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. ˃3/4th) 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–
- Onset of Paraplegia during conservative therapy
- Paraplegia getting worse or remaining stationary after 4 weeks of adequate conservative therapy
- Severe paraplegia of rapid onset indicating some pressure on cord
- 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
- 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”