Download PDF
CC BY-NC-ND 4.0 · Asian J Neurosurg 2021; 16(04): 695-700
DOI: 10.4103/ajns.AJNS_78_21
Original Article

Surgical management of spinal tuberculosis – A retrospective observational study from a Tertiary Care Center in Karnataka

Rakshith Srinivasa
Department of Neurosurgery, M S Ramaiah Medical College and Hospital, Bengaluru, Karnataka, India
,
Sunil Furtado
Department of Neurosurgery, M S Ramaiah Medical College and Hospital, Bengaluru, Karnataka, India
,
Kirthana Kunikullaya
1   Department of Physiology, M S Ramaiah Medical College and Hospital, Bengaluru, Karnataka, India
,
Sangeeta Biradar
Department of Neurosurgery, M S Ramaiah Medical College and Hospital, Bengaluru, Karnataka, India
,
Dravya Jayakumar
2   Medical student, M S Ramaiah Medical College and Hospital, Bengaluru, Karnataka, India
,
Eilene Basu
2   Medical student, M S Ramaiah Medical College and Hospital, Bengaluru, Karnataka, India
› Author Affiliations
› Further Information
Also available at
   Permissions and Reprints

Context: Tuberculosis (TB) is a common infectious disorder in developing countries. A significant load of patients with extrapulmonary TB are diagnosed in our institute, mostly involving the spine. Aim: We aimed to present our experience in the surgical management of spinal TB. Setting and Design: This was a retrospective observational study. Materials and Methods: Seventy patients (year 2016–2018) who underwent surgical management with minimum of 1-year follow-up (17 patients lost during follow-up) were graded as per the American Spinal Injury Association (ASIA) grading system for neurological deficits. All were surgically treated with laminectomy and epidural abscess drainage/transpedicular debridement of granulation with/without spinal stabilization. Thoracic and lumbar cases were managed by posterior approach; among them, 12 patients who had no significant cord compression and good ASIA grade with facet involvement (requiring fusion) underwent minimally invasive pedicle screw fixation. Cervical cases were managed mostly by anterior approach. All patients received Anti-tubercular treatment (ATT) post operatively as per protocol postoperatively, following which magnetic resonance imaging (MRI) spine was done. Statistical Analysis: Data were analyzed using SPSS software version 18.0 (SPSS Inc. Released in 2009. PASW Statistics for Windows, version 18.0. Chicago, IL, USA: SPSS Inc.). The continuous variables were analyzed using descriptive statistics using mean and standard deviation. Results: The average age was 42.5 years. The most common location was thoracic (28 patients), followed by lumbar (20 patients), cervical (16 patients), and thoracolumbar (6 patients). Twenty patients had epidural abscess with cord compression. All patients who presented within 4 weeks of onset of symptoms showed a statistically significant improvement postsurgery. Sixteen patients with epidural abscess had good neurological recovery immediately after surgery (ASIA B to ASIA D/E). Four patients with epidural abscess with late presentation remained ASIA A after surgery. All patients had good fusion rates (follow-up X-ray) at 1 year. After ATT course completion, all patients had complete eradication of disease (MRI spine). Conclusion: Surgical treatment for spinal TB, if performed early (within 4 weeks) with good decompression, results in satisfactory clinical outcome with early improvement in the neurological deficits. Posterior approach to the spine with decompression and fixation gives good results, and minimally invasive procedures further help lessen muscle dissection, less pain, and early mobilization.

Key-words:

Early surgical management - minimally invasive surgery - posterior approach - tuberculosis of spine

Financial support and sponsorship

Nil.




Publication History

Received: 22 February 2021

Accepted: 13 June 2021

Article published online:
16 August 2022

© 2021. Asian Congress of Neurological Surgeons. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

Thieme Medical and Scientific Publishers Pvt. Ltd.
A-12, 2nd Floor, Sector 2, Noida-201301 UP, India

 

