ABSTRACT

Tuberculosis is a chronic infectious disease ca-used by mycobacteria of the ""tuberculosis complex", mainly mycobacterium tuberculosis. The most frequ-ent site for extra pulmonary involvement of tuberculosis infection is the vertebral column. In undeveloped countries, the disease is a significant source of morbi-dity and mortality, and in these regions it still remains the most common cause of non-traumatic paraplegia. Spinal instability and progressive kyphosis deformity are the main problems associated with the disease. Chemotherapy appears to be the mainstay treatment for tuberculosis. Medical Research Council Working Party on Tuberculosis of the Spine recommends am-bulant chemotherapy consisting of a 6 or 9-month re-gimen of isoniazid and rifampin as the treatment of choice for developing countries. Surgery for tubercu-lous spondylitis is generally considered to be an adju-vant to the effective chemotherapy. Indications forsur-gical treatment include neurological involvement, kyphotic deformity and the presence of a large tuber-culosis abscess and/or abundant necrotic tissue. Cur-rently the gold standard practice is probably radical debridement via anterior approach and anterior fusion with anterior strut grafts. As spinal cord compression is usually located anteriorly, anterior approach and de-compression is the preferred route for neural decomp- ression. Satisfactory fusion rates have been reported with both either posterior or anterior approach. Howe-ver, albeit in low rates, graft resorption can be obser-ved in patients undergoing either anterior or posterior fusion alone, and kyphotic deformity due to asymmet-ric growth is likely in children. Recently, posterolateral or transpedicular drainage without anterior drainage or posterior instrumentation following anterior draina-ge during the same session has been offered as an al-ternative in an attempt to avoid kyphotic deformity. Posterior instrumentation in addition to anterior fusion, either sequential or staged, is associated with incre-ased morbidity. Use of anterior instrumentation has been reported in a limited number of series. Based on the results of our recent studies on the treatment of active tuberculous spondylitis with anterior instrumen-tation along with anterior debridement and fusion, it can be concluded that this procedure is effective and provides a very high deformity correction and mainte-nance rates. Furthermore, as demonstrated by seve-ral other studies, the use of metallic implants in the presence of active tuberculosis infection appears to be a safe procedure associated with a very low rate of complications.