Paraspinal Abscess of Spinal Tuberculosis : Which is The Best Surgical Approach ?
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Introduction. Spinal TB (Pott disease) is the most common as well as the most dangerous form of musculoskeletal TB and accounts for 1% of all TB cases. The most difficult cases to treat are those with extensive spine involvement, vertebral body collapse, severe deformity, neurological injury and large abscess. Paraspinal Abscesses occur at all levels and may be on one side only in front of the spine. Methods. All patients in this series had severe cases of spinal tuberculosis. The specific surgical procedure was selected based on degree of mechanical instability, location of the infection, presence of the largest abscess and spinal compression with neurological impairment. A single anterior cervical corpectomy was used in one case with spondylitis TB C5-6 and drainage paraspinal abscess on the lumbosacral has been carried on in one case. Another cases, 20 year old male with paraspinal abscess and spondylitis TB on the thoracolumbal underwent laminectomy+posterior stabilization+ evacuation of abscess. Anti-tuberculosis drugs was initiated at least two weeks before each surgical procedure. All patients completed two to four months of standard anti-tuberculosis drugs with isoniazid, rifampicin, pyrazinamide and ethambutol followed by an isoniazid and rifampicin regimen for a variable period. The average length of therapy was 14 months (range 10-20 months). Results. All patients improved significantly after surgery with nor acute surgery complication. Conclusions. Large abscesses and extensive vertebral column involvement, aggressive treatment with direct drainage and debridement, anterior reconstruction and posterior instrumentation can result in a rapid recovery and acceptable rate of complications combined with anti-tuberculosis drugs.