title: Posterior approach in thoracolumbar tuberculosis: a clinical and radiological review of 67 operated cases.
abstract: (1) To present the indications of single stage all posterior surgery in thoracic and lumbar tuberculosis. (2) To evaluate the results of single stage all posterior surgery. We analysed 67 patients who underwent single stage all posterior surgery with follow-up of 31.37 months. We performed the following operative procedures depending upon level and case requirements. (Group A) Instrumentation alone for instability. (Group B) Transpedicular decompression and instrumentation for neurological compression in thoracic and thoracolumbar spine. (Group C) Transforaminal approach for access to anterior column in lumbar spine in addition to posterior instrumentation. (Group D) Pedicle subtraction osteotomy and instrumentation for deformity correction. (Group E) Posterior decompression alone for isolated posterior epidural compression. (Group F) Reconstruction of anterior column by all posterior approach. Thirty-eight had neurological deficit whereas 29 were Frankel E. In 12 cases, anterior reconstruction was done. In the remaining 55 cases, we relied on vertebral reconstitution under chemotherapy. Operative time was 150.5 min and blood loss was 514.18 ml. Of 38 patients with deficit, 34 improved. There was radiological fusion in all patients. Pre- and post-operative Cobb's measurements were 9.95 and 8.1, respectively, in thoracic and thoracolumbar spine and -9.39 and -11.42, respectively, in lumbar spine. Of 55 cases where anterior reconstruction was not done, only 3 had progression of Cobb's >10°. Posterior approach can achieve adequate decompression of offending middle column and if required, even anterior reconstruction. Posterior approach is versatile, with many surgical options depending on the level and case requirements.
authors.affiliation: Division of Spine Surgery, Department of Orthopaedics, Spine Clinic, P D Hinduja National Hospital, Veer Savarkar Marg, Mahim, Mumbai 400016, India.
authors.forename: Saurabh
authors.initials: S
authors.lastname: Rawall
authors.forename: Kapil
authors.initials: K
authors.lastname: Mohan
authors.forename: Abhay
authors.initials: A
authors.lastname: Nene
mesh_terms: D003646:Debridement / Q000379:methods; D019299:Decompression, Surgical / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D008297:Male; D009984:Orthopedic Fixation Devices; D019637:Orthopedic Procedures / Q000379:methods*; D011859:Radiography; D019651:Plastic Surgery Procedures / Q000379:methods*; D013123:Spinal Fusion; D013904:Thoracic Vertebrae / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D016896:Treatment Outcome; D014399:Tuberculosis, Spinal / Q000175:diagnosis / Q000601:surgery*