Surgery in Pott Disease: Experience of 582 Cases

Abstract

Introduction Tuberculosis (TB) of the spine is the most common and dangerous form of TB infection accounting 50 to 60% of osseous TB. Although, uncommon spinal TB still occurs even in both developed and developing countries. The diagnosis of spinal TB is difficult and it commonly presents at an advanced stage. Delay in establishing diagnosis and management cause spinal cord compression and spinal deformity. Materials and Methods A total of 30 patients who had TB of the thoracic and lumbar spine with moderate to severe cord compression was studied. Variable degrees of neurological deficit with deformity were treated at NITOR and PGHL, DHAKA during the period from 2008 to 2010. Anterolateral decompression and autogenous strut bone grafting with simultaneous fixation by screws and rod were done. Posterior decompression, posterior interbody, and posterolateral fusion by bone graft with stabilization by transpediculer screws and rods. Appropriate antituberculous drugs was given to all patients for 18 to 24 months. The postoperative follow-up period was 12 months (range 3-21 months). Results Ovearll 20 cases with neurological deficits recovered totally or partially. No neurological improvement had occurred in five cases with paraplegia. Five cases were lost from follow-up. X-ray shows bony fusion was achieved in all cases for mean of 6 months(range 4-8 months). There were no recurrences. Two cases had bed sores postoperatively and there was no neurological improvement. Conclusion For patients with thoracolumbar spinal TB anterior debridement, auto graft bone fusion, anterior or posterior fixation appears to be effective in arresting disease, correcting kyphotic deformity and maintaining correction until solid spinal fusion.