Zafar Iqbal, Abdul Hameed, Muhammad Anwar, Tariq Salahuddin.
Anterior Decompression and Fixation with a Reconstruction Plate in Cervical and Cervicodorsal Spinal Tuberculosis: a study of 39 Cases.
Pak J Neuro Surg Jan ;14(1):61-8.

Objective: To evaluate the efficacy of anterior instrumentation in patients with subaxial and cervicodorsal spinal tuberculosis in reconstruction of the spine, providing pain relief, neurological recovery and prevention of deformity.Patients and Methods: This is a hospital based reteospective study conducted at Departments of Neurosurgery, Lahore General Hospital and Jinnah Hospital Lahore. Medical records of all the patients operated for subaxial cervical and cervicodorsal (C3-D2) spinal tuberculosis treated by anterior approach during January 2004 to December 2009 were reviewed and analysed. A five drug antituberculous regimen were used for 15-18 months. The follow up ranged from 2 years to 4 years. Clinical and radiological assessment was carried out at intervals.Results: Between January 2004 and December 2009, 39 patients of subaxial cervical and cervico-dorsal (D1, 2) Spinal tuberculosis has been operated by anterior approach. Three patients with involvement of D 1 and D2 vertebrae had a similar approach without excision of medial end of clavicle or manubrium sterni. The age ranged from 18-55 years with a mean age of 32.5 years. There were 26 male and 13 female patients with a male to female ratio of 2:1. Patients presented with Fever and weight loss 10 patients (25.6%), Pain 36, (92.3%), Dysphagia, 3 (7.6%), Motor deficit, 36 (92.3%), Small muscle wasting in hand, 6, (15.3%), Sensory deficit, 32 (82%), Sphincter involvement, 16 (41%), Cervical deformity, 30 (76.9%), Spasticity, 32 (82%). The mean duration between onset of symptoms and clinical presentation in our series was 9.3 months (range3 to 20 month). Cervical x-rays were carried out immediately post op and then at 3, 6, 12, and 24 months. Pain improved in 32 patients (88.8%). Motor deficit improved in all 36 patients. Degree of improvement was less in patients with severe motor deficit preoperatively. Spasticity improved in 28 patients out of 32 (87.5%).Sensory Deficit slowly improved in all 32 cases. Sphincter involvement improved in all 16 cases. Spinal deformity improved in 26 patients out of 30 (86.6). Small muscle wasting of hands present in 6 patients preoperatively didn’t recover in 2 patients. The results were classified as excellent (Grade 5/5 power on last follow up, no pain or deformity, 28 patients 71.7%), good (motor power Grade 4/5, mild pain, residual wasting but no functional sequale, 8 patients, 20.5%) and fair (persistent disability in 4 patients 7.7%). A satisfactory relief of pain and neurological improvement was seen in 36 patients (92.3%).Conclusions: Anterior reconstruction using titanium reconstruction plates and iliac bone graft for stabilization of the subaxial and cervicodorsal region tuberculosis is a very useful adjunct in improving neurological deficit, relieving pain and preventing kyphotic deformity. A satisfactory segmental stability and fusion is achieved by this technique

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