Abstract
Introduction
The study is an outcome of patients with tuberculous spondylitis, progressive neurologic deficit, and kyphotic deformity, who underwent single stage anterior corpectomy and posterior decompression with instrumented fusion
Material and Methods
20 (6M:14F) patients with spinal TB and varying degrees of motor deficits underwent surgery during the past 7 years. The range of age was from 2 to 65 years old (mean age of 34.8 years). The average duration of symptom was seven months (ranging from 3 months to 1 year). Anti-tuberculosis chemotherapy was initiated in all patients and continued for more than four weeks until ESR < 40mm/H before surgery. All had a minimum of 12 months of follow up (mean follow-up period 16 months). One patient had upper cervical disease, 10 patients had thoracic disease and 8 patients had lumbar or lumbo sacral involvement. The disease in 7 patients was characterized by Frankel Grade A/B (Medical Research Council Grade 0/5), in 8 patients by Frankel Grade C (unable to walk even with support) and 4 patients had Frankel Grade D (walk with support but weak legs) on admission. The kyphotic angle ranged from 5° to 40° before operation, with an average of 18° ± 12°. Three children below 10years of age underwent anterior corpectomy and debridement with rib or fibular grafts and posterior instrumented fusion. All the 17 patients underwent anterior corpectomy, debridement with cage insertion and posterior instrumented fusion. Physiotherapy was instituted in all patients.
Results
Local symptoms of pain were relieved significantly by three weeks postoperatively (mean VAS scores reduced from 6.8 to 2.7). 17/19 patients (89.4%) neurological deficit had excellent or good clinical results (P > 0.05). 6/7 patients improved from Frankel A/B to Frankel E (normal activity), ⅞ patients improved from Frankel C to Frankel E and all 4 patients with Frankel D became normal to Frankel 5. The average ESR was normal (10 ± 5mm/h) within 6 months in all patients. The average kyphotic angle decreased to 7 ° ± 5° postoperatively. Solid fusion was achieved in all cases. No significant loss of deformity correction was noted in these patients. Only one patient with lumbo-sacral disease showed recurrence after 18months of disease free interval.
Conclusion
Single stage anterior corpectomy with autogenous rib grafts or cage insertion and posterior instrumentation are safe and effective methods in the surgical management of spinal tuberculosis with neurological deficit. Combined single stage surgery helps to correct and maintain the deformity, foci clearance, spinal-cord decompression and pain relief in the treatment of tuberculous spondylitis.