Why are implants used in Pott's (Spinal Tuberculosis) spine despite the presence of infection?

From the Guidelines

Implants are used in Pott's (Spinal Tuberculosis) spine despite the presence of infection because they are necessary to stabilize the spine and prevent further neurological deterioration, even though the infection is still present.

Key Considerations

• The use of implants in spinal tuberculosis is generally reserved for cases where there is instability of the spine, poor response to chemotherapy, or relief of cord compression is needed 1.
• Surgical debridement in combination with chemotherapy has not been shown to have additional benefits compared to chemotherapy alone in uncomplicated cases of spinal tuberculosis 1.
• Chemotherapy is the primary treatment for spinal tuberculosis, with 6- to 9-month regimens containing rifampicin (RIF) being at least as effective as 18-month regimens without RIF 1.
• In cases where neurologic deficits persist or recur, surgery may be necessary to relieve cord compression and prevent further neurological deterioration 1.
• The decision to use implants in spinal tuberculosis should be made on a case-by-case basis, taking into account the individual patient's condition and response to treatment.

Important Points to Consider

• The presence of meningitis in spinal tuberculosis requires consideration of adjunctive corticosteroids and management as tuberculous meningitis 1.
• The use of implants in spinal tuberculosis may require extended duration of treatment, up to 12 months, to ensure adequate treatment of the infection 1.

From the Research

Use of Implants in Pott's Spine

• Implants are used in Pott's (Spinal Tuberculosis) spine despite the presence of infection to provide mechanical stability and prevent sequelae of neural complications 2.
• The use of implants in tubercular infection is considered safe, and indications for instrumented stabilization include pan vertebral disease, long-segment disease, and kyphosis correction 2.
• The choice of implant should be individualized according to the case, with options such as pedicle screw fixation and Hartshill sublaminar wiring stabilization 2.

Rationale for Implant Use

• The goal of treatment is to achieve a healed status with a near-normal spine, and implants help to prevent painful costo-pelvic impingement, respiratory distress, and late-onset paraplegia 2.
• Anterior spinal instrumentation and allograft fibula can be effective in treating multisegmental Pott disease, with a high fusion rate and minimal complications 3.
• The use of implants in spinal tuberculosis can help to maintain segmental correction and prevent deformity progression 3.

Management of Infections

• Infections associated with spinal implants can be challenging to manage, but early diagnosis and radical treatment can help to prevent complications 4.
• The choice of implant in spinal infections depends on the type of infection, with titanium implants potentially necessary in spondylodiscitis 5.
• Implant retention and antimicrobial therapy can be effective in treating early-onset spinal implant infections, while implant removal may be necessary in late-onset infections 6.