Posterior Decompression and Stabilization in Thoracic and Lumbar Spinal Tuberculosis: A Prospective Observational...

Spinal tuberculosis (TB) remains a common cause of spinal infection worldwide and may result in severe neurological deficits and progressive deformity if not treated appropriately. While anti-tubercular therapy (ATT) is the cornerstone of management, surgical intervention is indicated in patients with neurological deterioration or mechanical instability. Posterior decompression and stabilization have emerged as a safe and effective surgical option.

The aim of the study is to evaluate the functional and radiological outcomes in patients with thoracic and lumbar TB treated by posterior decompression and stabilization.

A prospective observational study was conducted on 30 patients with thoracic, lumbar, or thoracolumbar spinal TB between July 2022 and December 2023. Indications for surgery included neurological deterioration, sensory or sphincter deficits, recurrent neurological complications, or lack of improvement after 6 weeks of ATT. Functional outcomes were evaluated using the Visual Analog Scale (VAS) for pain, the American Spinal Injury Association impairment scale for neurological function, and the combined Prolo scale for functional and economic recovery. Radiological outcomes were assessed by kyphotic angle correction and Bridewell grading, while neurological recovery was additionally assessed by Kumar and Tuli's classification. Erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) were measured to monitor inflammatory activity.

The mean patient age was 39.9 ± 14.4 years, with higher female prevalence and more frequent thoracic involvement. The mean intraoperative blood loss was 266 ± 50.1 mL, mean operative time was 2.46 ± 0.41 h, and mean hospital stay was 13.9 ± 4.7 days. At final follow-up, the mean VAS score improved significantly to 2.33 ± 0.99. Mean ESR and CRP declined to 25.5 ± 5.5 mm/h and 16 ± 6.1 mg/L, respectively. The mean post-operative kyphotic correction was 11.7° ± 3.8°, with a mean correction loss of 3.4° ± 1.4° at final follow-up. Functional evaluation showed excellent recovery in 50% of patients on the Prolo scale, and 57.1% achieved Grade I fusion according to Bridewell criteria.

Posterior decompression and stabilization are safe and effective surgical strategies for thoracolumbar spinal TB. It provides reliable decompression, neurological recovery, deformity correction with maintenance, early mobilization, shorter hospital stays, and minimal complications, making it a viable option in resource-limited settings.