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Synergy of appropriate treatment and compliance of therapy must to beat Spinal TB

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By: Dr Puneet Girdhar

Prompt diagnosis and appropriate treatment helped the 20-year-old paralysed girl revive to normal life at BLK-Max Super Speciality Hospital. With the advent of advanced technology, doctors were not only able to remove the solidified pus cells from her spinal canal that caused paralysis but also surgically prevented a possible future kyphoscoliosis deformity (C or S- curvature in the spine).

Patient Nivedita (name changed) who had been suffering from severe pain in her lower back visited various doctors and investigations suggested a minor herniation in her lumbar region of the spine. Suspicious of spinal tuberculosis, she was advised for a short course of TB medications. Though she gradually felt relieved of her symptoms, non-compliance to a full-fledged regime of TB treatment, led to accumulation of the TB pus cells in the spinal canal that started to solidify over time. This led to sudden paralysis in her legs and got her bed-ridden.

After making several consultations at various hospitals, as a last ray of hope she was brought to BLK Hospital, where detailed investigations revealed a spinal TB and a contrast MRI confirmed the solidification of pus cells. Pertaining to the location of the spread of pus cells, compression of her spinal column had led to the paralysis which needed to be removed carefully without damaging the adjoining nerves.

Advanced technological modalities like Neuro-monitoring, Neuro-navigation and ultrasonic scalpels, has not only made the procedure accurate and precise but also ensures minimal collateral damage and sustains the functional value. In this case, ultrasonic scalpels were used to remove the bone over the solidified pus cells carefully and since the patient’s spine had to be aligned and stabilised to prevent future bending, minimally invasive spinal surgery was preferred to accurately straighten the spine. Preserving the aesthetic outcomes, post surgically her paralysis was reversed and the patient is on regular follow ups and is doing well.

According to medical statistics, around 10-15 per cent of the total TB patients in India suffer from bone TB and the numbers are constantly increasing. India is home to about one lakh people who suffer from osteoarticular tuberculosis which leads to limb shortening in growing children and full body paralysis in a few cases. Bone TB may affect the bone marrow, so a timely and complete course of treatment can only cure the patients. Duration of treatment will depend on the location and severity of the infection. But unlike TB of lungs, Bone and Spine TB takes a little longer depending on the severity of infection.

 Similar to what GPS has done for geographic navigation, 3D image-guided surgery has revolutionized spine surgery. There are several benefits of a minimally invasive spine surgery combined with a spinal navigation system as it proves to be beneficial for both the surgeon and patients. This highly effective navigation system assists surgeons with some of the most complex spine surgeries. During a conventional spine surgery without the use of surgical navigation, surgeons may take multiple X-ray images to verify the location of instruments and placement of implants throughout the procedure while this modern surgery eliminates the need for repetitive X-ray images, helping to reduce radiation exposure to both the patient and medical team.

The use of the equipment to pre-plan the operation, such as determining the size and location of screws to be implanted, saves valuable time and uncertainty associated with spinal surgery. Besides, image-guidance may increase a surgeon’s confidence in difficult cases, especially in revision cases where the patient’s anatomy may be changed from previous operations.

The writer is Senior Director & Head, Spine Surgery, BLK-Max Hospital

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