Our experience has enabled us to develop a protocol in the management of these patients depending on:
- The level of vertebral involvement (cervicodorsal/ dorsolumbar/ lumbar),
- The presence of single or multilevel disease, and
- Location of disease in the spinal columns.
In Dorsal lesions involving less than two consecutive levels with no deformity, we performed anterior procedure only. In multilevel dorsal lesions with no deformity we did anterior followed by posterior surgery. In Dorsal lesions with deformity we performed Back-Front-Back procedure. In single level Dorsolumbar lesion we did anterior procedure only.
In Lumbar lesion with anterior and middle column involvement without deformity anterior surgery was performed. In presence of all column involvement with deformity we did anterior followed by posterior surgery.
With the use of instrumentation we achieved satisfactory results in terms of correction of deformity. We were also able to carry out extensive debridement (with anticipation of gaining stability with instrumentation), thereby clearing infection locally and effecting neurological improvement in all our cases.
Instrumentation in Spinal Tuberculosis is safe. It allows the surgeon to debride the tissues safely and to stabilise the spine and thus prevent deformity. Instrumentation also allows early mobilisation. The radical debridement leads to a reduction in recurrence of infection at the operative site.