Role of Posterior Stabilization and Transpedicular Decompression in the Treatment of Thoracic and Thoracolumbar TB: A Retrospective Evaluation.
METHODS
A retrospective study.


OBJECTIVE
To evaluate the results of posterior pedicle-screw fixation with transpedicular decompression in 21 cases of thoracic and thoracolumbar spinal tuberculosis (TB) in terms of functional, neurological, and radiologic outcomes.


BACKGROUND
Spinal TB is predominantly an anterior disease that can lead to kyphotic deformity. Hence, anterior debridement and fusion was considered as the gold standard. However, with remarkable improvements in chemotherapy regimens and diagnostic tools, it is possible to detect the disease process early and treat them with less radical approaches. In the present study, authors have shown the results of posterior pedicle-screw fixation with transpedicular decompression in thoracic and thoracolumbar spinal TB.


METHODS
The study reviewed 21 patients with thoracic or thoracolumbar TB with kyphotic deformity who were operated with posterior pedicle-screw fixation and transpedicular decompression (pus aspiration through a Jamshidi needle) with kyphosis correction for either neurological deficits (11) or intractable pain (10), not responding to at least 4-6 weeks of chemotherapy. Patients with <3 spinal segment involvement, <30 degrees kyphosis, and <50% vertebral body destruction were included in the study.


RESULTS
The mean age of patients was 43.9 years and the mean kyphosis angle at the level of involvement was 21.61±3.72 degrees. Kyphosis improved postoperatively to 5.79±3.48 degrees. The mean follow-up period was 24.09 months, and final kyphosis correction was maintained at 8.74±3.65 degrees. Bony fusion was achieved in 80.5% cases. Eleven patients had neurological deficits, and all of them recovered. All patients had a Visual Analog score improvement from 9.52 to 2.57 postoperatively.


CONCLUSIONS
Posterior stabilization with transpedicular decompression can be considered as a good treatment option for the management of thoracic and thoracolumbar TB in patients with <50% vertebral body destruction and <30-degree kyphosis. It provides rapid relief of instability pain, improvement of neurological deficit, and prevents progression of deformity.
Spine Surgery, Orthopaedics Unit 2, Artemis Hospital, Gurgaon, Haryana.
Areena R
AR
D'souza
Spine Surgery-Unit 2, Indian Spinal Injuries Centre, Vasant Kunj, New Delhi, India.
Bibhudendu
B
Mohapatra
Departments of Spine Surgery-Unit 3.
Murari L
ML
Bansal
Departments of Spine Surgery-Unit 3.
Kalidutta
K
Das
D000293:Adolescent; D000328:Adult; D000368:Aged; D019299:Decompression, Surgical / Q000379:methods*; D005260:Female; D005593:Fracture Fixation, Internal / Q000379:methods*; D006801:Humans; D008159:Lumbar Vertebrae / Q000601:surgery*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D065289:Pedicle Screws; D012189:Retrospective Studies; D013904:Thoracic Vertebrae / Q000601:surgery*; D016896:Treatment Outcome; D014399:Tuberculosis, Spinal / Q000000981:diagnostic imaging / Q000601:surgery*; D064232:Visual Analog Scale; D055815:Young Adult