SURGICAL-MANAGEMENT OF TUBERCULOUS SPONDY LITIS IN ADULTS - REVIEW OF29 CASES

Purpose The management of tuberculous spondylitis remains much debated in countries with great tuberculous prevalence : the attitude in fron t of vertebral locus is divided between exclusive conservative treatme nt versus surgical treatment, The authors report their experience abou t surgical treatment of tuberculous spondylitis. Material and Methods Twenty nine out of thirty one adults underwent surgery for tuberculous spondylitis, between january 1988 and july 1994. The average age was 29 years (range 18 to 65 years). Five patients presented radicular syn drome. The operative indications were mechanical in 20 cases, neurolog ic and mechanical in 5 cases, etiological and mechanical in 4 cases, A nterior approach was performed in 26 cases, posterior approach in 3 ca ses. A disc sequestrectomy and/or resection associated to pus evacuati on and skeletal graft was performed in 24 cases. Fixation oi the graft by screwed plate was used in 3 cases. Antituberculous treatment was i nstituted in ail cases. Results The average duration of lime spent in hospital was 29 days. The average follow-up was 15.61 months (range : 8 monts to 5 years). Short and mean-term outcome was marked by a fistu la in 3 cases. These patients underwent a second procedure ; they had a good evolution. The long term outcome showed that all patients were considered as cured (functional and neurological results were satisfac tory) ; all patients obtained fusion. Stability was achieved after 3 t o 5 months. Discussion In our context, we prefer surgical treatment. S pine tuberculous is usually seen at an advanced anatomical and clinica l stage with major destruction of several vertebras. Conclusion Surger y allows to assert the diagnosis, to treat a compression, to evacuate pus, to treat or at less to avoid worsening of a deformation. and to r educe treatment duration.