instrumentation in cases of tuberculosis of spine

MANAGEMENT OF TB SPINE: OUR EXPERIENCE

Welcome

Dr.Ankit DesaiD.ortho.DNB Resident at CM hospitalDr. Adarsh Trivedi M.ch NeurosurgeryASSO. PROFF.

a presentation

Most common granulomatous spine infection in the world is TUBERCULOSIS

10% of tuberculosis patients develop bone and joint involvement and 50% of these develop spinal vertebral involvement

Neurologic involvement is seen in 10% to 47% pts.with tuberculus spondylities

Increased incidence is seen in HIV positive pts. with CD4 count < 200 cells/mm3

IntroductionCHANDULAL CHANDRAKAR HOSPITAL AND MEDICAL COLLEGE

Why instrumentation in POTTS SPINE

Operation to produce surgical fusion is a safe procedure it may performed without danger of aggravating disease it aids in giving stability to diseased portion of spine.

CHANDULAL CHANDRAKAR HOSPITAL AND MEDICAL COLLEGE

The insertion of a metallic implant is to provide mechanical stability and the use of an implant in tubercular infection is safe.

Indications for instrumented stabilization can be categorized as:

(a) pan vertebral disease (b) long-segment disease(c) Kyphosis correction(d)”spine at risk signs” are present.

Neurological signs not improving with conservative means

Progressive neurological signs Rapid onset paraplegia/ quadriplegia Posterior spinal disease with spinal tumor syndrome Prevertebral or paravertebral abscess Doubtful diagnosis Correction of deformity .

Indications of surgical therapyCHANDULAL CHANDRAKAR HOSPITAL AND MEDICAL COLLEGE

Instrumentation done in 18 patients of spinal tuberculosis in last 1 yr.

Radiologically and clinically proved cases of spinal tuberculosis having varied neurological deficit and active disease were selected.


Material & Methods

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MALE

FEMALE


Sex distribution

<10 yrs 10 to 20 20-30 30-40 >40012345678

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Age distribution

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6

8cervicaldorsaldorso lumbar


Sites involved

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paradiscalcentralanteriorposterior


Vertebral body distribution

Management

Cervical tubercular spondylitis- Anterior Decompression corpectomy + bone grafting / cage fixation and plating (n-4)


Pre-Op X-Ray

Pre-Op MRI


Post-Op X-Ray

Post-Op X-Ray


Thoracic tubercular spondylitis-Anteriolatral decompression with Posterior fixation by trans pedicular screw and rod with or without laminectomy (n-6)


Pre-Op X-Ray

Post-Op X-Ray


Thoraco-lumbar tubercular spondylitis- Antero lateral decompression with cage and plate fixation(n-8)


Pre-Op MR myelogram


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Pre-Op MRI

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Peroperative ImagesCHANDULAL CHANDRAKAR HOSPITAL AND MEDICAL COLLEGE

Postoperative ImagesCHANDULAL

CHANDRAKAR HOSPITAL AND MEDICAL

COLLEGE

Postoperative Images


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Pathological EvaluationCHANDULAL CHANDRAKAR HOSPITAL AND MEDICAL COLLEGE

Functional outcome assessmentModified criteria of Kirkaldy - willis

Grade DescriptionExcellent Return of normal work, very little or no

complaintsGood Return to normal work but have some

restrictions in other activities may have pain on occasions after heavy work, recurrent pain requiring rest for few days.

Fair Patient decreased his working capacity, taking a higher job or part time work and may occasionally have recurrence of pain requiring absence from work.

Poor Patient doesn't return to work


Post Operative outcome - One year followup

Preoperative Motor Power

- Postoperative recovery – Kirkaldy willlisExcellent Good Fair

4 to 5 (n-14) 12 2 01 to 3 (n-4) 0 0 4


• Instrumentation helps to produce rigid fixation of the spine to allow uninterrupted healing as movement in and around the spinal cord is still possible.

• Instrumentation also prevents any increase in spinal deformity that may occur in course of healing .

ConclusionCHANDULAL CHANDRAKAR HOSPITAL AND MEDICAL COLLEGE

It is distressing, both to the patients and the treating surgeon, to see an unsightly hunchback deformity in a case of Koch’s spine. Hence, we feel that every attempt should be made to minimize this deformity with some form of instrumentation wherever indicated.

Tuli SM.Tuberculosis of Skeletal System Jaypee Brothers Medical Publishers (p) Ltd.-1991, Rajshekharan S, Soundarapandian S. Progression of Kyphosis in tuberculosis of the spine treated by anterior arthrodesis J Bone Joint Surg 71A: 1314, 1989 , Ramamurthi B, Thayumanaswami VR: Laminectomy in Pott’s Paraplegia Ind J Surg 16:242,1954

References :CHANDULAL CHANDRAKAR HOSPITAL AND MEDICAL COLLEGE

Thank You ALWAYS FUSED DON’T REFUSED

FOR ANY UNSTABLE SPINE

instrumentation in cases of tuberculosis of spine

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