Mirza Osman Beg1, Md. Shah Alam2, Alamgir Samdany3, Habiba Akther4
1. Assistant Professor, Department of orthopaedics, North East medical college sylhet.
2. Professsor of orthopaedic surgery, NITOR
3. Associate Professor, Department of orthopaedics, North East medical college sylhet
4. Assistant Professor, Department of Gynae and Obstetrics, North East medical college sylhet
Abstract
Tuberculosis (TB) continues to be the leading worldwide cause of death from infectious disease and causing increasingly widespread concern. Spinal tubercular infection is the most common and serious form of skeletal tuberculosis. The spinal column is involved in less than 1% of all cases of tuberculosis. It constitutes 1/3 to 1/2 of all bone and joint tuberculosis. It is a result of haematogenous dissemination from primary focus usually in the lungs, lymph nodes or elsewhere. Proper selection of drug therapy and operative modalities is needed to optimize functional outcome for each individual case of pott’s disease. Development of enough skilled personnel is most important aspect of assessment, prevention and treatment of pott’s disease. This prospective non-randomized type of study was carried at National Institute of Traumatology and Orthopaedic Rehabilitation (NITOR) and North east medical college hospital,sylhet From 1st January 2013 to 30th June 2016. Total 26 samples were included in this study to evaluate the outcome of surgical management of spinal tuberculosis in thoracic and lumbar region This study shows that aveage age group 27-40 years. The mean±SD age was 27.04±13.29 years. Maximum 57.1% were female and 42.9% were male. Most of the common clinical presentations were pain (88.4%) then gibbus (61.5%), paraplegia (73%), difficulty in walking (26.9%), weakness (26.9%) and kyphoscoliosis deformity (7.69%). Regarding lesion 66.7% were dorsal, 23.8% were lumbar and 9.5% were dorsolumbar. Maximum 3.84% were ASIA grade A, 11.53% were ASIA grade B. 57.69% were ASIA grade C, 15.38% were ASIA grade D and 7.69% were ASIA grade E in preoperative. In postoperative assessment, 3.84% were ASIA grade B. 34.61% were ASIA grade D and 61.33% were ASIA grade E. The improvement was statistically significant (P<0.05), Majority (73.07%) of the patients had excellent outcome followed by 19.28% good outcome. 3.84% fair and 3.84% poor outcome. Posterior approach is a minimum surgical intervention that encourages neurological recovery, good correction of kyphosis, and prevention of progressive kyphosis. It is concluded that surgical procedure especially posterior decompression, fusion with transpedicular instrumentation are better surgical procedure for the patients with spinal tuberculosis in thoracic and lumbar region.
Key Words: Tuberculosis, kyphosis, paraplegia, ASIA(American spinal injury association)