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Tuberculosis Spondylitis Posterior approach
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Posterior Surgical Approach to Tuberculous Spondylitis
Abstract
Objectives: Foraminotomy is a simple posterior surgical approach useful for treatment of radicular (nerve root) pain
in TB spondylitis. It doesn't affect the stability of the facet joint, requires neither fusion nor implants. It is therefore cheap and affordable for patients with low income. We describe a simple form of posterior spinal surgery for patients with tuberculous spondylitis.
Methods: Out of the 45 cases of Pott's disease managed from Jan 2006-Jan 2008, three patients had foraminotomy due to failed medical treatment. An additional discectomy was performed in one patient. Foraminotomy involves the removal of lateral half of adjacent laminae and medical half of the facet joint. The ligamentum flavum and the epidural fat are cleared to free the nerve root. No implant or fusion is required.
Results: All the three patients improved post operatively. Physiotherapy was started on 7th day after surgery. The pain
completely resolved in two patients while the third one had a remarkable improvement at discharge. They were all able to walk without support. One patient is still on regular follow up and has a power of 5/5 in both lower limbs while the remaining two were lost to follow up at 5 and 8 months post surgery. They both had power of 4/5 at the time they defaulted.
Conclusion: Foraminotomy with or without discectomy is a simple posterior surgical approach to T B spine with good neurological outcome. It is adapted to our environment because no fusion or implant is required.
Key words: Tuberculosis, Spondylitis, Posterior approach
in TB spondylitis. It doesn't affect the stability of the facet joint, requires neither fusion nor implants. It is therefore cheap and affordable for patients with low income. We describe a simple form of posterior spinal surgery for patients with tuberculous spondylitis.
Methods: Out of the 45 cases of Pott's disease managed from Jan 2006-Jan 2008, three patients had foraminotomy due to failed medical treatment. An additional discectomy was performed in one patient. Foraminotomy involves the removal of lateral half of adjacent laminae and medical half of the facet joint. The ligamentum flavum and the epidural fat are cleared to free the nerve root. No implant or fusion is required.
Results: All the three patients improved post operatively. Physiotherapy was started on 7th day after surgery. The pain
completely resolved in two patients while the third one had a remarkable improvement at discharge. They were all able to walk without support. One patient is still on regular follow up and has a power of 5/5 in both lower limbs while the remaining two were lost to follow up at 5 and 8 months post surgery. They both had power of 4/5 at the time they defaulted.
Conclusion: Foraminotomy with or without discectomy is a simple posterior surgical approach to T B spine with good neurological outcome. It is adapted to our environment because no fusion or implant is required.
Key words: Tuberculosis, Spondylitis, Posterior approach
