Golden Wires and Rectangle: A Cost-Effective Treatment for Tuberculosis of the Thoracic Spine

STUDY DESIGN: This was a retrospective study. PURPOSE: The purpose of this study was to compare the functional outcome and cost of surgery for tuberculosis (TB) of the thoracic spine between two commonly used fixation modalities “pedicular screws and rods” and “Hartshill loop rectangle and sublaminar wires.” OVERVIEW OF LITERATURE: TB is a common ailment in Asia. Surgical indications have remained almost unchanged since the middle-path regimen was advocated by Tuli. Pedicle screws and Hartshill loop rectangle with sublaminar wires are the two common fixation techniques used. MATERIALS AND METHODS: This retrospective observational study was performed at a single tertiary center. Patients were divided into two groups depending on the method of fixation (pedicle screw rod/Hartshill loop rectangle and sublaminar wires). All patients were evaluated preoperatively by X-rays and magnetic resonance imaging. Patients were assessed clinically by preoperative and postoperative neurology and Visual Analog Scale score and radiologically assessed by the K angle. These variables were separately compared in both the groups. RESULTS: The functional outcomes of Hartshill loop rectangle and sublaminar wire fixation and that of pedicular screw fixation were comparable. Hartshill loop rectangle and sublaminar wire fixation was found to be more cost-effective. CONCLUSION: Hartshill loop rectangle and sublaminar wire fixation gets purchase over the posterior column structures alone when compared to pedicle screws which have a 3-column hold. However, when combined with meticulous neural decompression and skillful preparation of osteogenic bed with autologous strut grafting and additional onlay grafting, it gives overall adequate stabilization of the column with functional outcome comparable to pedicular screw and rod fixation with additional benefit of cost-effectiveness. Although Hartshill loop rectangle and sublaminar wire fixation is less commonly used now, it has a special place in the management of TB, especially in a resource-poor setting like some countries of Asia.