One-stage lateral rhachotomy and posterior spinal fusion with compression hooks for Pott’s paralysis in the elderly

B Wang, H Ozawa, Y Tanaka, F Matsumoto, T Aizawa, S Kokubun
Department of Orthopaedic Surgery, Tohoku University School of Medicine, Sendai, Japan

Purpose. To evaluate the safety and effectiveness of one-stage lateral rhachotomy and posterior fusion with compression hooks, for the treatment of Pott’s paralysis in the elderly.

Methods. 11 elderly patients underwent lateral rhachotomy (costotransversectomy and pediculectomy) to debride the tuberculosis focus extending into the epidural space and to decompress the spinal cord. After debridement, the interbody cavity was packed with autologous iliac bone chips. For stabilisation, posterior fusion was performed using a compression lamina hook system. Patients were followed up for at least 2 years for complications. Neurological status was assessed using the Frankel score. The kyphotic deformity was measured on lateral radiographs taken before surgery and at follow-up.

Results. During separation of the adhesion around the abscess, a dural tear occurred in one patient and a pleural tear in another. Both tears were successfully repaired. One patient had mild pneumonia after surgery. The Frankel scores of the 11 patients improved from C or D before surgery to D or E after surgery. No relapse of spinal tuberculosis was encountered. The mean deformity angle was 25.5 degrees before surgery and 23.2 degrees at the final follow-up. Spinal fusion was achieved in all patients.

Conclusion. Without the need of thoracotomy, onestage lateral rhachotomy with posterior spinal fusion using compression hooks was an effective option for treating Pott’s paralysis in the elderly.