Surgical reconstruction of the anterior column in the management of the tuberculosis of the spine (Chris Hani Baragwanath Academic Hospital experiance: 2012-2015)

Abstract

Background: The anterolateral surgical approach to the tuberculosis of the spine has evolved from the ab initio gold standard to the use of titanium mesh cage and anterior instrumentation to construct the anterior column after adequate debridement.
Objective: The aim of the study was to review the outcomes in patients that underwent this procedure between January 2012 and December 2015.
Methods: This was a retrospective review of 60 patients treated. The surgical procedure was standardized irrespective of the HIV status. The measured outcomes include Oswestry Disability Index (ODI) for disability, the Frankel Neurological Grading for neurological deficits and the Cobb angle to measure the kyphosis.
Results: The ODI improved from a mean of 95.4% before surgery to a mean of 8.00% after surgery at the last follow up. Fifty eight patients scored Frankel A or B before surgery, 56 patients achieved Frankel D or E, at the last follow up. The mean kyphosis was 33.9 degrees before surgery, this improved to 23.7 degrees in the immediate post-operative period and a mean of 26.3% at the last follow up.
Conclusions: Anterior column reconstruction using titanium mesh cage and anterior instrumentation is safe and effective for the surgical management of the tuberculosis of the spine. There were good clinical outcomes as determined by the ODI score and the Frankel Grading. The study showed a loss of kyphosis correction that was not associated with negative neurological outcome.

Key words: Tuberculosis, Spine, Anterior column reconstruction, Disability