Transthoracic approach for Pott's disease.

Spinal tuberculosis with paraplegia, although decreasing in incidence, remains a problem in certain sections of the United States and in most underdeveloped nations. Evacuations of the tuberculous abscess, debridement of necrotic bone, and fusion of the anterior spine are maneuvers performed increasingly by thoracic surgeons. Twenty-two patients with Pott's disease and symptoms of back pain, gibbous deformity, and neurological deficit underwent thoracotomy. Nine were paraplegic prior to operation. Postoperatively, spinal fusion occurred in all cases. All paraplegic patients can walk now, and 17 of the 22 treated operatively have been completely rehabilitated and are in school or working. The average hospital stay was 2.4 months. There was 1 operative death. Medical treatment for Pott's disease consisted of bed rest and chemotherapy and resulted in progressive neurological deficit in 2 patients with an average hospital stay of 2.2 years. We believe operative treatment offers two distinct advantages: excellent reversal of even long-standing paraplegia and markedly shortened hospital stay.