^1,2Post Graduate, ³Lecturer, Department of Orthopaedics, Government Medical College, Jammu, INDIA.

⁴Registrar, Department of Pathology Government Medical College, Rajouri J & K, INDIA.

Email: shubham45surmal@gmail.com

RESULTS

The most common age group was third and fourth decade (66 percent). There was almost equal distribution in males and females (male 56 and female 44%).

Table 1: Age and gender distribution

The level of lesion most commonly affected was lower thoracic including thoracolumbar junction (70%).

Table 2: Level of the Lesion

The mean preoperative ESR value was 114.9 and mean postoperative value was 20.26. Preoperative mean kyphotic deformity was 26.36 percent and postoperative after correction mean kyphotic deformity was 7.72 as calculated by cobbs angle in postoperative X-ray‘s.

Table 3: ESR and Cobb's angle

Neurological function preoperative, postoperative and on subsequent follow up was graded according to Frankel et al., grading. Preoperatively 9 patients were classified under grade B, 40 patients graded under grade C and 1 patient under grade D. Postoperatively 35 patients improves to grade E, 13 patients to grade D, 1 patient under grade C, and 1 patients remains unchanged to grade B.

Table 4: Neurological outcome

Complications - One patient develops implant failure with chronic discharging sinus at one year follow up, patient had stop taking ATT from the last 6 months. Neurological status of the patient improves and on corrective surgery intraoperatively as the implant removed a bone fusion mass was present at infective site.

DISCUSSION

The treatment of tuberculosis of spine consists of conservative methods or surgical management. Conservative method comprises Bed rest with or without Plaster casts, Chemotherapy, Supervision with Imaging and blood markers every 3 months followed by resumption of activity with braces. It requires long period of immobilization and it leads to complications of prolonged recumbency like deep vein thrombosis, bed sore and chest infection. It cannot prevent the progression of kyphotic deformity. To circumvent the problems associated with conservative management and those who did not show signs of progressive recovery, development of neurological problems, neurological worsening during conservative therapy, advanced cases and in the elderly, surgery is indicated. The goals of surgery in Tuberculosis of spine are adequate decompression, adequate debridement, maintenance and reinforcement of stability and correction and to stop the progression of kyphosis.⁹ The average age of presentation of spinal tuberculosis was 37.6 in our study. In a similar study it was noted that mean age of tuberculosis was 34.¹⁰ Manuel Fuentes Ferrer et al.,¹¹ reviewed 37 articles with a total of 1,997 patients; the median of the patients mean age was 43.4 years. The no. of male patient were 28 and female 22 in our study. Similar trends were seen in study conducted by Hodgson AR.¹² The mean ESR noted in our study was 114.9 preoperatively. Erythrocyte sedimentation rate (ESR) is a sensitive marker of infection and can be used to monitor therapeutic response, but its low specificity is a concern. Usually in TB, ESR is >20 mm/h and decreases as healing progresses. In study by Wang et al.,¹³ mean ESR of the patients at the initial hospitalization was 96.4 ± 20.8 mm/h. The mean kyphosis as calculated by cobbs angle was 26.36 preoperative and after corrective surgery mean kyphosis was 7.72. In a study conducted by Xu Cui et al.,¹⁴ the kyphotic deformities were corrected from 32.1° ± 10.3° to 10.2° ± 2.1° in the anterior group and from 33.8° ± 11.7° to 12.6° ± 2.7° in the posterior group. The mean preoperative kyphosis was 27.2° (50-16) and mean postoperative kyphosis was 9.0° (20-0) in a study conducted by Saurabh Singh et al.,¹⁵ There is marked correction in deformity by operative measures which leads to reversal of neurological complication, better cosmetic appearance and helps in preventing complications like sinus formation, bed sores DVT. About 40 patients falls in grade C, 9 in grade B and 1 in grade D preoperatively and post operatively there is significant improvement in neurological status and by the end of one year follow up 35 patients improves to grade E, 13 to grade D, 1 patient to grade C and 1 patient remains in grade B. In a study by Xu Cui et al.,¹⁴ the neurologic statuses of the 23 patients with preoperative neurologic deficits improved in each group. In an another by Sombat Kunakornsawat et al.,¹⁶ study No patients had Frankel grade A or B postoperatively at the final follow-up. In some patients with Pott's disease of the spine early surgical intervention is preferred, because they will not benefit from medical treatment alone due to presence of sequestrum or constricting fibrous bands compressing the spinal cord. The kyphotic deformity of greater than 40 degree requires correction Surgical intervention allows early mobilization of patients avoiding complications such as deep vein thrombosis, pulmonary complications, psychological well being, sinus formation, pain gets settle in shorter time period and bedsores.

CONCLUSION

There is excellent improvement in neurological status of patients who gets operative treatment in Pott’s spine. Surgical intervention will lead to excellent improvement in neurological status, correction of deformity is also achieved in desired manner and overall complication of Pott’s spine will be minimized.

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