Aware of MRC study which found chemo alone, debridement and radical debridement + fusion to have similar functional outcomes, relapse or late onset paraplegia but less deformity in fusion
Some authors advocate universal surgical intervention in all cases of paraplegia
I will consider the Tuli middle path regime where chemotherapy is the fundamental treatmentbut to consider surgery if lack of response, severe weakness, worsening neurology, instability and deformities (NID)
+ bracing to prevent NID while giving chemotherapy
Neurology tends to improve as compared to acute traumatic cord injuries
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Surgical principles?
Goals = decompress, debride, maintain stability and prevent deformity
1) Abscess drainage
2) Debridement of infected material
3) Debridement and fusion with or without stabilization
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What approach?
Previously commonly anterior approach as TB mainly affects anterior column
Nowadays, posterior procedures more commonly performed as it is able to achieve circumfrential decompression and deformity control with pedicle screws
Others– A+P
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Primary instrumentation for TB Spine?
Safe. Oga 1993 et al. shows that tubercle bacilli do not adhere to metal or film biofilm. So safe to instrument.
11 patients with TB had primary instrumentation. No cases of persistence or recurrence infection after surgery.
Adherence properties of Mycobacterium TB to stainless steel was also investigated - found few bacteria adherent and a little thin biofilm observed as opposed to Staph Aureus which had a thick adherent biofilm