The role of surgery in the management of Pott's disease in Yaoundé. A review of 43 cases.

INTRODUCTION

Pott's disease is a common entity in our hospital. The authors report their experience in the surgical treatment of Pott disease.

PATIENTS AND METHODS

This is a retrospective study including all patients who underwent surgery for Pott's disease in our institution between November 1999 and November 2004.

RESULTS

Forty-three patients were included, including 23 men and 20 women (ratio 1.15). Location of the disease was cervical (2 cases), dorsal (19 cases), dorsolumbar (2 cases) lumbar (16 cases) and sacrolumbar (4 cases). Ten patients were HIV positive (24%). The surgical indication was sometimes diagnostic, but predominantly therapeutic (medullary compression, instability or deformity). Spinal decompression alone was performed in 23 cases, associated with internal fixation of the spine (17 cases) or external immobilization (Halo Vest) in two cases. The anterior approach was used in four cases and a posterior approach in 38 cases. Decompression by posterior approach included 1 or 2 level laminectomy alone or associated with internal plate fixation (4 pedicle screws and 2 plates). There was no functional recovery in patients with a complete neurological deficit (Frankel A); those with a severe deficit (Frankel B) partially recovered, while those with more moderate deficits (Frankel C and D) recovered completely. Fusion was obtained (graft integration) regardless of the surgical approach used, progression of the deformity was stopped and early mobilization was possible.

CONCLUSION

Surgery definitely plays a role in the diagnosis and treatment of Pott's disease, especially in countries where patients are seen at a late stage of the disease when complications have developed. Surgical decompression should not be delayed until lesions become ischemic and irreversible (Frankel A).

LEVEL OF EVIDENCE

Level IV. Retrospective study.