A Study of Anterior Decompression and Instrumentation in Tuberculosis of Spine

Prabhakar, R (2006) A Study of Anterior Decompression and Instrumentation in Tuberculosis of Spine. Masters thesis, Madras Medical College, Chennai.

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Abstract

INTRODUCTION: In April 1993, World Health Organization (WHO) has declared Tuberculosis as a global emergency because it was out of control in many parts of the world. More than 3.8 million new cases of all forms of tuberculosis, 90% of them from developing countries, were reported to the WHO in 2001. However, because of low level of case detection and incomplete notification, reported cases represent only the tip of the iceberg and it is estimated that 8.5 million new cases of tuberculosis occurred Worldwide in 2001, 95% of them in developing countries. It is also estimated that 1.8 million deaths from tuberculosis occurred in 2000, 98% of them in developing countries. BACKGROUND: The tubercle bacillus has co-existed with Homo sapiens since time immemorial. The Rig Veda, Atharva Veda (3000-1800 BC) and Samhita of Charaka & Sushruta (1000 & 600BC) recognized the disease as “Yakshme” in humans, which by its symptoms and signs could only be tuberculosis of the lungs. Tuberculous lesions have been found in Egyptian mummies and the Greco Roman civilization recognized phthisis or consumption as a problem of the lungs. AIM: To assess the results of anterior decompression and anterior instrumentation in patients with dorsal and lumbar caries spine with kyphotic deformity and neurological deficit. MATERIALS AND METHODS: This study was conducted in Government General Hospital, Chennai from May 2002 to April 2006. 20 patients with tuberculosis spondylitis with neurological deficit for whom anterior decompression and stabilization was done; were assessed, out of which 13 cases where taken up for study. Females were marginally high in our study. Male to female ratio was 6:7. The age group of the patient ranged from 15-60 years, mean age being 34.92. Table-I Dorsal Involvement was more in study Dorsal 8, Dorsolumbar - 3 and Lumbar – 2. RESULTS: Of the 13 patients who had involvement had an pre-operative kyphosis that ranged from 60 to 380 with a mean of 19.81. Post operatively the kyphosis ranged from 10 to 250 with a mean of 10.31. At follow up the kyphosis ranged from 40 to 260 with a range of 16.79. All cases showed a progression of the kyphus angle, i.e. there was loss of correction in all cases. The loss of correction varied from 10 to 170. The correction achieved was calculated by subtracting pre operative Kyphus angle from post operative angle. CONCLUSION: Based on the results of our study, we like to conclude that adjuvant anterior stabilization results in early mobilization and rehabilitation, thereby helping in reducing the morbidity of the patients. Radical anterior debridement clears the diseased focus allowing reconstruction and restoration of the anterior column, as well as stabilization in the same sitting. Healing of the disease and fusion of the graft across the affected vertebra are hastened while neurological recovery is unaffected. Intra or postoperative complications related to surgery were not seen. These was no additional risk of infection with the use of implant anteriorly, even in the presence of large quantities of pus.

Item Type: Thesis (Masters)
Uncontrolled Keywords: Anterior Decompression ; Instrumentation ; Tuberculosis ; Spine
Subjects: MEDICAL > Orthopaedics
Depositing User: Subramani R
Date Deposited: 14 Sep 2017 01:48
Last Modified: 14 Sep 2017 01:48
URI: http://repository-tnmgrmu.ac.in/id/eprint/3073

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