Prospective study on Functional and Radiological Outcome of Tuberculosis of Dorsal and Lumbar Spine-Anterior Reconstruction and Posterior Stabilization through Posterior only approach

Bharathiraja, P (2020) Prospective study on Functional and Radiological Outcome of Tuberculosis of Dorsal and Lumbar Spine-Anterior Reconstruction and Posterior Stabilization through Posterior only approach. Masters thesis, Madurai Medical College, Madurai.

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Abstract

INTRODUCTION: 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. AIM OF THE STUDY: In this study we clinicoradiologically evaluated the outcome of debridement, decompression, reconstruction using bone graft/cage, stabilisation with pedicle screws and fusion for tuberculosis of dorsal and lumbar spinethrough posterior only approach. OBJECTIVES: 1. To study the effectiveness of posterior decompression, stabilisation with pedicle screws and fusion, reconstruction using bone graft/cage for tuberculosis of dorsal and lumbar spine. 2. To study the improvement in the angle of kyphosis. 3. To evaluate that posterior surgery associated with reduced morbidity and mortality. MATERIALS & METHODS: Patients with Tuberculosis of Dorsal and Lumbar spine admitted at Government Rajaji Hospital ,Madurai In Department of Orthopaedics and Traumatology will be taken up for study after obtaining informed consent between October 2017& October 2019. All patients were treated with posterior approach and stabilised with Pedicle screw system, reconstruction using bone graft/ cage. RESULT: The most common age group affected was 2nd and 3rddecade (40%). The most common mode of presentation is pain (66.7%). The dorsal spine is most commonly affected (40%) followed by dorsolumbar junction (35%)The mean duration between surgery and onset of symptoms was 7.2 months (range 5-10months). The mean surgical time was 2 hours 2 minutes (range 1h 45 min-4hr 10 min). The average blood loss was 300 ml (250 ml – 500ml). The mean preoperative Visual analog score was 8.68 (range8-10) which improved to 1.33(1-3) at final follow up implying better pain score postoperatively. The mean preoperative ESR value was 116.63 which improved to 26.44 at final follow up which indicates improvement in disease activity. There is significant improvement in function and neurology in all other patients. The mean preoperative kyphosis in the thoracic and thoracolumbar spine was 29.4 degrees which was corrected to a mean of 14.05 degrees in the final follow up radiographs implying better correction and maintenance of kyphosis. CONCLUSION: The posterior approach (extracavitory approach) gives a reasonable access to the lateral and anterior aspects of the cord for an equally good decompression of the cord. It is a less morbid approach and avoids problems associated with thoracotomy and laprotomy.It facilitates early mobilization and avoids problems of prolonged recumbency. It provides better functional outcome and significantly better sagittal plane and kyphosis correction. Posterior approach preferred because of its familiarity, its simplicity, and its low complication rate.

Item Type: Thesis (Masters)
Additional Information: 221712103
Uncontrolled Keywords: Spinal tuberculosis, Posterior approach, Interbody fusion, Internal fixation.
Subjects: MEDICAL > Orthopaedics
Depositing User: Subramani R
Date Deposited: 13 Feb 2021 14:40
Last Modified: 13 Feb 2021 14:40
URI: http://repository-tnmgrmu.ac.in/id/eprint/14108

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