post operatively one patient of grade A remained same while other four improved to grade C in follow up and rest of all pts. improved to grade E in two year follow up. Pre-op cob's angle was 39.06 ± 10.92 (Mean±SD) which improved to -5.51 ± 4.77 (Mean±SD). P value is < 0.05. In comparison of visual analogue score there is also statistically significant difference in pain improvement. All patients had single stage radical debridement, decompression and instrumentation. Anterior coloumn reconstruction was done in all patients using standalone titanium cage.
Conclusion
The use of titanium cages effectively restores the sagittal deformity in TB spine with no donor site morbidity.