IOSR Journal of Dental and Medical Sciences (IOSR-JDMS) e-ISSN: 2279-0853, p-ISSN: 2279-0861.Volume 19, Issue 4 Ser.5 (April. 2020), PP 54-61 www.iosrjournals.org DOI: 10.9790/0853-1904055461 www.iosrjournal 54 | Page “Surgical Outcome of Posterior Decompression and Stabilization by Pedicle Screw & Rod with Fusion inThoracolumbar Tuberculosis” HumayunKabir Reza 1 ,Samir Kumar Das 2 ,Mohammed Mohsin Reza 3 , Abdullah Al Mamun Choudhury 4 , Mohammad Hossain Rasel 5 1 Medical Officer, MS (Orthopaedics), OSD, Directorate General of Health Services (DGHS), Mohakhali, Dhaka, Bangladesh 2 Resident Surgeon (Orthopaedics& Traumatology), Sir Salimullah Medical College Mitford Hospital, Mitford, Dhaka, Bangladesh 3 Assistant Registrar (Ortho), National Institute of Traumatology &Orthopaedic Rehabilitation (NITOR), Sher E Bangla Nagar, Dhaka, Bangladesh 4 Medical Officer (Ortho), National Institute of Traumatology &Orthopaedic Rehabilitation (NITOR), Sher E Bangla Nagar, Dhaka, Bangladesh 5 Assistant Registrar (Spine Surgery), National Institute of Traumatology &Orthopaedic Rehabilitation (NITOR), Sher E Bangla Nagar, Dhaka, Bangladesh Corresponding Author:HumayunKabir Reza Abstract Introduction:Despite the availability of modern effective antitubercular drugs and healthcare provisions, tuberculosis (TB) remains a serious health problem, especially in developing countries as well as in ours. The spinal column is involved in less than 1% of all cases of tuberculosis. It constitutes 50% of all bone and joint TB. Proper selection of drug therapy and operative modalities are needed to optimize functional outcome for each individual case of Pott’s disease. Objective: To evaluate the effectiveness of surgical management by posterior decompression and stabilization by pedicle screw & rod with fusion in the treatment of thoracolumbar tuberculosis. Materials & Methods: It was a prospective observational type of study carried out at National Institute of Traumatology and Orthopaedic Rehabilitation (NITOR) from 15th July 2015 to 30th June 2017. A total number of 16 patients of spinal tuberculosis involving thoracolumbar region were included in between age 14 to 65 years. All patients were subjected to operative management by posterior decompression and stabilization by pedicle screw and rod and fusion along with anti TB chemotherapy for 18 months. Informed written consent was taken. Regular follow up was targeted at least 6 to 18 months. Pain assessed according to VAS score. Neurological deficit graded according to ASIA impairment scale. Final fusion assessment was done according to Bridwell criteria. Functional outcome assessed according to Macnab criteria. Results:The analyses revealed that mean age was 28.62±10.14 years with maximum 10(62.5%) patients belonging to the age group of 21-40 years. Maximum 10 (62.5%) patients were female and 6 (37.5%) were male. Common clinical presentations were back pain in 14 (87.5%) patients then gibbus in 10 (62.5%), Paraplegia in 8 (50%), paraparesis in 7 (43.75%), constitutional symptoms 4(25%) and bowel bladder involvement 2(12.5%) patients. The mean VAS score for back pain improved from 6.25±2.49 preoperatively to 1.44±1.67 postoperatively. P value is < 0.001, Paired “t” test is significant. Preoperatively 2(12.5%) patients were ASIA grade A which improved to one B and one C grade at final follow up. Before operation 3(18.75%) were grade B, 3(18.75%) were grade C, 7(43.75%) were grade D and one (6.25%) patient was grade E. On the other hand, at final follow up 1(6.25%) patient was ASIA B, 2(12.5%) patients were ASIA C, 3(18.75%) patients were ASIA D and 10(62.5%) patients were ASIA E. The mean kyphotic angle was 29.38±9.98⁰ preoperatively, significant correction of kyphotic angle (16.25±6.19⁰) in immediate postoperative radiographs and at final follow up 16.88±5.74⁰. So average correction after final follow up was 12.50±4.24⁰ (P value <0.001). In case of bony fusion grade I - 10(62.5%), grade II- 5(31.25%) and grade III- 1(6.25%) of the patients (Bridwell criteria). The study shows majority 10(62.5%) patients had excellent functional outcome followed by 3(18.75%) patients had good outcome, 2(12.5%) patients had fair and 1(6.25%) patient had poor outcome according to Macnab criteria. Conclusion:It is concluded that surgical treatment by posterior decompression and stabilization with pedicle screw & rod with fusion is an effective and safe, with good clinical and radiological outcome for the patients with spinal tuberculosis involving thoracolumbar region. Keywords:Posterior decompression, Posterolateral fusion, Surgical outcome, Thoracolumbar tuberculosis. --------------------------------------------------------------------------------------------------------------------------------------- Date of Submission: 02-04-2020 Date of Acceptance: 18-04-2020 ---------------------------------------------------------------------------------------------------------------------------------------