Evaluation of Surgical Decompression by Laminectomy and Fusion by Strut Graft 3 with Stabilization by Pedicle Screw and Rod in Lumbar Spinal Tuberculosis

Potts disease is a common cause of neurological complications and kyphotic deformity in our country. When deformity progressed that may leads to painful costo-pelvic impingement, respiratory distress, risk of paralysis of muscle of lower limb and consequent reduction in quality, longevity of life. The treatment strategy is to avoid neurological complication and achieve a near normal spine. In TB, spinal column may become unstable. Pathological fracture/dislocation of a diseased vertebral body may occur due to mechanical insult. Surgical decompression cause further instability. The insertion of a metallic implant is to provide stability. Pedicle screw fixation in kyphotic correction in old potts disease is a most suitable device. This prospective interventional study was done on BSMMU for the period of 60 months with minimum follow up period of 2 years. 20 cases (13 males and 7 females) of lumbar spinal tuberculosis with neurological deficit were operated with a transpedicular decompression and screw fixation along with anti-tubercular drug treatment. All of these patients had varying degrees of neurological deficit and single level involvement with vertebral body destruction and mild kyphosis of 5–15 degrees. Long segment pedicle screw fixation, posterior decompression, and correction of kyphosis were performed in single stage. The mean age of patients was 50.9 and kyphosis improved from 10.4±2.9 degrees to 4.0±1.2 degrees . Neurological recovery occurred in 18 patients (90%). Bony fusion was achieved in 67.5% cases. At 2-years follow-up mean VAS score improved from 5.5 to 0.75. So posterior decompression and transpedicular stabilization with continued chemotherapy is a good treatment option for the management of the lumbar TB in patients with vertebral body destruction.