DOI: http://dx.doi.org/10.18203/2320-6012.ijrms20203542

Postoperative outcome in thoracolumbar spinal tuberculosis: a retrospective study

Shaji U. Abu, Lijo J. Kollannur, Sreenath K.

Abstract


Background: Spinal tuberculosis is the most common location of extra pulmonary tuberculosis. ATT alone may not be suitable in all situations, especially when treating patients with risk of instability, progression of neurologic deficit, and failure of medical treatment. Surgical intervention is a major treatment modality for symptom relief in spinal tuberculosis.

Methods: The aim of this study was to assess the immediate post-operative outcome in surgically treated patients with dorsolumbar spine tuberculosis at Department of Neurosurgery Government Medical College, Thrissur. All operated patients of dorsolumbar spinal tuberculosis during 2014 September to 2019 august were included under study.

Results: A total of 57 patients were included in the study. The mean age of the patient was 42.77 years. There were 40 males (70.2%) and 17 females (29.8%). 55 (96.5%) out of 57 patients were having sensory symptoms. 41 (71.9%) out of 57 patients were having motor symptoms. Bladder involvement 23 (40.4%) and bowel involvement 15 (26.3%) were also noted in the study. Sensory symptoms improvement in post-operative period was noted in 46 (80.7%). Motor symptoms improvement was observed in 23 (56.1%) out of 41. Bladder symptoms improved in 6 (26.1%) out of 23. There is improvement in clinical symptoms, neurological function immediately after surgery. Surgical patients have faster improvement and can be mobilized earlier. Improvement in sensory symptoms (96.5%), motor symptoms (56.1%) and bladder symptoms (26.1%) were noted in our study in the immediate post-operative period.

Conclusions: There was significant immediate relief in symptoms and morbidity of patients undergoing surgical treatment for dorsolumbar spine tuberculosis.


Keywords


Postoperative outcome, Spinal tuberculosis, Thoracolumbar

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References


Tuli SM. Tuberculosis of the skeletal system. 3rd Ed. New Delhi: Jaypee Brothers Medical Publishers; 2004: 191-194.

World Health Organization. Global Tuberculosis Report, Geneva. 2012. Available at: https://www.who.int/tb/publications/global_report/gtbr12_main.pdf?ua=1. Accessed on 17 July 2019.

Tuli SM. Tuberculosis of the spine: a historical review. Clin Orthop Relat. 2007;460:29-38.

Moon MS, Ha KY, Sun DH, Moon JL, Moon YW, Chung JH. Pott's Paraplegia- 67 cases. Clin Orthop Relat. 1996;323:122-8.

Moon MS, Kim I, Woo YK, Park YO. Conservative treatment of tuberculosis of the thoracic and lumbar spine in adults and children. Int Orthop. 1987;11:315-22.

Moon MS. Tuberculosis of the spine. Controversies and a new challenge. Spine. 1997;22:1791-7.

Nene A, Bhojraj S. Results of nonsurgical treatment of thoracic spinal tuberculosis in adults. Spine. 2005;5:79-84.

Kirkaldy-Willis WH, Thomas TG. Anterior approaches in the diagnosis and treatment of infections of the vertebral bodies. J Bone Joint Surg Am. 1997;47:87-110.

Moon MS, Woo YK, Lee KS, Ha KY, Kim SS, Sun DH. Posterior instrumentation and anterior interbody fusion for tuberculous kyphosis of dorsal and lumbar spines. Spine. 1995;20:1910-6.

Hodgson AR, Stock FE, Fang HS, Ong GB. Anterior spinal fusion. The operative approach and pathological findings in 412 patients with Pott's disease of the spine. Br J Surg. 1960;48:172-8.

Jain AK. Treatment of tuberculosis of the spine with neurologic deficit. Clin Orthop. 2002;398:75-84.

Benli IT, Acaroglu E, Akalin S, Kis M, Duman E, Un A. Eur Spine J. 2003;12(2):224-34.

Jain AK. Tuberculosis of spine: research evidence to treatment guidelines. Indian J Orthop. 2016;50(1):3-9

Garg RK, Somvanshi DS. Spinal tuberculosis: a review. J Spinal Cord Med. 2011;34:440-54.

Jain AK. Tuberculosis of the spine: a fresh look at an old disease. J Bone Joint Surg. 2010;92:905-13.

Jain AK, Dhammi IK Tuberculosis of the spine: a review. Clin Orthop Relat Res. 2007;46:39-49.

Li M, Du J, Meng H, Wang Z, Luo Z .One-stage surgical management for thoracic tuberculosis by anterior debridement, decompression and autogenous rib grafts, and instrumentation. Spine J. 2011;11:726-33.

Swanson AN, Pappou IP, Cammisa FP, Girardi FP. Chronic infections of the spine: surgical indications and treatments. Clin Orthop Relat Res. 2006;444:100-6.

Ledermann HP, Schweitzer ME, Morrison WB. MR imaging findings in spinal infections: rules or myths? Radiology. 2003;228(2):506-14.

Rasouli MR, Mirkoohi M, Vaccaro AR. Spinal tuberculosis: diagnosis and management. Asian Spine J. 2012;6(4):294-308.

Jiang T, Zhao J, He M, Wang K, Fowdur M, Wu Y. Outcomes and treatment of lumbosacral spinal tuberculosis: a retrospective study of 53 patients. PLoS One 2015;10(6):e0130185.

Pooswamy SS, Muralidharaogpalan NR. Thoraco lumbar spinal tuberculosis-assessment of functional outcome following posterior decompression and posterior instrumentation. Int J Res Orthop. 2019;5:109-14.

Gupta A, Jain P, Thakur R, Sharma S. Posterior only debridement and instrumentation in thoracolumbar spinal tuberculosis. Int J Orthop. 2017;3(2):38-42.

Patidar AB, Mehta RP, Sharma SK, Vyas GB, Singh V, Ramchandra O. Single-stage posterior-only debridement and transpedicular screw fixation for dorsolumbar tuberculosis: A prospective study of twenty cases. J Orthop Allied Sci. 2017;5:74-9.

Mahesh M, Jain V, Ravikumar TV. Outcome of instrumentation in spinal tuberculosis. J Trauma. 2017;12(2):8-12.