Selection of surgical approach in spinal tuberculosis: Experience of 663 cases

4^th Global Congress on Spine and Spinal Disorders

September 05-06, 2018 Auckland, New Zealand

Md Shah Alam

National Institute of Traumatology and Orthopedic Rehabilitation, Bangladesh

Keynote: J Spine

Abstract :

Background: Tuberculosis of the spine is a common form of TB infection for 50-60% of osseous tuberculosis. Although uncommon, spinal TB still occurs in both developed and developing countries. The diagnosis of spinal tuberculosis is difficult and it commonly presents at an advanced stage. Delays in establishing diagnosis and management result in complications such as spinal cord compression and spinal deformity. Method: A total of 663 patients with tuberculosis of the cervical, thoracic and lumbar spine with moderate to severe cord compression were studied. Variable degrees of neurological deficit with deformity were treated from January 2003 to July 2017. Thoracotomy along with anterolateral decompression and autogenous strut bone grafting with simultaneous fixation by screws and rods were done in 113 cases. Posterior decompression, posterior interbody and posterolateral fusion by bone graft with stabilization by transpedicular screws and rods were done in the remaining 550 cases. Appropriate anti TB drugs were given to all patients for 12-18 months. The follow-up period was 3 months to 10 years. Result: The average age was 47 (9-85) years. All patients survived surgery. There were 8 cases of superficial infections (1.2%) whilst there were 5 cases (0.7%) of deep infections. Revision surgery was performed in 7 patients (1.0%). Implant failure occurred in 5 cases (0.7%) whilst malposition of screws occurred in 14 cases (2.1%). Perioperative bleeding complications were reported for 5 patients (0.7%). Neurological improvement occurred in all patients except for two cases (0.3%). Preoperatively, most patients (n=245, 37%) were classified with Class A on the American Spinal Injury Association (ASIS) neurological impairment scale. This was significantly reduced postoperatively to 0.3%. Conclusion: For patients with spinal tuberculosis anterior debridement, auto graft bone fusion, anterior or posterior fixation appears to be effective in arresting disease, correcting kyphotic deformity and maintaining correction until solid spinal fusion.

Biography :

Md Shah Alam is an eminent Spine and Orthopedic Surgeon in Bangladesh. He has been working as a Professor and Unit Chief at the National Institute of Traumatology and Orthopedic Rehabilitation (NITOR), Dhaka, Bangladesh. He is a FCPS in General Surgery and MS in Orthopedic Surgery. He was awarded FRCS from the Royal College of Surgeons of Edinburgh, UK. He has special interest on spinal infections and deformity correction. He is the Secretary General of Bangladesh Spine Society and Council Member of APSS.

E-mail: dr.s.alam@hotmail.com