Anterior Surgical Approaches: TB Spine

Abstract

The surgical strategy for treating spinal tuberculosis is thorough debridement of the infected tissue, effective anti-tuberculosis treatment, neural decompression, and spinal column reconstruction to achieve spinal stability. This provides a sound foundation for effective anti-tuberculosis treatment. There has been widespread debate regarding optimal surgical approach to achieve these goals.

The use of single-stage anterior spine surgical approach has been found to effectively achieve adequate debridement, decompression, and internal fixation to stabilise the spine. Generally, the disease process starts and/or is mainly localised to the anterior column, and hence the anterior approach helps address the diseased area directly. It also prevents damage to the posterior column which may not be affected by the disease, shortens the operative time, and allows sound reconstruction of the anterior spinal column and satisfactory wound healing. Thus, it is an important surgical treatment for spinal tuberculosis (Jain AK et al., Indian J Orthopaedic. 2010;44(4):409–16; Rawall et al., Musculoskelet Surg 97(1):67–75, 2013).

The anterior approach has demonstrated that often the disease frequently is found to be more extensive than suspected allowing for more effective debridement reducing the risk of subsequent relapse (Hodgson et al., Br J Surg. 48:172–8, 1960).

We shall discuss the surgical technique of anterior spinal approach for tuberculosis of the spine at different levels and also consider the recent advances in dealing with the pathology effectively while reducing the ensuing post-surgical morbidity.