Title: Surgical Management for Spinal Tuberculosis: A Review
Authors: Dr Ahsan Shaik Mohammed, Dr Xiaozhong Zhou, Dr Zhentao Zhou, Dr Bingchen Shan M.B.B.S (M.S Orthopedic)
DOI: https://dx.doi.org/10.18535/jmscr/v5i3.66
Abstract
Spinal tuberculosis (TB) incidence in both developing and developed countries has dramatically increased, owing to the increase of HIV infection and drug resistance [1,2]. Antituberculous chemotherapy is proven to be ineffective in the prevention of paraplegia, kyphosis and instability of vertebrae [3]. Surgical procedures are a supplementary of chemotherapy playing an important role in the treatment of patients with neurological deficit, caseous abscesses or sequestrum formation, unstable spine and kyphotic deformity[4, 5]. Current surgical approaches mainly advocated by the surgeons are anterior approach alone, posterior approach alone and combined approach. To date, consensus as to whether anterior or posterior approach or combined approach should be applied in the treatment of spinal TB is not available in the literature. Based on analysis of many literatures, an anterior radical debridement and strut grafting with instrumentation allow reaching the focal point of the disease directly, effective debridement of the focal point. But, it also has many disadvantages which includes great surgical invasion, crinose complications and comparatively ineffective correction of instability and lordosis. Though a posterior debridement and strut grafting with instrumentation may not fit for the patients with prevertebral or paravertebral huge abscess or large vertebral destruction, it is safer, technically easier, effective kyphosis correction and less potential intra- and post- operative complication which can be associated with the anterior and combined posterior procedures. The combined approach owns both advantages of anterior and posterior surgery suitable for patients with extreme prevertebral or paravertebral huge abscess or large vertebral destruction. But, it is not advisable for every patient, as it has a longer operation time, longer healing duration, and higher incidence of surgical complications. Consequently, the operating management choices for spinal TB should follow to the needs of the individual patient. With the continuous development of posterior techniques, the posterior debridement achieves the role of anterior debridement to a certain extent. Based on analysis of the literatures, posterior debridement and bone grafting fusion with posterior instrumentation mentioned by more and more surgeons and acquired favorable outcomes can be the superior surgical approach to spinal TB at early metaphase.
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