Primary Posterior Fixation For Tuberculosis Of The Spine

Tuberculosis of the spine is a very frequent case in the practice of spine surgeons in the developing world, and is set to pose a challenge to the developed world in near future. Only anterior surgery seems to be falling short in potential for correction of the kyphotic deformity as well as of preventing gradual collapse later on. Posterior fixation has shown an excellent potential for correction of deformity and prevention of secondary collapse when combined with anterior reconstruction and fusion in cases of trauma and deformity, and its potential is now being tested worldwide for tuberculous spine. We treated 100 patients with tuberculosis of various spinal levels with different levels of neurological impairments with primary posterior corrective fixation and second stage anterior debridement, decompression and reconstruction and followed them up for an average of 41 months. We didn't face any graft related problems, could mobilize the patient immediate after the surgery and achieved solid fusion in all cases. We faced only 4 un-acceptable adverse events in these cases in form of infection (2), neurological injury (1) and non-fusion (1). The mean preoperative kyphotic angle was 36.6 degrees and correction of a mean of 10.375 degrees (36.6%) was maintained at final follow up of 41 months. We find that for cases of exudative stage tuberculosis of spine, primary posterior fixation and second stage anterior debridement and reconstruction provides good neurological decompression, early bony fusion and correction and/or prevention of deformity, allows early and better rehabilitation and is a recommendable strategy of surgical treatment for carefully selected patients.