Abstract
Purpose: A descriptive cohort study of the surgical treatment of spinal tuberculosis in a single unit in the United Kingdom
Tuberculosis is a common disorder and may be increasing in prevalence. 83 cases of spinal involvement with TB occurred and of these 40 patients had a total of 61 interventional procedures.
Indications for intervention were:
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Progressive neurological deterioration
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Failure to respond to treatment
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Doubt about the diagnosis
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Progressive deformity.
Results: The age range was from 12 to 73. Sixteen patients had 17 closed biopsies to assist in establishing the diagnosis, of these four went on require further surgical procedures. There were five intermediate level procedures such as application of halo or removal of hardware.
Two patients were Caucasian with no predisposing factors and delays occurred in the initial diagnosis. Diabetes was a significant associated co-morbidity particularly in Asian patients.
Multiple procedures were required usually for staged stabilisation after anterior decompression. 2 patients had four procedures, 2 had three procedures and 10 had two procedures 27 had a single procedure.
Nine patients that underwent anterior decompression and strut grafting for neurological deterioration went on to have a second stage extra focal fixation and became ambulant. One death occurred from mesenteric infarction at 4 months post op in this group. Significant neurological recovery occurred after surgery in the neurologically impaired patients.
Two revision procedures were required in the cervical spine for inadequate primary stabilisation.
Conclusion: About half of the spinal TB cases come to interventional procedures.
Surgery when required is often a complex decompression and staged reconstruction
Correspondence should be addressed to: Mr N. J. Henderson, BASS, c/o BOA, The Royal College of Surgeons, 35–43 Lincoln’s Inn Fields, London WC2A 3PE.
