Results of anterior decompression and fusion in thoracic spinal tuberculosis patients presenting with advanced neurological deficit: A prospective mid-term follow-up study

Background: Advanced neurological complication following thoracic spinal tuberculosis can cause significant morbidity requiring surgical intervention. The aim of the present study was to evaluate the results of transpleural anterior decompression and fusion with or without instrumentation in tuberculous paraplegic patients of thoracic spinal affection.

Methods: A prospective study was conducted on all eligible patients with modified Tuli SM classification system stage III – V neurological impairment following thoracic spinal tuberculosis and who underwent transpleural anterior decompression and fusion at a tertiary care hospital between July 2016 and September 2019. The nominal variables were presented using frequency and percentage. Chi-square test for significance was used to test the significance of association between variables. Z-test for single proportion was used to compare the proportions. The level of significance was set at 5% and all p-values less than 0.05 were treated as significant.

Results: Seventeen patients met the inclusion criteria with highest incidence between 25-34 years age group in both sexes. Of all patients (n=17), 14 patients (82.35%) achieved complete or near complete neurological recovery within 3 months, while 2 patients (11.76%) had partial recovery (ambulation with some support) and 1 patient (5.88%) failed to show any improvement at final follow-up.

Conclusion:  Surgical management involving transpleural anterior decompression and fusion with or without instrumentation gives good neurological and functional outcomes in tuberculous paraplegic patients of thoracic spinal affection as it allows through and complete decompression of pathological focus by directly addressing the pathological focus under vision.