Comparison of clinical, radiological and functional outcome of short segment V/S long segment posterior fixation of tuberculosis of spine
Journal Title: National Journal of Clinical Orthopaedics - Year 2018, Vol 2, Issue 4
Abstract
Introduction: Spinal tuberculosis is most common form of extra-pulmonary TB, accounting for 50% of cases of musculoskeletal TB, however TB spine is a potentially debilitating condition not only because of its chronic nature but also because of ever present danger of spinal cord compression with resultant neurological deficit, the cardinal clinical feature of TB spine is localized backache. Anti-TB Treatment is still remains the cornerstone of therapy for spinal TB, surgery may be required in selected cases, those with large abscesses, severe kyphosis, progressive neurological deficit or lack of response to medical treatment. The goals of surgery in Pott’s spine are neurological decompression, radical debridement, correction of deformity and stabilization to prevent further neurological trauma and recurrence of deformity. Among the routine surgical approach to posterior fixation is double level posterior instrumentation is most commonly used. The aim of present study is to evaluate the clinical, radiological and functional outcome of short segment V/S long segment posterior fixation in TB spine. Aim: The aim of present study is to compare the clinical, radiological and functional outcome of short segment V/S long segment posterior fixation of tuberculosis of spine. Our secondary goal is also to evaluate results with either treatment in respect to involvement of segments and junctional area. Materials and Methods: The study consisted of 80 patients. All included patients were operated through posterior approach of spine with posterior instrumentation. All patients were followed up at 1, 6months and 12 months. At each follow up evaluation plain radiographic studies were obtained in standing position to determine the fusion status, development or progression of deformity after surgery and instrumentation failure. Clinical examination was also performed at each follow up visit in form of general and neurological examination and history of improvement in constitutional symptoms asked. Patients were also evaluated for radiological parameters like improvement in local kyphosis. All patients Neurological function on admission was graded according to Frankel et al grading. Functional assessment done according to Modified Macnab score, Fusion grading done according to Bridwell fusion scale at each follow up, for deformity correction and maintenance the angle of kyphos is was measured by a technique similar to that described by Konstam and Bolsovsky. Results and Discussion: In our study there is more deformity correction in form of measuring post op kyphotic angle and maintenance of corrective deformity is more in long segment fixation because of biomechanical advantage of long segment fixation with more pedicular fixation point then short segment fixation. Long segment fixation can share load much more efficiently then short segment without disturbing diseased segment. So long segment fixation can achieve more biomechanical stability and maintenance then short segment leads to more correction, maintenance of deformity and maintain sagittal balance. As seen our results of functional out-come in form of modified Macnab score in excellent and good category in long segment is 25%, 58.33% and in short segment is 10% and 30% observed which is statistically significant. Conclusion: Biomechanically superior technique, long segment implant fixation achieves better results in form of better neurological recovery, better deformity correction and better maintenance of corrected deformity, better maintenance of sagittal spinal balance, and better fusion status leads to so better rehabilitation of patients and so ultimately leads to better functional outcomes.
Authors and Affiliations
Dr. Mitul Mistry, Dr. Shailendrasinh Gohil, Dr. Aditya Dabhi, Dr. Harikrishna Ahir, Dr. Harshil Poriya, Dr. Pratik Bhabhor
Keywords
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