Objective: To study the neurological and radiological outcomes in patients who underwent
surgery for tuberculosis of thoracic and lumbar spine. Patients ad Methods: We
retrospectively reviewed 18 patients with tuberculous spondylitis of thoracic and lumbar
spine treated surgically. These patients were treated between January 2004 and April
2006. Patients were assessed clinically, regarding severity of pain and neurological status,
and radiologically, regarding the presence of epidural abscess and spinal instability. Nine
patients were treated by anterior approach and nine patients were treated by posterolateral
approach. All patients were followed up from 6 months to 3 years. Results: Eight patients
were men and ten patients were women, with ages ranging from 30 to 85 years (mean 49).
Persistent back pain was present in all 18 patients and 17 patients had neurological deficit
in the form of weakness attributable to the location of their lesion. The neurological status
was assessed according to the scoring system of Frankel et al. The thoracic spine was
involved in ten patients and lumbar spine in eight patients. Plain X-ray, MRI and
occasionally CT and 3D-CT scan confirmed spondylodiscitis. Back pain was fully relieved
in seven patients and eleven patients reported improvement compared with their
preoperative condition. Neurological deficits were improved at the final follow up
examination in 17 patients as defined by the scoring
system of Frankel et al. Conclusion:
Spinal tuberculosis was best treated with appropriate anti-tuberculous chemotherapy and
radical debridement surgery when indicated. Surgery is reserved for patients with
progressive neurological deficit, spinal instability, drainage of abscess or severe pain
despite of anti-tuberculous therapy. Surgical treatment has provided much earlier healing,
quicker pain relief, earlier abscess drainage and sinus tract resolution, and a better chance
of neurologic recovery, as well as a lesser degree of spinal deformity. |
