DOES SPINAL SURGERY FOR SPINAL TUBERCULOSIS DURING ACTIVE INFECTION PREDISPOSE TO POST OPERATIVE SEPSIS

SURGERY FOR SPINALTUBERCULOSIS ATKNH

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 encounteredextrapulmonary form of spinal tuberculosis.

•It is one of the oldest diseases known to mankind and hasbeen 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 incidentcases of TB: 5.4 million among men, 3.2 million among womenand 1.0 million among children.

•The MDG target of halting and reversing TB incidence by 2015was achieved globally, in all six WHO regions and in 16 of the22 high TB burden countries.

SPINAL TUBERCULOSIS

•Spinal TB is the most common form of skeletal TB.

•The exact incidence and prevalence of spinal tuberculosis inmost parts of the world are not known.

•Approximately 10% of patients with extrapulmonarytuberculosis have skeletal involvement. The spine is the mostcommon 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 andunderwent spinal surgery at the Kenyatta National Hospital between2005 to 2015.

•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 startedimmediately after tuberculosis of the spine wasdiagnosed.

• A combination of isoniazid, rifampicin, ethambutol andpyrazinamide was used for the first three monthsfollowed by isoniazid and rifampicin for another ninemonths.

•3 patients had extraspinal TB.

RESULTS

RESULTS

•Out of the 18 patients:

• 12 showed improvement in their post op frankle

RESULTS

SPINAL LEVEL

SURGERY

CERVICAL

C5-C6

Ant decompression + bone fusion

THORACIC

T2-T3

Decompression + CAGE

T5-T6 (3 pts)

Decompression + bone grafting

T6-T7 (2 pts)

Decompression + bone grafting

T8-T9

Decompression + CAGE

Decompression + bone grafting

T9-T10

CAGE + Posterior instrumentation

T12

Decompression + Pedicle screws

T12-L1 (2pts)

Decompression + CAGE

LUMBAR/LUMBOSACRAL

Posterior instrumentation,CAGE,L2corpectomy

L2-L3

Decompression + bone grafting

L4-L5

Decompression and pedicle screwplacement

L4-S1

Laminectomy

Foraminotomy release

CONCLUSION

•Spinal surgery is safe for patients with active tuberculousinfection.

STUDIES

•HA KY et al:On the contrary to S. epidermidis, adherence andbiofilm formation of M. tuberculosis on implant surface areless likely, and it can provide the basis of successfulinstrumentation in spine tuberculosis.

•The authors demonstrate the effectiveness of radicaldebridement of infected bone and placement ofinstrumentation in patients with spinal infections.

Ha KY, Chung YG, Ryoo SJ

Lee MC, Wang MY, Fessler RG, Liauw J, Kim DH

THANKYOU