TB Spine . with its indication and some operative pic.

1. MANAGEMENT OF
TB SPINE: OUR
EXPERIENCE
Welcome

2. Dr.Ankit Desai
D.ortho.
DNB Resident at CM hospital
Dr. Adarsh Trivedi
M.ch Neurosurgery
ASSO. PROFF.
a presentation

3.  Most common granulomatous spine infection in
the world is TUBERCULOSIS
 10% of tuberculosis patients develop bone and
joint involvement and 50% of these develop
spinal vertebral involvement
 Neurologic involvement is seen in 10% to 47%
pts.with tuberculus spondylities
 Increased incidence is seen in HIV positive pts.
with CD4 count < 200 cells/mm3
Introduction
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4. Why instrumentation in
POTTS SPINE
 Operation to produce surgical
fusion is a safe procedure it may
performed without danger of
aggravating disease it aids in
giving stability to diseased
portion of spine.
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5. The insertion of a metallic implant is to
provide mechanical stability and the use of
an implant in tubercular infection is safe.
 Indications for instrumented stabilization can
be categorized as:
 (a) pan vertebral disease
 (b) long-segment disease
 (c) Kyphosis correction
 (d)”spine at risk signs” are present.

6.  Neurological signs not improving with conservative
means
 Progressive neurological signs
 Rapid onset paraplegia/ quadriplegia
 Posterior spinal disease with spinal tumor syndrome
 Prevertebral or paravertebral abscess
 Doubtful diagnosis
 Correction of deformity
.
Indications of surgical
therapy
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7.  Instrumentation done in 18 patients of spinal
tuberculosis in last 1 yr.
 Radiologically and clinically proved cases of spinal
tuberculosis having varied neurological deficit and
active disease were selected.
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Material & Methods

8. 8
10
MALE
FEMALE
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Sex distribution

9. 1
2
3
7
5
0
1
2
3
4
5
6
7
8
<10 yrs 10 to 20 20-30 30-40 >40
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Age distribution

10. 4
6
8 cervical
dorsal
dorso
lumbar
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Sites involved

11. 33
11.6
2.1 1
paradiscal
central
anterior
posterior
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Vertebral body
distribution

12. Management

13. Cervical tubercular
spondylitis- Anterior
Decompression
corpectomy + bone
grafting / cage fixation
and plating (n-4)
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14. Pre-Op X-Ray
Pre-Op MRI
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15. Post-Op X-Ray
Post-Op X-Ray
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16. Thoracic tubercular
spondylitis-
Anteriolatral
decompression with
Posterior fixation by
trans pedicular screw
and rod with or without
laminectomy (n-6)
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17. Pre-Op X-Ray
Post-Op X-Ray
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18. Thoraco-lumbar
tubercular spondylitis-
Antero lateral
decompression with
cage and plate fixation
(n-8)
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19. Pre-Op MR myelogram
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MEDICAL COLLEGE
Pre-OpMRIPre-OpMRI

20. Pre-Op MRI
Pre-OpMRIPre-OpMRI
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COLLEGE

21. CHANDULAL CHANDRAKAR HOSPITAL AND MEDICAL COLLEGE

22. CHANDULAL CHANDRAKAR HOSPITAL AND MEDICAL COLLEGE

23. Peroperative Images
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24. Peroperative ImagesCHANDULAL CHANDRAKAR HOSPITAL AND MEDICAL COLLEGE

25. Postoperative Images
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CHANDRAKAR
HOSPITAL AND
MEDICAL COLLEGE

26. Postoperative
ImagesCHANDULAL CHANDRAKAR HOSPITAL AND MEDICAL COLLEGE

27. Postoperative
Images
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28. 6
5
3
4
ABSCESS
GRANULATION
TISSUE
SQUESTERATED
BONEANDDISC
PATHOLOGICAL
SUBLAXATIONAND
DISLOCATIONOF
VERTEBRAE
0
1
2
3
4
5
6
7
Sales
Pathological Evaluation
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29. Functional outcome assessment
Modified criteria of Kirkaldy - willis
Grade Description
Excellent Return of normal work, very little or no
complaints
Good Return to normal work but have some
restrictions in other activities may have
pain on occasions after heavy work,
recurrent pain requiring rest for few
days.
Fair Patient decreased his working capacity,
taking a higher job or part time work
and may occasionally have recurrence
of pain requiring absence from work.
Poor Patient doesn't return to work
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30. Post Operative outcome
- One year followup
Preoperative
Motor Power
- Postoperative recovery –
Kirkaldy willlis
Excellent Good Fair
4 to 5 (n-14) 12 2 0
1 to 3 (n-4) 0 0 4
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31. • Instrumentation helps to
produce rigid fixation of the
spine to allow uninterrupted
healing as movement in and
around the spinal cord is still
possible.
• Instrumentation also prevents
any increase in spinal
deformity that may occur in
course of healing .
Conclusion
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32.  It is distressing, both to the
patients and the treating surgeon,
to see an unsightly hunchback
deformity in a case of Koch’s
spine. Hence, we feel that every
attempt should be made to
minimize this deformity with
some form of instrumentation
wherever indicated.

33. Tuli SM.Tuberculosis of Skeletal System Jaypee
Brothers Medical Publishers (p) Ltd.-1991,
Rajshekharan S, Soundarapandian S.
Progression of Kyphosis in tuberculosis of the
spine treated by anterior arthrodesis J Bone Joint
Surg 71A: 1314, 1989 , Ramamurthi B,
Thayumanaswami VR: Laminectomy in Pott’s
Paraplegia Ind J Surg 16:242,1954
References :
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34. Thank You ALWAYS FUSED
DON’T REFUSED
FOR ANY UNSTABLE SPINE