What is the role of surgery in the treatment of Pott disease (tuberculous [TB] spondylitis)?

Updated: Aug 08, 2019
  • Author: Jose A Hidalgo, MD; Chief Editor: John L Brusch, MD, FACP  more...
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Answer

While most patients should respond to medical treatment, a surgical approach needs to be evaluated and considered. Indications for surgical treatment of Pott disease generally include the following: [52, 53]

  • Neurologic deficit - Acute neurologic deterioration, paraparesis, and paraplegia
  • Spinal deformity with instability or pain
  • No response to medical therapy - Continuing progression of kyphosis or instability
  • Large paraspinal abscess
  • Nondiagnostic percutaneous needle biopsy sample

Resources and experience are key factors in the decision to use a surgical approach. The lesion site, extent of vertebral destruction, and presence of cord compression or spinal deformity determine the specific operative approach (kyphosis, paraplegia, tuberculous abscess). [54, 55, 56]

Vertebral damage is considered significant if more than 50% of the vertebral body is collapsed or destroyed or a spinal deformity of more than 5° exists.

The most conventional approaches include anterior radical focal debridement and posterior stabilization with instrumentation.  Several variations of this approach have been described. The specific advantages and limitations of surgical techniques vary. [57] Individualization of the case is of greatest importance. [21, 58, 59, 60, 61] Newer modalities and techniques are being reported, such as thoracoscopic decompression. [62]

In Pott disease that involves the cervical spine, the following factors justify early surgical intervention:

  • High frequency and severity of neurologic deficits
  • Severe abscess compression that may induce dysphagia or asphyxia
  • Instability of the cervical spine

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