title: Surgical Outcome of Anterior Decompression, Grafting and Fixation in Caries of Dorsolumbar Spine.
abstract: OBJECTIVE
  To evaluate the surgical outcome of anterior decompression, grafting and fixation in tuberculosis of the dorsal and lumbar spine with compression over the neural tissue and neural deficit.
  
  
  METHODS
  A case series.
  
  
  METHODS
  Department of Neurosurgery Unit-I, Lahore General Hospital, Lahore, from January 2008 to March 2012.
  
  
  METHODS
  Patients with caries spine having compression over the thecal sac with neurological deficit and kyphosis were included in the study. Patients below 17 years and above 56 years of age; those with bed sores and unfit for anesthesia were excluded from the study. Complete blood picture with ESR, X-rays of chest and of the relevant spinal level, and MRI were done. All patients were treated with corpectomy, debridement, drainage of abscess and grafting followed by fixation with poly-axial screws and rods. All patients were assessed by ASIA Impairment Scale before and after surgery and with Bridwell grading after surgery.
  
  
  RESULTS
  Among 79 patients, 47 were males and 32 females. The mean age was 35.97 ± 8.8 years. The commonest level involved was the dorsolumbar junction (n=42, 53.16%). Lower limb power improved to ambulatory level in 60% of patients with complete paraplegia; recovery was excellent in patients with partial weakness; only 2 patients (2.53%) deteriorated to a lower grade. There was no postoperative mortality. One patient had long ICU stay due to lung injury.
  
  
  CONCLUSIONS
  Corpectomy followed by grafting and fixation is safe and effective procedure for dorsolumbar spinal caries. Even those patients presenting with complete paraplegia showed improvement in motor power to ambulatory level and those who had partial deficit showed excellent improvement.
authors.affiliation: Department of Neurosurgery Unit-I, Lahore General Hospital,Lahore.
authors.forename: Ijaz Hussain
authors.initials: IH
authors.lastname: Wadd
authors.affiliation: Department of Neurosurgery Unit-I, Lahore General Hospital,Lahore.
authors.forename: Ainullah
authors.initials: A
authors.lastname: Khan
authors.affiliation: Department of Neurosurgery Unit-I, Lahore General Hospital,Lahore.
authors.forename: Abdullah
authors.initials: A
authors.lastname: Haroon
authors.affiliation: Department of Neurosurgery Unit-I, Lahore General Hospital,Lahore.
authors.forename: Anjum Habib
authors.initials: AH
authors.lastname: Vohra
mesh_terms: D000328:Adult; D016025:Bone Transplantation / Q000379:methods*; D003646:Debridement / Q000379:methods; D019299:Decompression, Surgical / Q000379:methods*; D017586:Diskectomy; D005260:Female; D005593:Fracture Fixation, Internal / Q000379:methods*; D006801:Humans; D007738:Kyphosis / Q000150:complications; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging / Q000601:surgery*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D010264:Paraplegia / Q000150:complications; D011859:Radiography; D016103:Spinal Fractures / Q000000981:diagnostic imaging / Q000601:surgery*; D013123:Spinal Fusion / Q000379:methods*; D015599:Trauma Severity Indices; D016896:Treatment Outcome; D014399:Tuberculosis, Spinal / Q000000981:diagnostic imaging / Q000601:surgery*; D055815:Young Adult