This document discusses the management of tuberculosis of the spine using instrumentation. It begins by providing background on tuberculosis of the spine. It then discusses the rationale for using instrumentation in spinal tuberculosis, including to provide stability and allow healing without increased deformity. The document outlines the authors' experience using instrumentation in 18 patients with spinal tuberculosis of varying locations and neurological involvement. It describes the surgical approaches and instrumentation used. Post-operative imaging and outcomes including functional assessment are presented, showing good recovery in most patients. The conclusion emphasizes the role of instrumentation in minimizing deformity in spinal tuberculosis.

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
CHANDULAL CHANDRAKAR HOSPITAL AND MEDICAL COLLEGE

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.
CHANDULAL CHANDRAKAR HOSPITAL AND MEDICAL COLLEGE

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
CHANDULAL CHANDRAKAR HOSPITAL AND MEDICAL COLLEGE

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.
CHANDULAL CHANDRAKAR HOSPITAL AND MEDICAL COLLEGE
Material & Methods

8. 8
10
MALE
FEMALE
CHANDULAL CHANDRAKAR HOSPITAL AND MEDICAL COLLEGE
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
CHANDULAL CHANDRAKAR HOSPITAL AND MEDICAL COLLEGE
Age distribution

10. 4
6
8 cervical
dorsal
dorso
lumbar
CHANDULAL CHANDRAKAR HOSPITAL AND MEDICAL COLLEGE
Sites involved

11. 33
11.6
2.1 1
paradiscal
central
anterior
posterior
CHANDULAL CHANDRAKAR HOSPITAL AND MEDICAL COLLEGE
Vertebral body
distribution

12. Management

13. Cervical tubercular
spondylitis- Anterior
Decompression
corpectomy + bone
grafting / cage fixation
and plating (n-4)
CHANDULAL CHANDRAKAR HOSPITAL AND MEDICAL COLLEGE

14. Pre-Op X-Ray
Pre-Op MRI
CHANDULAL CHANDRAKAR HOSPITAL AND MEDICAL COLLEGE

15. Post-Op X-Ray
Post-Op X-Ray
CHANDULAL CHANDRAKAR HOSPITAL AND MEDICAL COLLEGE

16. Thoracic tubercular
spondylitis-
Anteriolatral
decompression with
Posterior fixation by
trans pedicular screw
and rod with or without
laminectomy (n-6)
CHANDULAL CHANDRAKAR HOSPITAL AND MEDICAL COLLEGE

17. Pre-Op X-Ray
Post-Op X-Ray
CHANDULAL CHANDRAKAR HOSPITAL AND MEDICAL COLLEGE

18. Thoraco-lumbar
tubercular spondylitis-
Antero lateral
decompression with
cage and plate fixation
(n-8)
CHANDULAL CHANDRAKAR HOSPITAL AND MEDICAL COLLEGE

19. Pre-Op MR myelogram
CHANDULAL CHANDRAKAR HOSPITAL AND
MEDICAL COLLEGE
Pre-OpMRIPre-OpMRI

20. Pre-Op MRI
Pre-OpMRIPre-OpMRI
CHANDULAL CHANDRAKAR HOSPITAL AND MEDICAL
COLLEGE

21. CHANDULAL CHANDRAKAR HOSPITAL AND MEDICAL COLLEGE

22. CHANDULAL CHANDRAKAR HOSPITAL AND MEDICAL COLLEGE

23. Peroperative Images
CHANDULAL CHANDRAKAR HOSPITAL AND MEDICAL COLLEGE

24. Peroperative ImagesCHANDULAL CHANDRAKAR HOSPITAL AND MEDICAL COLLEGE

25. Postoperative Images
CHANDULAL
CHANDRAKAR
HOSPITAL AND
MEDICAL COLLEGE

26. Postoperative
ImagesCHANDULAL CHANDRAKAR HOSPITAL AND MEDICAL COLLEGE

27. Postoperative
Images
CHANDULAL CHANDRAKAR HOSPITAL AND MEDICAL COLLEGE

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
CHANDULAL CHANDRAKAR HOSPITAL AND MEDICAL COLLEGE

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
CHANDULAL CHANDRAKAR HOSPITAL AND MEDICAL COLLEGE

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
CHANDULAL CHANDRAKAR HOSPITAL AND MEDICAL COLLEGE

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
CHANDULAL CHANDRAKAR HOSPITAL AND MEDICAL COLLEGE

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 :
CHANDULAL CHANDRAKAR HOSPITAL AND MEDICAL COLLEGE

34. Thank You ALWAYS FUSED
DON’T REFUSED
FOR ANY UNSTABLE SPINE