Introduction: Spinal tuberculosis has been managed with various modalities of treatment ranging from only antituberculous drugs to radical
surgical extirpation. Opinion is divided on management of Potts Paraplegia with respect to surgical approach to the lesion. Results are conflicting
on anterior verses posterior approaches as well combined approach. There is also confusion on to when to do anterior first or to operate from
posterior first, in combined approaches. In the present study we present 10 year follow-up of our results, clinical and radiological outcomes, of
Single stage Circumspinal decompression and pedicle screw fixation through lateral extracavitatory approach with anterior and posterior spinal
fusion in cases of Pott's paraplegia.
Methods:The study was a retrospective and prospective follow up of 30 patients with active tuberculosis of thoracolumbar spine with neurological
deficit, who underwent posterior spinal instrumentation with lateral extra cavitatory approach with circumspinal decompression and pedicle screw
instrumentation. Diagnosis of spinal tuberculosis was made by laboratory findings such as anaemia, elevated ESR, radiological features with
typical MR imaging findings. 8 patients had multilevel involvement. Kyphosis of 250 to 550 was present. Circumspinal decompression, correction
of kyphosis, anterior and posterior spinal fusion was performed in a single stage. The average follow up was 7.67 years (92 months).
Results: The mean kyphosis angle improved from 320 preoperatively to 80 in early follow up, followed by a minor loss of correction of 30.
Neurological recovery occurred in 28 patients out of 30 patients. 15 patients recovered from Asia A to AIS E. 13 patients recovered to ASIA D.
The visual analog scale and ASIA grade improved in all the cases. Implant failure in the form of rod breakage was seen in 1 patient but with no
neurological complications.
Conclusion: Drainage of abscess, debridement by extracavitatory route constitutes a less demanding, relatively safe, minimally traumatic
operative technique with adequate circumspinal decompression of spinal cord, correction and maintenance of sagittal balance with relatively less
morbidity is the added advantage.
Short- versus long-segment posterior spinal fusion with vertebroplasty for osteoporotic vertebral collapse with neurological impairment in thoracolumbar spine: a multicenter study
