A STUDY OF SURGICAL MANAGEMENT OF SPINAL TUBERCULOSIS
Journal Title: Journal of Evidence Based Medicine and Healthcare - Year 2017, Vol 4, Issue 48
Abstract
BACKGROUND Tuberculosis has been a major public health problem. As the 20th century began, tuberculosis was a leading cause of death in the Western countries. The development and the introduction of antituberculosis chemotherapeutic agents in the 1940s reduced the death rate. Of all the patients with tuberculosis, nearly 1-3% has involvement of the skeletal system. MATERIALS AND METHODS This study was conducted on patients operated for spinal tuberculosis between 2013 and 2016. Inclusion Criteria- All patients operated for spinal tuberculosis from the cranio-vertebral (CV) junction to the lumbosacral spine. This includes all the types of surgeries performed including decompression procedures to relieve pressure on the spinal cord and all stabilisation procedures done to prevent spinal instability. Exclusion Criteria- All patients who were treated conservatively. Preoperative Assessment- The patients were assessed preoperatively with regard to the following- 1. Age and sex. 2. Neurological assessment using the MRC grading of motor power and Nurick’s grading of functional disability for CV junction, cervical and dorsal spine involvement. The ASIA impairment scale was used for the lumbar spine. 3. Clinical assessment of bladder function. 4. Radiological assessment using x-rays, MRI and CT. 5. Other relevant investigations like CXR, Mantoux test and ESR. Preoperative Evaluation- About the type of the disease and the extent from radiology including x-rays, CT and MRI, preoperative planning of the surgical approach depending on the extent and location of spinal cord pressure and the need for stabilisation based on peroperative findings. DISCUSSION 1. CV junction tuberculosis- Two patients underwent surgery. Mean age was 57.5 years, mean duration of symptoms was 4.5 months and incidence was 3.03% (Table 1). The clinical presentation was neck pain in all patients. Other symptoms are radicular pain, quadriparesis and bladder symptoms. All patients had spasticity and paraspinal muscle spasm (Table 2 and 3). One patient had retropharyngeal abscess. 2. Cervical and cervicodorsal spine- Twenty patients underwent surgical treatment. Mean age was 43.2. There was female preponderance (55%) and the mean duration of symptoms was 7.62 months. Incidence was 33.33% (Table 1). Preoperative symptoms were neck pain 95%, radicular pain in 35%, upper limb weakness in 80%, lower limb weakness in 75%, sensory symptoms in 35%, bladder symptoms in 35%, spasticity in 90%, discharging sinus in 10% and paraspinal muscle spasm in 30% (Table 2 and 3). 10% had neck swelling. One patient had past history of pulmonary tuberculosis and one patient had history of contact with tuberculosis (Table 4). 3. Dorsal and dorsolumbar caries- 35 patients were operated upon. Mean age was 39.95 with a female preponderance of 54.28%. Mean duration of symptoms was 4.46 months (Table 1). The chief presenting complaints were back pain in all cases, radicular pain 42.85% and swelling in the back was seen in 4 patients. Upper limb power was normal in all patients. 77.14% had paraparesis and 20% had paraplegia, bladder function was affected in 54.28%. 28.57% had paraspinal muscle spasm. 34 patients had spasticity. Only 4 patients had sinus. Gibbus deformity was seen in 5 (14.28%) patients (Table 2 and 3). 11.4% had pulmonary tuberculosis and 2.85% had history of contact with tuberculosis. One patient had tuberculosis meningitis earlier (Table 4). CONCLUSION In all patients who underwent surgical decompression of the spinal cord, there was improvement in the neurological status as evidenced by the progressive improvement in Nurick’s grading, MRC grading for motor power and the ASIA Scoring System. In all stabilised patients, early mobilisation could be done.
Authors and Affiliations
Loki Krishna K, Hareesh K, Satya Prasad J
Keywords
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- EP ID EP220158
- DOI 10.18410/jebmh/2017/583
- Views 92
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