[Is there a place for surgery in Pott's disease in adults? Our experience in Gabon]

Tuberculous spondylitis treatment in developing nations remains controversial. We report our experience, working in a Center where appropriate medical and human structures are available. 22 of 78 adults treated at Jeanne-Ebori Hospital (Gabon), for tuberculous spondylitis, between August 1982 and June 1992, underwent surgery. The average age was 48 years (range, twenty-six to sixty-eight years). Eighteen patients had neurological complications: progressive spinal cord lesions: 15 cases (tetraplegia: 3, paraplegia: 11, tetraparesis: 1) and radicular syndromes (3 cases). The patients were seen in advanced stages of the disease with bone destruction, associated with collapse of vertebrae in ten cases. Indications for surgery were: neurologic in eleven cases, mechanical in one case, and mixed in ten cases (neurologic and mechanical: 5, etiologic and mechanical: 3, etiologic and neurologic: 2). Anterior approach were performed in 10 cases, posterior approach in 12 cases, generally, following an initial three weeks course of antituberculous therapy. The average length of time spent in hospital including rehabilitation had been 10.4 weeks. The average follow-up was 23.7 months (range: 8 months to 8 years). All patients obtained fusion, and stability was achieved after 3-5 months. The neurological recovery was complete in 9 cases, partial in 8 cases, unchanged in one case. All patients were considered medically cured. The analysis of material and socio economic difficulties obliges us to reduce the treatment length by favoring surgical intervention in relatively advanced lesions. Moreover, that allows to specify the diagnosis.