Introduction Tuberculosis of the spine is a common form of TB infection for 50% to 60% of osseous tuberculosis. Although uncommon, spinal TB still occurs in both developed and developing countries. The diagnosis of spinal tuberculosis is difficult and it commonly presents at an advanced stage. Delays in establishing diagnosis and management result in complications such as spinal cord compression and spinal deformity. Material and Methods A total of 582 patients with tuberculosis of the cervical, thoracic and lumbar spine with moderate to severe cord compression were studied. Variable degrees of neurological deficit with deformity were treated from January, 2003 to July, 2014. Thoracotomy along with anterolateral decompression and autogenous strut bone grafting with simultaneous fixation by screws and rods were done in 113 cases. Posterior decompression, posterior interbody and posterolateral fusion by bone graft with stabilization by transpedicular screws and rods were done in the remaining 469 cases. Appropriate anti TB drugs were given to all patients for 18–24 months. The follow-up period was 3 months to 10 years. Results The average age was 32.5 years. All patients survived surgery. There were 7 cases of superficial infections (1.2%) while there were 4 cases (0.7%) of deep infections. Revision surgery was performed in 6 patients (1.0%). Implant failure occurred in 4 cases (0.7%) while malposition of screws occurred in 12 cases (2.1%). Perioperative bleeding complications were reported for 4 patients (0.7%). Neurological improvement occurred in all patients except for 2 cases (0.3%). Preoperatively, the majority of patients (n = 221, 38%) were classified with Class A on the American Spinal Injury Association (ASIS) neurological impairment scale. This was significantly reduced postoperatively to 0.4%. Conclusion For patients with spinal tuberculosis 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.

Quasi-experimental design purpose: Compare intra and postoperative parameters, surgeons' satisfaction, and cost-effectiveness between general anesthesia (GA) and spinal anesthesia (SA) on patients undergoing surgery in the lumbar spine surgery. Overview of literature: Surgery on the lumbar spine is the commonest surgical procedure among all spinal surgical practices. Both the GA and SA are shown to be suitable techniques for performing the surgery safely. GA is used most frequently. But, SA became increasingly more popular because it allows the patient to self-position thereby reducing various complications associated with GA in a prone position. Methods: A total of 64 patients from June 2016 to July 2019 who underwent either discectomy, laminectomy, or lamino-foraminotomy for herniated lumbar disc or canal stenosis in 1 or 2 levels were included. During the study period, 32 patients were non-randomly selected for each of the GA and SA groups. The heart rate (HR), mean arterial pressure (MAP), blood loss, total anesthetic time, surgeons' satisfaction, analgesic requirements, cost of the procedure, and hospital stay were recorded and compared. Results: In the context of demographic characteristics, baseline HR, or MAP, no significant differences were noted between SA and GA groups. Mean anesthetic time, mean PACU time, mean doses of analgesic requirement, cost of anesthesia, and the surgeon's satisfaction was significantly lower in the SA Group (P < 0.05). The blood loss, duration of operation, and hospital stay were not significant too. No major Intra and postoperative complications were reported nor were significant differences found in either series. Conclusion: Safety and efficacy of SA in comparison to GA were similar for the patients undergoing surgery on the lumbar spine. Notable advantages of SA include shorter anesthesia duration, fewer drug requirements, relative cost-effectiveness, and fewer complications rate. Successful surgery can be performed using either anesthesia type.

Introduction Scoliosis is a complex three dimensional deformity characterized by coronal, sagittal and horizontal plane deviation. Non operative treatment is a widely accepted approach. A significant number of cases need surgical intervention. Revolutionary design & capability of spinal instruments have drastically changed the principle of scoliosis correction by surgical intervention. Material and Methods During the period February 2009 to November 2014, 64 cases of different types of Scoliosis underwent surgical intervention at NITOR, BSOH and other private hospitals in Dhaka. 45 were female and 19 were male and age ranged from 14 to 38 years. Results The pedicle is a power nucleus of the vertebra and offers a secure grip of all 3 columns. Pedicle screw instrumentation has advantages of rigid fixation with improved 3D correction and it has been accepted as a reliable method with a high margin of safety. Accurate placement of the pedicle screws is important to reduce possible irreversible complication. So, all cases were corrected by transpedicular screws and rods and 1 case stabilized by sub laminar wring. 61 cases were managed by only posterior approaches and 3 cases required both anterior releases, costoplasty, posterior stabilization as well. In every case fusion was done in selected segments. Conclusion Total follow up time was ~5 years (6 months-5yrs). All patients were assessed in terms of correction of deformities, cosmesis, and functional outcome. 64 patients had average coronal plane cobb's angle measuring ~70 degree pre-operatively and 17.12 degree immediate post-operative period. 4 patients (5.7%) developed neurological deficit. 3 regained completely but another one regaining her neurological deficit very slowly. There were malposition of screws in 9 (14%) cases, Painful prominence of screws in 6 cases (9%), full flexion lack in 8 cases (12.5%) & superficial infection in 1 case (1.5%). 80% patients improved cosmetically.

