Insights in Neurosurgery

Transpedicular Surgical Decompression of Dorsal Spinal Tuberculosis (Pottas Disease) with Vertebral Collapse without Fixation

Introduction: Spinal tuberculosis is prevalent in developing countries. Advancements in technique and technology has improved the outcome, but cost of the newer prosthetic implants and insufficient public healthcare infrastructure in third world countries pose difficulty in surgical treatment of many of these patients.

Methods: Twenty two patients of dorsal Pott’s disease having anterior or anterolateral compressionswith significantneurologicaldeficitswereprospectively studied in five years period (2010 to 2015) and were subjected to unilateral transpedicular decompression of the dorsal cord with maximal preservation of bony elements including ribs without fixation by prosthetic implants. Patients were advised absolute bed rest for 3 months after surgery.

Results: Study group included 12 males and 10 females of with average age 37.5 years (range 14 to 68 years). Clinical improvement was observed in all but one patient, who showed recovery in the follow up. Three patients had recurrence with neurological deterioration due to discontinued antitubercular chemotherapy and required second surgery leading to clinical recovery. There was no increase in kyphosis in follow up in any patient.

Conclusion: Unilateral transpedicular decompression with bed rest for three months appear an option in selected patients of dorsal Pott’s disease with anterior/ anterio-lateral compression with significant neurological deficit.

Author(s):

Deepak K Jha, Rahul Singh, Ishita Pant, Mukul Jain, Suman Kushwaha and Rima Kumari

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