Abstract
Instrumentation in Spinal Tuberculosis is a controversial issue. The introduction of Pedicle screws in spinal fixation offered a new dimension to the management of this difficult problem.
We operated on 127 patients with Spinal Tuberculosis between 1990 and 2000. Between 1990 and 1995, we treated 45 patients in the traditional manner with anterior decompression and strut grafting. During this period we encountered an unacceptably high rate of complications, such as graft collapse, progression of deformity and pseudoarthrosis.
Between 1995 and 2000, we adopted the practice of anterior radical surgery combined with instrumentation, and employed this approach in 82 patients. Of these:
18 patients underwent surgery at dorsal vertebral level, 30 at dorsolumbar level, and 34 at lumbar level.
Our experience has enabled us to develop a protocol in the management of these patients depending on:
a/ the level of vertebral involvement (cervicodorsal/ dorsolumbar/ lumbar),
b/ the presence of single or multilevel disease, and
c/ location of disease in the spinal columns.
In Dorsal lesions involving less than two consecutive levels with no deformity, we performed anterior procedure only. In multilevel dorsal lesions with no deformity we did anterior followed by posterior surgery. In Dorsal lesions with deformity we performed Back-Front-Back procedure. In single level Dorsolumbar lesion we did anterior procedure only. In presence of multisegment involvement with or without deformity we did Back-Front-Back procedure. In Lumbar lesion with anterior and middle column involvement without deformity anterior surgery was performed. In presence of all column involvement with deformity we did anterior followed by posterior surgery.
With the use of instrumentation we achieved satisfactory results in terms of correction of deformity. We were also able to carry out extensive debridement (with anticipation of gaining stability with instrumentation), thereby clearing infection locally and effecting neurological improvement in all our cases. There were a few minor complications in our second (instrumented) group. No major complications (death, deep secondary infection or deterioration of the neurology), occurred in this group.
We conclude that Instrumentation in Spinal Tuberculosis is safe. It allows the surgeon to debride the tissues safely and to stabilise the spine and thus prevent deformity. Instrumentation also allows early mobilisation. The radical debridement leads to a reduction in recurrence of infection at the operative site.
The abstracts were prepared by Mr Richard Buxton. Correspondence should be addressed to him at Bankton Cottage, 21 Bankton Park, Kingskettle, Cupar, Fife KY15 7PY, United Kingdom
