DOES IT REMAIN A PLACE FOR SURGERY IN TUB ERCULOUS SPONDYLITIS IN ADULT - OUR EXPERIENCE IN GABON (CENTRAL-AFRICA)

Tuberculous spondylitis treatment in developing nations remains contro versial. We report our experience, working in a Center where appropria te medical and human structures are available. 22 of 78 adults treated at Jeanne-Ebori Hospital (Gabon), for tuberculous spondylitis, betwee n August 1982 and June 1992, underwent surgery. The average age was 48 years (range, twenty-six to sixty-eight years). Eighteen patients had neurological complications : progressive spinal cord lesions : 15 cas es (tetraplegia : 3, paraplegia : 11, tetraparesis : 1) and radicular syndromes (3 cases). The patients were seen in advanced stages of the disease with bone destruction, associated with collapse of vertebrae i n ten cases. Indications for surgery were : neurologic in eleven cases , mechanical in one case, and mixed in ten cases (neurologic and mecha nical : 5, etiologic and mechanical : 3, etiologic and neurologic : 2) . Anterior approach were performed in 10 cases, posterior approach in 12 cases, generally, following an initial three weeks course of antitu berculous therapy. The average lenght of time spent in hospital includ ing rehabilitation had been 10.4 weeks. The average follow-up was 23.7 months (range : 8 months to 8 years). All patients obtained fusion, a nd stability was achieved after 3-5 months. The neurological recovery was complete in 9 cases, partial in 8 cases, unchanged in one case. Al l patients were considered medically cured. The analysis of material a nd socio economic difficulties obliges us to reduce the treatment leng th by favoring surgical intervention in relatively advanced lesions. M oreover, that allows to specify the diagnosis.