DOES CHOICE OF SURGICAL APPROACH TRANSLATES INTO BETTER OUTCOMES IN TUBERCULOSIS OF SPINE: A CLINICORADIOLOGIC STUDY
Dr. Manoj Phalek
MBBS, MCh (Neurosurgery)
Associate Professor, Department of Neurosurgery
All India Institute of Medical Sciences. AIIMS
MBBS, MCh (Neurosurgery)
Associate Professor, Department of Neurosurgery
All India Institute of Medical Sciences. AIIMS
Aim and objective:
To compare two available surgical treatments for spinal tuberculosis -anterior and posterior approach with respect to change in spinal cord diameter, area and clinical outcome at 1 year.
Materials and Methods:
Prospective study of 36 patients C3-L1 Potts spine at Department of Neurosurgery, AIIMS, (18 patients in each cohort). Patients <10 years of age, past history of spine trauma, refusal to participate, extensive metallic artifacts on follow-up MRI were excluded. The surgical approach was decided by the operating surgeon. Spinal cord diameters were assessed at nerve exit cut on T2W axial MRI. For assessing the area, the spinal cord was considered as an ellipse. Change in sagittal diameter and area change was noted using preoperative and Postoperative MRI at 1 year. Preoperative and postoperative clinical evaluation was done using Frankel grade, and plain radiographs at 0,4th,12th,24th, and 52nd week, and CT. All patients received ATT for 18 months as departmental protocol.
Results:
15 patients in anterior approach group and 14 patients in the posterior approach group were eligible. The cohorts were comparable in age, sex, duration of surgery, postoperative stay. Cervical spine was involved in 40% and 22% in the anterior and posterior approach respectively. Mean spinal cord diameter and area for anterior approach patients was 3.85 mm, 37.57 mm2 (preoperative) and 5.29 mm, 46.26 mm2 (postoperative) respectively. Mean spinal cord diameter and area for posterior approach patients was 3.85 mm, 42.38 mm2 (preoperative) and 6.74 mm, 71.04 mm2 (postoperative) respectively. A significant increase in change of spinal cord sagittal diameter and the area was seen in posterior approach patients (p= 0.02, 0.04 respectively). Significantly higher blood loss was observed in the posterior approach group (p=0.005). Both groups were comparable for Frankel A/B/C grade at presentation. All patients improved at 1-year follow-up to Frankel D/E.
Conclusions:
Neurologic improvement is not dependent on the type of approach, or age and the treatment choice needs to be individualized.