Nishant Nishant
Aim: To study role of temporary fixation by pedicular screw in spondylodiscitis secondary to tuberculous origin by percutaneous placement of pedicular screw with recent update on advancements in role of surgical intervention in such scenario.
Methods: We share the details of prospectively 32 cases of spondylodiscitis secondary to tuberculosis treated for time span of one year. Management process included clinical assessment, radiological evaluation and lab studies with over a year follow up after surgery. Visual Analogue Scale (VAS score) and Oswestry Disability Indices (ODI scale, Hindi version) were used for outcome measure.
Results: 32 cases had percutaneous fixation for tuberculous spondylodiscitis by using percutaneous pedicular screw instrumentation. The female to male to ratio was 19:13. The average follow up was 14 months ± 6 days and the duration for fusion was reported around six months. The mean duration of stay in hospital was 4.006 ± 1.17 days. The average loss of blood was 27.18 ml ± 17.71. The mean surgical time was 121.25 ± 14.59 minutes. The medical management in the form of ATT was continued for 12-18 months. Mean 48 days after surgery, and one year at follow up, CRP, ESR, pain scores (VAS Score), and ODI returned to their baseline from their the initial rise. No skips lesions were found on MRI in any case. No failure of instrumentation was reported without any decline in neurovascular condition after operative intervention.
Conclusion: Primary treatment of tuberculosis spine has been chemotherapy with limited indications for surgery and that too in selected cases with proper indications. Severe pain in the presence of spondylodiscitis with neurological deficit or deformity projects as an unclear situation and a temporary surgical fixation gives stability to prevent uneventful neurological injury, promote early healing with faster rehabilitation in contrast to strict bed rest and external bracing.
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