Pott's disease surgery
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
Surgery
Indications for Surgery
The following are the indications for surgery in patients with Pott's disease:
- Neurological deficits
- Potential mechanical instability
- Kyphosis leading to sagittal imbalance or severe kyphosis ≥60°
- Large thoracic spine abscess casing esophageal obstruction or cervical abscess causing difficulty in breathing
- Abscess increasing in size even after 3 to 6 months of standard medical therapy
- Worsening neurological function during the period of medical therapy
- Children ≤7 years of age, with three or more affected vertebral bodies
Surgical Options
- Surgical therapy for spinal tuberculosis is by decompression of the cord with debridement of the infected tissue via the anterior or anterolateral approach.[1]
- Anterior transposition of cord with shaving of the internal gibbus can be performed in patients with severe kyphotic deformities with compression of the cord.[2][3]
- Laminectomy for decompression is contraindicated in cases with anterior spinal tuberculosis, as it increases the unstability of the spine.[4]
References
- ↑ Golwala P, Kapoor C, Shah M, Merh A, Kansagra A (2016). "A Case of Koch's Spine Treated with Modified Transpedicular Vertebral Curettage and Posterior Fixation: A Novel Technique". Cureus. 8 (12): e915. doi:10.7759/cureus.915. PMC 5218885. PMID 28083459.
- ↑ Pan Z, Luo J, Yu L, Chen Y, Zhong J, Li Z; et al. (2017). "Débridement and Reconstruction Improve Postoperative Sagittal Alignment in Kyphotic Cervical Spinal Tuberculosis". Clin Orthop Relat Res. doi:10.1007/s11999-017-5306-9. PMID 28265884.
- ↑ D'souza AR, Mohapatra B, Bansal ML, Das K (2017). "Role of Posterior Stabilization and Transpedicular Decompression in the Treatment of Thoracic and Thoracolumbar TB: A Retrospective Evaluation". Clin Spine Surg. doi:10.1097/BSD.0000000000000498. PMID 28169940.
- ↑ Li J, Huang X, Chen F, Dai F, Zhou Q, Luo F; et al. (2017). "Computed Tomography-Guided Catheterization Drainage to Cure Spinal Tuberculosis With Individualized Chemotherapy". Orthopedics: 1–7. doi:10.3928/01477447-20170117-02. PMID 28112788.