Ijaz Ahmad, Atiq-uz Zaman, Amer Aziz.
Caries Spine-Results of Anterior Decompression and Stabilization with Cage in Thoraco Lumbar Cases.
Surgimed Med Dent J Jan ;1(3):3-7.

Objective: To determine the functional outcome of anterior decompression and stabilization with cage in terms of control of pain & improvement in neurology. Study Design: Descriptive case series. Place of study: The study was conducted at Department of Orthopedics, Ghurki Trust Teaching Hospital / Lahore Medical & Dental College, Lahore, from January 2005 to October 2007. Material and Methods: A total of 50 cases, with an age range of 15-60 years, both male and females, were included in this study. They did not have previous spinal surgery for spinal tuberculosis form D7-L5, were not responding to the conservative treatment and disease involved less than three vertebrae. Anterior decompression of the involved vertebrae was carried out through anterolateral approach and stabilization was done with titanium mesh cage. Patients were given Boston brace for a period of 6 months, followed up and evaluated for the results. Results: Study included 34 (68%) males and 16 (32%) females with their mean age being 42 years. Thirty two patients (64%) had thoracic caries from T2-T12 and 18(36%) had lumbar caries. Most of these patients were paraparetics. According to ASIA Impairment Scale, 14 patients (28%) were in Scale "B", 30 (60%) of Scale "C" and 06 (12%) of Scale "D". Postoperatively, 10(20%) with Scale B improved to Scale "E" while rest of the 04(8%) improved to Scale "D". Thirty patients of Scale "C" and 06 of Scale "D" improved to Scale "E" postoperatively. Regarding Denis Pain Scale, 44 patients (88%) had severe/constant pain (P4/5) while 06 (12%) had moderate pain (P3). Post operatively, out of 44 patients having severe pain (P5), 38 (76%) improved to P1 (no pain) while the remaining 06 (12%) had minimal pain (P2). Other 06 patients having moderate pain (P3) preoperatively had complete alleviation of pain (P1) six months after surgery. Conclusion: Anterior decompression and stabilization with titanium cage and bone grafting is a better option for treating selected patients of TB spine. Patients not only have excellent pain relief but they also experience neurological improvement after surgery.

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