[Role of surgery in the treatment of Pott's disease in adults. Apropos of 29 cases].
OBJECTIVE
The management of tuberculous spondylitis remains much debated in countries with great tuberculous prevalence; the attitude in front of vertebral focus is divided between exclusive conservative treatment versus surgical treatment. The authors report their experience about surgical treatment of tuberculous spondylitis.


METHODS
Twenty nine out of thirty one adults underwent surgery for tuberculous spondylitis, between january 1988 and july 1994. The average age was 29 years (range 18 to 65 years). Five patients presented radicular syndrome. The operative indications were mechanical in 20 cases, neurologic and mechanical in 5 cases, etiological and mechanical in 4 cases. Anterior approach was performed in 26 cases, posterior approach in 3 cases. A disc sequestrectomy and/or resection associated to pus evacuation and skeletal graft was performed in 24 cases. Fixation of the graft by screwed plate was used in 3 cases. Antituberculous treatment was instituted in all cases.


RESULTS
The average duration of time spent in hospital was 29 days. The average follow-up was 15.61 months (range: 8 months to 5 years). Short and mean-term outcome was marked by a fistula in 3 cases. These patients underwent a second procedure; they had a good evolution. The long term outcome showed that all patients were considered as cured (functional and neurological results were satisfactory); all patients obtained fusion. Stability was achieved after 3 to 5 months.


CONCLUSIONS
In our context, we prefer surgical treatment. Spine tuberculous is usually seen at an advanced anatomical and clinical stage with major destruction of several vertebras.


CONCLUSIONS
Surgery allows to assert the diagnosis, to treat a compression, to evacuate pus, to treat or at less to avoid worsening of a deformation, and to reduce treatment duration.
Ghadouane
M
M
Service de Traumato-Orthopédie, Hôpital Militaire Mohammed V, Rabat, Maroc.
Elmansari
O
O
Bousalmame
N
N
Lezrek
K
K
Aouam
H
H
Moulay
I
I
D000293:Adolescent; D000328:Adult; D000368:Aged; D000995:Antitubercular Agents / Q000627:therapeutic use; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016268:Internal Fixators; D008297:Male; D008875:Middle Aged; D013123:Spinal Fusion; D013166:Spondylitis / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D014057:Tomography, X-Ray Computed; D014399:Tuberculosis, Spinal / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*
D000995:Antitubercular Agents
Place de la chirurgie dans le traitement du mal de Pott de l'adulte. A propos de 29 cas.