Introduction Degenerative Spondylolisthesis refers to slip of one vertebral body over the one below as a result of degenerative changes in the spine. Mild to moderate symptoms are initially treated by conservative means such as NSAIDs, epidural injections, physiotherapy, etc. But once patient suffers from severe neurological symptoms like intermittent claudication or vesico-rectal disorder due to spinal stenosis, it leads the patients to experience surgical procedures. There is no uniform agreement among surgeons about the optimal treatment. But our experience along with several high quality studies indicate that surgery provides better clinical outcome for degenerative spondylolisthesis & that fusion provides better outcome than decompression alone which also results a safety profile. Material and Methods A prospective study was designed over 82 patients who had degenerative lumbar spondylolisthesis with severe neurological symptoms. The study time was from January 2003 to July 2014 in NITOR & BSOH, Dhaka. We selected the patients for surgery depending on two major criteria: (1) The patient has clinically important & significant pain or neurological symptoms; (2) The patient has not shown sufficient clinical improvement despite conservative care at least for 3 months. But we tried to manage those having significant osteoporosis & infection through conservative treatment despite fulfilling the above criteria. Our choice of surgery was TLIF for each patient. The steps included laminectomy, insertion of cage in the disc space, interbody chips bone graft surrounding the cage & posterolateral bone grafting with fixation of spine by transpedicular screws & rods. Total follow up time was 11 years & the minimum follow up time was 6 months. Evaluation of the patients was done comparing their pre & post-operative states which included clinical evaluation, X-ray showing gradual fusion with special investigation including CT scan & MRI Results 82 patients (Female- 51 & male-31) with average age of 59 years (41–76 years.) having degenerative lumbar spondylolisthesis with severe neurological symptoms met the inclusion criteria. Among the patients, 57 had osteoarthritis. Total follow up time was 11 years & minimum 6 months. The potential side effects included bleeding, post-operative infection, nonunion, residual deformity with spinal stenosis & malposition of screws & rods. The mean anterior slip was 26.1% (0–50%) prior to surgery & 24.8% at the final follow up. The longer was the duration of pre-operative insult to the spinal cord or nerve root, the slower was the rate of recovery. According to these, the excellent outcome was seen in 69 patients (84% of cases), fair result was seen in 4 (5%), good in 5 (6%) & poor result in 4 (5%) cases. Nonunion after surgery was observed in 3 patients. The Oswestry Disability Index Scores averages 11.1% (Range 0–62). Conclusion Though surgical procedures cannot confirm lifelong recovery of the patients with symptoms, but does ensure a better and comfortable lifestyle with potential...

Introduction Tuberculosis of the spine is the most common and dangerous form of TB infection accounting 50 to 60% of osseous tuberculosis. Although uncommon, spinal TB still occurs even in both developed and developing countries. The diagnosis of spinal tuberculosis is difficult and it commonly presents at an advanced stage. Delay in establishing diagnosis and management cause spinal cord compression and spinal deformity. Patients mostly present with lower limb weakness, Gibbus, pain, palpable mass, and kyphotic deformity in long standing cases. Material and Methods To evaluate the efficacy and clinical outcome of surgical treatment of spinal tuberculosis treated by different approaches consisting decompression surgery, autogenous bone grafting and anti-TB chemotherapy. Before that a strong evidence-based diagnosis must be established which can be done by clinical features, MT test, and MRI of spine. Because vertebral body collapse from TB may be misdiagnosed as compression fracture. A total of 582 patients who had tuberculosis of the cervical, thoracic, and lumbar spine with moderate-to-severe cord compression were studied. Variable degrees of neurological deficit with deformity were treated at NITOR and BSOH, Dhaka, in the period from January 2003 to July 2014. Anterolateral decompression and autogenous strut bone grafting with simultaneous fixation by screws and rods were done. Posterior decompression, posterior interbody, and posterolateral fusion by bone graft with stabilization by transpedicular screws and rods. Appropriate anti-TB drugs were given to all patients for 18 to 24 months. The postoperative follow-up period was 12 months (range, 3–21 months). Results Overall, 427 (73.4%) cases with neurological deficits recovered totally or partially. No neurological improvement had occurred in 69 (11.9%) cases with paraplegia. Overall, 56 (9.6%) cases were lost from follow-up. X-ray showing bony fusion was achieved in all cases for mean of 6 months (range, 4–8 months). There was no recurrence. Seven (5.1%) cases developed bed sore postoperatively. Excellent result was seen in 70% cases, fair in 15%, good in 10%, and poor in 5% cases. Conclusion For patients with spinal tuberculosis 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.