Neurological Improvement after Decompression for Dorsal Spine Tuberculosis (TB)

Abstract

Objectives: To assess the neurological improvement after decompression for dorsal spine tuberculosis in terms of Frankel grading.
 Materials and Method: Prospective study was done in the Neurosurgery department, Prime Teaching Hospital Peshawar from 2018 to 2021. Patients of both genders aged between 18 to 60 years were selected while those unfit for surgery or requiring conservative management were excluded from the study. After clinical examination and radiological findings, the patients were diagnosed with dorsal spine tuberculosis requiring surgery. All patients were followed for 3 months post-operatively. Neurological improvement was measured by comparing pre and post-op Frankel grading. Complications were also documented.
 Results: Out of 38 patients included in the study, 16 (42%) were male and 22 (58%) were female. The mean age of presentation was 34 ± 5. The distribution for age groups was 18 – 30 (08), 31 – 40 (13), 41 – 50 (11), and 51 – 60 (06). Level of disease D4 – D8 were 17 (44.8%) and D9 – D12 was 21 (55.2%). Pre-operative neurological status of the patients was (5.2%) Frankel A, (10.5%) Frankel B, (47.3) Frankel C, (22%) Frankel D, and (7.8%) Frankel E while Post-operative grading was (2.6%) Frankel A, (5.2%) Frankel B, (23.6%) Frankel C, (47.3%) Frankel D and (18.4) Frankel E. 3 patients experienced worsening of neurology, 2 patients bleeding and CSF leak and 1 patient died as a complication of the surgery.
 Conclusion: Surgical option involving decompression of spine TB followed by stabilization is utilized in a majority of patients with neurological deficits. It is very effective and the results are good. The main advantage is thorough debridement and achievement of spinal stabilization.
 Keywords: Dorsal Spine Tuberculosis, Frankel Grading, Spinal Stabilization.

Spinal tuberculosis: MRI findings in a case series of 35 patients

“…Although multi-drug resistant tuberculous strains are in the rise, most cases respond very well to medical treatment. Surgery is reserved only for decompression of neurological complications that do not respond to medical therapy, the restoration of stability of the spinal column, and the correction of any severe deformity [4,12,13]. MR signs that favor a diagnosis of tuberculosis rather than the other differential diagnostic entities include: thoracic involvement, endplate abnormal signals, intact posterior vertebral septum, skip lesions, kyphotic deformity, early disc sparing, collapse of vertebral body [10] and cold abscesses, seen in about 70 % of cases [14].…”