Vol 43 | January 2022 | page: 28-33 | Sachindra Kumar Dash
Authors: Sachindra Kumar Dash 
 Department of Orthopaedics, S.C.B. Medical College and Hospital, Cuttack, Odisha, India.
Address of Correspondence
Dr. Sachindra Kumar Dash
Department of Orthopaedics, S.C.B. Medical College and Hospital, Cuttack, Odisha, India.
Introduction: The study has been designed with all perseverance’s, to observe and evaluate the results of single stage transpedicular decompression and posterior fixation in Dorso Lumbar Spinal Tuberculosis.
Material and Methods: The present study “Evaluation of Single Stage Posterolateral Decompression and Posterior Fixation in Dorsolumbar Spinal Tuberculosis: A Prospective Study” was conducted on clinicopathologically diagnosed cases of spinal tuberculosis of dorsal and lumbar region during a period of two years from “October 2018 to October 2020” in the Department of Orthopaedics, S.C.B. Medical College and Hospital, Cuttack, Odisha.
Method of Collection of Data: This is a clinical and prospective study conducted on patients admitted to S.C.B. Medical College, Cuttack after obtaining ethical clearance from the institutional ethical committee. A total of 25 cases of tuberculosis of spine in thoracic and lumbar region were selected for this procedure after obtaining proper informed and written consent.Patients were admitted based on clinical presentation such as prolonged back pain usually with tender gibbus, with/ without neurologic deficit.
Objective of the Study: The objective of the study is to evaluate the efficacy of single stage posterolateral decompression and posterior fixation in spinal tuberculosis. The patients are to be evaluated postoperatively regarding following parameters: –
• Postoperative neurological status and its improvement
• Degree of pain relief
• Radiological fusion of vertebra
• Correction of angle of kyphosis
Discussion: This piece of work conducted in Department of Orthopaedics, SCB Medical College, Cuttack, is meant for an analytical study of transpedicular decompression and debridement of spinal cord and fixation of the unstable spine by means of screws & rod system in a single stage posterior approach surgery. In our study we followed Tuli’s Middle Path Regimen in the management. Hence, all clinicoradiological diagnosed TB spine cases were administered ATT drugs under govt. sponsored DOTS Therapy Schedule. The pts who didn’t show signs of improvement, or deteriorating neural deficit, or progressive and gross kyphosis, or patients with severe pain were taken up for surgery and then followed up regularly at 3 months interval for a minimum average follow up period of 1 year. In our study, out of 25, 11 patients recovered completely from neurological deficit and was found to have Frenkel grade E. Another 12 patients had recovered to Frenkel grade D. Hence almost 92 percent of patients had satisfactory neurological recovery. In our study fusion was seen in 64 percent of cases which was significant and comparable with the studies of Gueven et al, Lee et al, and Chacko et al. Pain reduced in all cases.
Conclusion: There was neurological recovery in all cases except one, indicating debridement by transpedicular approach is still effective though not radical. Pain was significantly reduced in all cases. Another vital observation was a correction in kyphotic deformity which was significant and also quite stable. There was fusion in more than half of the cases
Keywords: Single Stage Posterolateral Decompression, Posterior Fixation in Dorsolumbar Spinal Tuberculosis, Potts Paraplegia
1. Albee F.H. The Bonegraft in TB Spine Journal of American Medical association 94-1930.
2. Bhojraj SY Mehta Tuberculosis of thoracic spine JBJS 2001., 83B.
3. Bulawaya, Paraplegia in pott’s disease. JBJS 60B, 1978.
4. Butterman GR paraplegia in pott’s disease clinical orthopaedic 1997.
5. Cameroon, J.A.P., Robinson Radical Treatment of pott’s disease American Review of respiratory diseases 86-1962.
6. Chen W.J. Chen C.H Surgical Treatment of TB spine. Acta othop. Scand 66, 1995.
7. Goel M.K. pott’s paraplegia. Indian journal of surgical 26,1964.
8. Guven O, Kumano K fixation for preventing kyphosis in spinal Tuberculosis. Spine 1994:19.
9. Ghobadi F, Potenza A Computed tomography in TB Spine state journal of Medicine 75. 1975.
10. Judicious management of TB Spine. Indian Journal of orthopaedic 1985, 19.
11. Results of Treatment of spinal TB by middle path regimen JBJS 57 B 1975.
12. Treatment of neurological complication in TB spine JBJS 51 A 1969.
13. Tuli SM. Srivastav, T.P. Verma Tuberculosis of spine Acta. Orthopaedicscand 1967, 38.
14. Sahoo MM, Mahapatra SK, Sethi GC, Dash SK et al. Posterior-only Approach Surgery for Fixation and Decompression of Thoracolumbar Spinal Tuberculosis: A Retrospective Study. Journal of Spinal Disorder and Technique 2012
15. Kin C, Kenneth M.C. Cheung et al; Surgical treatment of acute TB spondylitis : indications and outcomes ; Eur spine journal 2013
|How to Cite this Article: Dash SK | Evaluation of Single Stage Posterolateral Decompression and Posterior Fixation in Dorsolumbar Spinal Tuberculosis: A Prospective Study | Odisha Journal of Orthopaedics & Trauma | January 2022; 43: 28-33.