title: The Extended Posterior Circumferential Decompression Technique in the Management of Tubercular Spondylitis with and without Paraplegia.
abstract: METHODS
  Retrospective clinical series.
  
  
  OBJECTIVE
  To study the clinical, functional and radiological results of patients with tuberculous spondylitis with and without paraplegia, treated surgically using the "Extended Posterior Circumferential Decompression (EPCD)" technique.
  
  
  BACKGROUND
  With the increasing possibility of addressing all three columns by a single approach, posterior and posterolateral approaches are gaining acceptance. A single exposure for cases with neurological deficit and kyphotic deformity requiring circumferential decompression, anterior column reconstruction and posterior instrumentation is helpful.
  
  
  METHODS
  Forty-one patients with dorsal/dorsolumbar/lumbar tubercular spondylitis who were operated using the EPCD approach between 2006 to 2009 were included. Postoperatively, patients were started on nine-month anti-tuberculous treatment. They were serially followed up to thirty-six months and both clinical measures (including pain, neurological status and ambulatory status) and radiological measures (including kyphotic angle correction, loss of correction and healing status) were used for assessment.
  
  
  RESULTS
  Disease-healing with bony fusion (interbody fusion) was seen in 97.5% of cases. Average deformity (kyphosis) correction was 54.6% in dorsal spine and 207.3% in lumbar spine. Corresponding loss of correction was 3.6 degrees in dorsal spine and 1.9 degrees in the lumbar spine. Neurological recovery in Frankel B and C paraplegia was 85.7% and 62.5%, respectively.
  
  
  CONCLUSIONS
  The EPCD approach permits all the advantages of a single or dual session anterior and posterior surgery, with significant benefits in terms of decreased operative time, reduced hospital stay and better kyphotic angle correction.
authors.affiliation: Department of Orthopaedics, Christian Medical College and Hospital, Vellore, India.
authors.forename: Barani
authors.initials: B
authors.lastname: Rathinavelu
authors.affiliation: Department of Orthopaedics, Christian Medical College and Hospital, Vellore, India.
authors.forename: Justin
authors.initials: J
authors.lastname: Arockiaraj
authors.affiliation: Department of Orthopaedics, Christian Medical College and Hospital, Vellore, India.
authors.forename: Venkatesh
authors.initials: V
authors.lastname: Krishnan
authors.affiliation: Department of Orthopaedics, Christian Medical College and Hospital, Vellore, India.
authors.forename: Rohit
authors.initials: R
authors.lastname: Amritanand
authors.affiliation: Department of Orthopaedics, Christian Medical College and Hospital, Vellore, India.
authors.forename: Gabriel David
authors.initials: GD
authors.lastname: Sundararaj
keywords: Circumferential spinal canal decompression; Extended posterior approach; Interbody fusion; Kyphosis correction; Neurological recovery