^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

In present study most common age group was 31-40 years (34 %) followed by 21-30 years (32 %). There was almost equal distribution in males and females (male 56 and female 44%). The level of lesion most commonly affected was lower thoracic including thoracolumbar junction (70%).

Table 1: General characteristics

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. 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 2: Outcome

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. 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.⁵ Effective medical and surgical management of spinal TB has improved outcome of these patients significantly even in the presence of neurologic deficits and spinal deformities.⁶ In a similar study Joaquim Soares et al.,⁷ noted that mean age of tuberculosis was 34 years. In present study, average age of presentation of spinal tuberculosis was 37.6 years. While in a meta-analysis of 37 articles with 1,997 patients; the median of the patients mean age was 43.4 years.⁸ In present study, 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.,⁹ 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. While Saurabh Singh et al.,¹⁰ noted that mean preoperative kyphosis was 27.2° (50-16). The mean postoperative kyphosis was 9.0° (20-0). 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. In present study, 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.,⁹ the neurologic statuses of the 23 patients with preoperative neurologic deficits improved in each group. This signifies that there is excellent improvement in neurological status of patients who gets operative treatment in Pott’s spine. As above study involves both anterior as well as posterior approaches there isn‘t much difference apart from one case of posterior approach who lands up in implant failure that to because of stoppage of ATT.

Anterior approach is considered the gold standard for debridement and decompression in Pott‘s spine. Anterior radical surgery was popularized by Hodgson and Stock in 1960.¹¹ Advantages of the traditional anterior approach are ability to directly access the disease and perform decompression, better correction of deformity, less muscle dissection and the ability to place a graft under compressive load for fusion. Posterior instrumentation has been reported to be quite effective in preventing graft related complications and progression of kyphosis. The main advantage of posterior instrumentation is that it can provide good fixation through posterior elements as the disease pathology is anterior. Posterior fixation also helps in correcting pre-existing kyphosis effectively. Though anterior approach is a favored method for debridement and decompression as the lesion is situated anteriorly, there is an increased morbidity related to the approach (transthoracic, trans pleural). The posterior/ posterolateral approach (extracavitory approach) gives a reasonable access to the lateral and anterior aspects of the cord for an equally good decompression of the cord. Better functional outcome and significantly better sagittal plane and kyphosis correction by the posterior approach are strong pointers favoring the posterior approach.¹² Careful X-Ray examination of the spines and clinical history, blood investigations (ESR) nearly always disclose the diagnosis but investigation like MRI is done in order to pick the disease in early stage as well as strengthening the diagnosis.

CONCLUSION

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. Operative intervention leads 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.

REFERENCES

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