Surgical management of Pott´s spine - A single centre Indian experience
EANS Academy. Kumar MA A. 09/25/19; 275822; EP02117
Dr. Arun Kumar MA
Dr. Arun Kumar MA

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Abstract
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Background: Presently, India has the infamy of being world's Tuberculosis capital with a quarter of all cases worldwide. Pott's Spine accounts for 3% of these & assumes importance due to its chronic morbidity. Even with adjunctive use of anti-tubercular chemotherapy (ATT), surgical intervention plays major role.
Methods: Retrospective study was conducted at our institute with medical records data between 2011-2019. Demographic data, clinical history, neurological status, imaging, blood investigations, operative records & condition at discharge were recorded. Patients were followed up as outpatients.
Results: Fifty-two patients were included, averaging 39.4 years. Majority presented with backache and paraparesis. On MRI, dorsal spine was most commonly involved (54%) followed by lumbar (38.5%) and cervical (7.5%). 85% patients had two or more levels of involvement and 71% patients had pre & paravertebral collection. ESR was elevated in two-thirds of patients (average 55mm/Hr). Twenty-eight patients had dorsal spine involvement. Twenty-two of them were approached posteriorly, rest by transthoracic or anterolateral approach. Among twenty patients with lumbar involvement, 16 were approached posteriorly & remaining by anterolateral retroperitoneal approach. Stabilization with transpedicular screws and rods construct was used in more than 50% patients with posterior approach. Histological proof of granulomas was found only in 21 patients and only one patient showed AFB positivity. ATT was started empirically in the rest based on clinical suspicion and radiological findings. Average hospital stay was 11 days. Most patients (94.3%) had immediate improvement in symptoms by the time of discharge with 50% patients having improvement in motor power. Among the eight patients presenting with paraplegia, 50% improved within 1 week of surgery.
Conclusion: Prompt diagnosis & intervention showed good neurological outcomes, even in patients with paraplegia. Hence, surgery plays major role in Spinal Tuberculosis management. However, resurgence of tuberculosis with multi-drug resistance and increased association with HIV pose fresh challenges.
Background: Presently, India has the infamy of being world's Tuberculosis capital with a quarter of all cases worldwide. Pott's Spine accounts for 3% of these & assumes importance due to its chronic morbidity. Even with adjunctive use of anti-tubercular chemotherapy (ATT), surgical intervention plays major role.
Methods: Retrospective study was conducted at our institute with medical records data between 2011-2019. Demographic data, clinical history, neurological status, imaging, blood investigations, operative records & condition at discharge were recorded. Patients were followed up as outpatients.
Results: Fifty-two patients were included, averaging 39.4 years. Majority presented with backache and paraparesis. On MRI, dorsal spine was most commonly involved (54%) followed by lumbar (38.5%) and cervical (7.5%). 85% patients had two or more levels of involvement and 71% patients had pre & paravertebral collection. ESR was elevated in two-thirds of patients (average 55mm/Hr). Twenty-eight patients had dorsal spine involvement. Twenty-two of them were approached posteriorly, rest by transthoracic or anterolateral approach. Among twenty patients with lumbar involvement, 16 were approached posteriorly & remaining by anterolateral retroperitoneal approach. Stabilization with transpedicular screws and rods construct was used in more than 50% patients with posterior approach. Histological proof of granulomas was found only in 21 patients and only one patient showed AFB positivity. ATT was started empirically in the rest based on clinical suspicion and radiological findings. Average hospital stay was 11 days. Most patients (94.3%) had immediate improvement in symptoms by the time of discharge with 50% patients having improvement in motor power. Among the eight patients presenting with paraplegia, 50% improved within 1 week of surgery.
Conclusion: Prompt diagnosis & intervention showed good neurological outcomes, even in patients with paraplegia. Hence, surgery plays major role in Spinal Tuberculosis management. However, resurgence of tuberculosis with multi-drug resistance and increased association with HIV pose fresh challenges.
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