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TITLE:

SAFETY AND EFFECTIVENESS OF TITANIUM MESH CAGE (TMC) INSERTION THROUGH POSTERIOR APPROACH IN SINGLE LEVEL UPPER THORACIC SPINAL TUBERCULOSIS FROM T3 TO T6

AUTHORS:

Malik Liaqat Ali Jalal, Muhammad Shaukat Farooq, Atta ur Rehman Khan, Wajahat Hussain, Zunaira Javed, Muhammad Imran

ABSTRACT:

Introduction: The standard anterior approach for cage fixation in upper thoracic spine is more aggressive and less familiar. Moreover in upper thoracic spine T3 to T5 this approach for cage fixation is quite complicated because of limited space for cage placement due to presence of heart and major vessels.However cage insertion through posterior approach is simple with lesser complications, decreased duration of surgery and shorter hospital stay. Furthermore the neurosurgeons are more familiar with posterior approaches in spine. The aim of study was to determine the safety and effectiveness of posterior cage insertion in upper thoracic spine Methods: This study was conducted at neurosurgery department, Ghazi Medical College, Dera Ghazi Khan. Eight cases of thoracic spinal tuberculosis from T3 to T5 level were enrolled in this study in which only single level was involved. These patients underwent decompression and cage insertion through posterior approach. All eight patients had neurologic deficits in the form of weakness of lower limbs, sphincteric disturbances and back pain. All patients were followed 3 monthly for one year. The efficacy of procedure was assessed by the neurological status of lower limbs, decrease in backache and reduction in erythrocyte sedimentation rate (ESR). Antituberculous treatment was given to all patients for one year. Results: Average duration of surgery was two and half hours. All patients improved neurologically as assessed by Frankel grading and spasticity in lower limbs. No dislodgement of cage was noted during followup period . There was no wound infection and ESR reduction was evident in all cases Conclusion: The use of posterior approach for cage insertion in single level upper thoracic spinal tuberculosis is safe ,effective and canbe used as an alternative to anterior and / or anterolateral approach especially in t3 to t6. Key Words :Thoracic, spine, tuberculosis, cage insertion

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