INDICATION OF SURGERY IN TB SPINE/POTT’S SPINE

       I.            Indications in pt. without “Neurological deficit”:

1)    Common Indications–

1.            Failure to improve or, Recrudescence

2.            Primary drug resistance & Irregular chemotherapy

3.            To prevent deformity:-

• Vertebral loss ˃0.75 (i.e. ˃3/4^th) in dorsal & dorsolumbar level; & greater than 1 in lumbar region.
• Children who present Kyphus ˃30⁰ before the start of treatment

2)    Rare Indications–

1.            To establish diagnosis

2.            In pt. with persistent sinuses & abscess

3.            TB of Cx spine with prevertebral abscess causing difficulty in deglutition & respiration.

     II.            Indications in pt. with “Neurological deficit”(Pott’s paraplegia):

1)    Absolute Indications–

1. Onset of Paraplegia during conservative therapy
2. Paraplegia getting worse or remaining stationary after 4 weeks of adequate conservative therapy
3. Severe paraplegia of rapid onset indicating some pressure on cord
4. Paraplegia of severe degree:-

• Paraplegia in flexion/ flaccid paraplegia with sensory & motor loss for 6 months
• Complete motor loss with bladder & bowel involvement for 1 month

5. Paraplegia with such a degree of spasm that adequate rest is not possible

2)    Relative Indications–

i.            Recurrent Paraplegia

ii.            Painful paraplegia

iii.            Paraplegia in elderly pt.

iv.            Paraplegia with complications like- UTI & renal stones.

3)    Rare Indications–

1.            Posterior Spinal Disease

2.            Spinal Tumour Syndrome

3.            Severe paralysis secondary to cervical spine disease

4.            Severe “Conus medullaris” or, ”Cauda Equina Syndrome”