SPINE TUBERCULOSIS

Posterior Approach in Sugery of Spondylitis TB

at Hasan Sadikin Hospital

Dr. Rahim.A.H., M.D., M.Epid

Spine Section

Department of Orthopaedic & Traumatology Hasan Sadikin Hospital Bandung

Indonesia

Abstract

Background

Tuberculosis still remain a serious worldwide problem. Tuberculous spondylitis is the commonest form of skeletal tuberculosis and it constitutes about 50 percent of all cases of tuberculosis of bones and joint.

The most common sites are the lower thorax and upper lumbar vertebrae. Kyphosis has been a common complication in patient treated with chemotherapy alone.

The posterior approach is the most common approach to the thoracolumbar spine. Providing access to spinal cord, cauda equine and intervertebral discs, it can expose the posterior elements of the spine; the spinosus processes, laminae, facet joint and pedicles. The approach is through the midline and it may be extended proximally and distally.

Material and Method

This is review of Tuberculous Spondylitis patients that hospitalized at Orthopedic and Traumatology Departement, Hasan Sadikin General Hospital Bandung, which underwent surgical treatment by posterior approach during January 2000 until December 2004. A retrospective study of 130 patients was performed. The data was collected through medical record.

Result

Operative treatment was perform to tuberculous spondylitis patients, who were admitted and under went for surgery at Hasan Sadikin General Hospital from January 2000 to December 2004. From this study, there were 130 tuberculous spondylitis patients, consist of 34 men (26,2%) and 96 women (73,%). Age of patients were between 9 to 61 years old and the most common age was 24 years old. Vertebral level of tuberculous spondylitis in this study are cervical 3 patients (2,3%), thoracal 64 patients (49,2%), lumbar 49 patients (37,7%) and multiple 14 patients(11,2%). The preoperative neurological condition are 5 patients (3,8%) with frankle A, 4 patients (3,1%) with frankle B, 13 patients (10%) with frankle C, 20 patients (15,4%) with frankle D and 85 patient (67,7%) with frankle E. Operative treatment by posterior approach were done in 111 patients (86,2%)

Discussion

The option for anterior or posterior approach is depend on selected case. The choice of approach is depend on: the surgeon preference and experience, the appropriateness of operating room environment as well as the patient age and medical condition. Additional considerations are: number of segment involved, the primary pathological process and signs of neural compression. There are also advantages and disadvantages of anterior approach compare to the posterior approach.

Conclusion

Primary debridement, stabilization by posterior approach was a one technique in treatment for tuberculous spondylitis and gives good result to prevent neurological and other complication.

Keyword : Tuberculous Spondylitis, posterior approach.