[Tuberculous spondylodiscitis with neurologic problems: results of surgical treatment]

The purpose of this study is to describe the outcome of surgical treatment for tuberculous spondylitis in 29 patients. These patients were part of an overall series of 67 cases of tuberculous spondylitis treated at the Traumatology and Orthopedic Department of the Yalgado-Ouedraogo National Hospital Center (YONHC) in Ouagadougou, Burkina Faso. Almost 90% of the 29 patients that underwent surgical treatment of tuberculous spondylitis associated with neurological manifestations were from poor rural areas. Mean age was 48 years and most patients were men. The procedure consisted of corporectomy via the anterolateral approach. Resection of variable extent was followed by replacement with forced insertion of a fibular graft. Intraoperative complications included non-fatal cardiovascular arrest (n = 1), inadvertent incision of the peritoneum (n = 3), and technical error in exposure of the damaged vertebrae (n = 1). Postoperative complications included emphysema (n = 2), massive pleurisy (n = 1), chylothorax (n = 1), pneumonia (n = 1), worsening of neurological manifestations (n = 1), and subacute peritonitis (n = 1). Surgical mortality was 10.3% (n = 3). Bone fusion was achieved in all patients. Functional recovery ranged from 50 to 60% after surgical treatment, which is comparable to rates in previous African reports. Choice of therapeutic modalities must take into account cost within the national health care context, duration of hospitalization and invasiveness. Surgical treatment should be used only when absolutely necessary.