Clinical Outcome of Thoracotomy, Anterior Spinal Decompression and Fixation With Screws and Rods for Dorsal Spine Tuberculosis

Abstract

BACKGROUND: The posterolateral or transpedicular approach has been used extensively for themanagement of spinal TB. This approach is a viable and importantly a safe surgical option for ventraldecompression in thoracic spine TB when followed by anti tuberculosis treatment for 18 months andimmobilization in an alkathene shell for 3 months.OBJECTIVE: To determine clinical outcome of thoracotomy, anterior spinal decompression andfixation with screws and rods for dorsal spine TB.MATERIAL AND METHODES: This observational prospective study was conducted inNeurosurgery Department Lady Reading Hospital Peshawar from Mar 2013 to March 2014. All patientsadmitted with dorsal spine tuberculosis and undergone thoracotomy, anterior spinal decompression andfixation with screws & rods were included in the study while those having unstable dorsal spine due tothe metabolic, neoplastic, traumatic pathologies & stable dorsal spine tuberculosis cases were excluded.Patients’ age, sex, addresses, level of dorsal spine tuberculosis, pre operative signs & symptoms, per &post op complications and post op variations in clinical status were recorded on a designed proforma.Minimum 6 months follow up was done. Data was analyzed by SPSS version 17 and expressed in theform of tables and charts.RESULTS: Total 24 patients were included in this study in which males and females were equal innumber. The age range was from 15 to 50 years and mean age was 31.5 ±3.8 years. Backward & hillyareas patients 15(62.5%) were on the top. D7,8,9 levels had highest frequency of involvement 45.83%(11) . Lower limbs weakness was present in all cases (100%) followed by back ache in 23 (95.8 %)while power >3/5,3/5 were noted in 22(75.4 %) followed by gibus formation in 29.3 % cases. Postoperative improvement in pain and power was 100%, 62.5 % while complications occurred in 4 (16.7%) cases having no mortalityCONCLUSIONS: Incidence of dorsal spine tuberculosis is more in backward hilly areas of KPKeffecting lower part of dorsal spine and great improvement in power of lower limbs & pain occurs afterthoracotomy, decompression, bone grafting with cage placement and fixation with screws and rods withacceptable mortality and morbidityKEY WORDS: Dorsal spine tuberculosis, Thoracotomy, Anterior spinal decompression & stabilizationwith screws and rods, clinical outcome.