Abstract

Background: Tuberculosis is a common disease across the world and India alone accounts for 24% of global burden of the disease. Tuberculosis involving vertebral column is one of the commonest presentations in the extra-pulmonary tuberculosis. It is associated with significant morbidity. Therefore, social burden of the spinal tuberculosis is high, especially in the developing countries. The condition needs medical management and surgical intervention to achieve relief of cord compression, correction of deformities and stabilization when necessary. Aim: Present study aimed to analyse both short and long term follow up of the spinal tuberculosis patients who underwent surgical stabilisation using implants. Methods: All the patients with spinal tuberculosis treated in the Department of Neurosurgery, Gandhi Hospital, Secunderabad between January 2009 and December 2014 who underwent surgical stabilization using implant were included in the study. The study was taken up on both prospective and retrospective basis. Total 52 patients were included in the study. Preoperative and post operative status was analyzed in reference to the clinical symptoms and radiological evaluation. Their kyphotic angle regressions are specifically recorded during follow-up imaging. Parameters like time for mobilisation, duration of hospital stay, persistence of lesions and ESR trends and return to previous activity of the patient were followed. Results: The risk of neurological deterioration was reported following surgical intervention which is minimised with sound techniques of surgery and advent of better imaging and instrumentation. Duration and severity of neurological involvement prior to surgery is an important factor determining the final outcome. The patients undergoing surgery involving implant stabilisation were mobilised as early as second postoperative day and could be discharged very early. Total hospital stay has been reduced significantly. Rapid neurological improvement helps in early rehabilitation. Patients could go back to their previous work earlier compared to the medical management group as reported in the past. Follow up clinical evaluation and imaging was encouraging without problems like recrudescence or morbidity or need for prolongation of chemotherapy instead there was good union rate with normal ESR trends by end of three months. Conclusion: This study aimed to assess the outcome and benefits of surgical stabilisation using implants for TB spine patients with neurological deficits and instability. There was significant advantage for the patients allowing reduction of hospitalisation, early mobilisation and recovery such that they are able to attend their previous work.

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