SURGERY FOR SPINAL TUBERCULOSIS AT KNH Dr Mohamed Areeb Chaudry:Medical Officer Dr Akil Fazal:Consultant Orthopaedic Surgeon KNH

Introduction: Definition Disease Burden Treatment Modalities Materials and Methods Results Conclusion Other Studies. CONTENTS

DEFINITION Spinal tuberculosis is a frequently encountered extrapulmonary form of spinal tuberculosis. It is one of the oldest diseases known to mankind and has been found in Egyptian mummies dating back to 3400 BC. The disease is popularly known as Pott's spine.

BURDEN Tuberculosis (TB) is a major global health problem. Globally in 2014, there were an estimated 9.6 million incident cases of TB: 5.4 million among men, 3.2 million among women and 1.0 million among children. The MDG target of halting and reversing TB incidence by 2015 was achieved globally, in all six WHO regions and in 16 of the 22 high TB burden countries.

SPINAL TUBERCULOSIS Spinal TB is the most common form of skeletal TB. The exact incidence and prevalence of spinal tuberculosis in most parts of the world are not known. Approximately 10% of patients with extrapulmonary tuberculosis have skeletal involvement. The spine is the most common skeletal site affected, followed by the hip and knee

TREATMENT MODALITIES Antibiotics Surgery: Debridement Debridement with stabilisation Indications for surgery were: pan-vertebral lesions, refractory disease, severe kyphosis, an evolving neurological deficit, clinical deterioration or lack of clinical improvement.

MATERIALS AND METHODS This was a retrospective study of patients who had spinal TB and underwent spinal surgery at the Kenyatta National Hospital between 2005 to Variables included: Age Gender Time of diagnosis Spinal Level Presence of extraspinal TB Preop frankel grade Surgical approach Duration of surgery Chemotherapy Post op frankel grade ESR/CRP

RESULTS There were 18 patients in total;10 male and 8 female. The average age of the patients was 35 years. For all the patients, chemotherapy was started immediately after tuberculosis of the spine was diagnosed. A combination of isoniazid, rifampicin, ethambutol and pyrazinamide was used for the first three months followed by isoniazid and rifampicin for another nine months. 3 patients had extraspinal TB.

RESULTS

Out of the 18 patients: 12 showed improvement in their post op frankle

RESULTS SPINAL LEVELSURGERY CERVICALC5-C6Ant decompression + bone fusion THORACICT2-T3Decompression + CAGE T5-T6 (3 pts)Decompression + bone grafting T6-T7 (2 pts)Decompression + bone grafting T8-T9Decompression + CAGE Decompression + bone grafting T9-T10CAGE + Posterior instrumentation T12Decompression + Pedicle screws T12-L1 (2pts)Decompression + CAGE LUMBAR/LUMBOSACRALL3Posterior instrumentation,CAGE,L2 corpectomy L2-L3Decompression + bone grafting L4-L5Decompression and pedicle screw placement L4-S1Laminectomy L5Foraminotomy release

CONCLUSION Spinal surgery is safe for patients with active tuberculous infection.

STUDIES HA KY et al:On the contrary to S. epidermidis, adherence and biofilm formation of M. tuberculosis on implant surface are less likely, and it can provide the basis of successful instrumentation in spine tuberculosis. The authors demonstrate the effectiveness of radical debridement of infected bone and placement of instrumentation in patients with spinal infections. Ha KY, Chung YG, Ryoo SJ Lee MC, Wang MY, Fessler RG, Liauw J, Kim DH

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