  • References

  • 1 Sai Kiran NA, Vaishya S, Kale SS, Sharma BS, Mahapatra AK. Surgical results in patients with tuberculosis of the spine and severe lower-extremity motor deficits: A retrospective study of 48 patients. J Neurosurg Spine 2007;6:320-6.
  • 2 India TB Report 2020 – National Tuberculosis Elimination Programme. Available from: https://tbcindia.gov.in/showfile.php?lid=3538. [Last accessed on 2021 Apr 20].
  • 3 Khanna K, Sabharwal S. Spinal tuberculosis: A comprehensive review for the modern spine surgeon. Spine J 2019;19:1858-70.
  • 4 Cavus G, Gezercan Y, Ökten AI, Tolunay O, Çelik T, Arslan A, et al. Surgical approaches to upper thoracic Pott's disease with spinal instability during childhood: Two cases. Childs Nerv Syst 2018;34:1221-7.
  • 5 Fam AG, Rubenstein J. Another look at spinal tuberculosis. J Rheumatol 1993;20:1731-40.
  • 6 Bailey HL, Gabriel M, Hodgson AR, Shin JS. Tuberculosis of the spine in children. Operative findings and results in one hundred consecutive patients treated by removal of the lesion and anterior grafting. J Bone Joint Surg Am 1972;54:1633-57.
  • 7 Tuli SM. Treatment of neurological complications in tuberculosis of the spine. J Bone Joint Surg Am 1969;51:680-92.
  • 8 Rivas-Garcia A, Sarria-Estrada S, Torrents-Odin C, Casas-Gomila L, Franquet E. Imaging findings of Pott's disease. Eur Spine J 2013;22 Suppl 4:567-78.
  • 9 Nussbaum ES, Rockswold GL, Bergman TA, Erickson DL, Seljeskog EL. Spinal tuberculosis: A diagnostic and management challenge. J Neurosurg 1995;83:243-7.
  • 10 Rajasekaran S, Khandelwal G. Drug therapy in spinal tuberculosis. Eur Spine J 2013;22 Suppl 4:587-93.
  • 11 A 10-year assessment of a controlled trial comparing debridement and anterior spinal fusion in the management of tuberculosis of the spine in patients on standard chemotherapy in Hong Kong. Eighth Report of the Medical Research Council Working Party on Tuberculosis of the Spine. J Bone Joint Surg Br 1982;64:393-8.
  • 12 Halsey JP, Reeback JS, Barnes CG. A decade of skeletal tuberculosis. Ann Rheum Dis 1982;41:7-10.
  • 13 Soares do Brito J, Batista N, Tirado A, Fernandes P. Surgical treatment of spinal tuberculosis: An orthopedic service experience. Acta Med Port 2013;26:349-56.
  • 14 Rasouli MR, Mirkoohi M, Vaccaro AR, Yarandi KK, Rahimi-Movaghar V. Spinal tuberculosis: Diagnosis and management. Asian Spine J 2012;6:294-308.
  • 15 McLain RF, Isada C. Spinal tuberculosis deserves a place on the radar screen. Cleve Clin J Med 2004;71:537-9, 543-9.
  • 16 WHO | Guidelines for Treatment of Tuberculosis. Available from: https://www.who.int/tb/publications/2010/9789241547833/en/. [Last accessed on 2020 Oct 27].
  • 17 Guerado E, Cerván AM. Surgical treatment of spondylodiscitis. An update. Int Orthop 2012;36:413-20.
  • 18 Bjune G, Cotton M. WHO | Guidance for National Tuberculosis Programmes on the Management of Tuberculosis in Children. WHO. Available from: http://www.who.int/tb/publications/childtb_guidelines/en/. [Last accessed on 2020 Sept 29].
  • 19 Blumberg HM, Burman WJ, Chaisson RE, Daley CL, Etkind SC, Friedman LN, et al. American Thoracic Society/Centers for Disease Control and Prevention/Infectious Diseases Society of America: Treatment of tuberculosis. Am J Respir Crit Care Med 2003;167:603-62.
  • 20 Phalak M, Kale SS. Tuberculosis of the thoracic spine- when and how to operate. Current practice in Neurosciences. 2019;1:1-12.
  • 21 Pandita A, Madhuripan N, Pandita S, Hurtado RM. Challenges and controversies in the treatment of spinal tuberculosis. J Clin Tuberc Other Mycobact Dis. 2020;19. doi:10.1016/j.jctube.2020.100151. eCollection 2020 May.
  • 22 Garg RK, Somvanshi DS. Spinal tuberculosis: A review. J Spinal Cord Med 2011;34:440-54.
  • 23 D'souza AR, Mohapatra B, Bansal ML, Das K. Role of posterior stabilization and transpedicular decompression in the treatment of thoracic and thoracolumbar TB: A retrospective evaluation. Clin Spine Surg 2017;30:E1426-33.
  • 24 Zhang H, Sheng B, Tang M, Guo C, Liu S, Huang S, et al. One-stage surgical treatment for upper thoracic spinal tuberculosis by internal fixation, debridement, and combined interbody and posterior fusion via posterior-only approach. Eur Spine J 2013;22:616-23.
  • 25 Jain A, Jain RK, Kiyawat V. Evaluation of outcome of transpedicular decompression and instrumented fusion in thoracic and thoracolumbar tuberculosis. Asian Spine J 2017;11:31-6.
  • 26 Rath SA, Neff U, Schneider O, Richter HP. Neurosurgical management of thoracic and lumbar vertebral osteomyelitis and discitis in adults: A review of 43 consecutive surgically treated patients. Neurosurgery 1996;38:926-33.
  • 27 Güven O, Kumano K, Yalçin S, Karahan M, Tsuji S. A single stage posterior approach and rigid fixation for preventing kyphosis in the treatment of spinal tuberculosis. Spine (Phila Pa 1976) 1994;19:1039-43.
  • 28 Cui X, Ma YZ, Chen X, Cai XJ, Li HW, Bai YB. Outcomes of different surgical procedures in the treatment of spinal tuberculosis in adults. Med Princ Pract 2013;22:346-50.
  • 29 Dai LY, Jiang LS, Wang W, Cui YM. Single-stage anterior autogenous bone grafting and instrumentation in the surgical management of spinal tuberculosis. Spine (Phila Pa 1976) 2005;30:2342-9.
  • 30 Hodgson AR, Stock FE. Anterior spinal fusion a preliminary communication on the radical treatment of Pott's disease and Pott's paraplegia. Br J Surg 1956;44:266-75.
  • 31 Ito M, Sudo H, Abumi K, Kotani Y, Takahata M, Fujita M, et al. Minimally invasive surgical treatment for tuberculous spondylodiscitis. Minim Invasive Neurosurg 2009;52:250-3.
  • 32 Kandwal P, Garg B, Upendra B, Chowdhury B, Jayaswal A. Outcome of minimally invasive surgery in the management of tuberculous spondylitis. Indian J Orthop 2012;46:159-64.
  • 33 Garg N, Vohra R. Minimally invasive surgical approaches in the management of tuberculosis of the thoracic and lumbar spine. Clin Orthop Relat Res 2014;472:1855-67.