Interdisciplinary Neurosurgery (Dec 2023)
Pott’s disease surgery in Senegal: Management difficulties and results of 212 cases in a developing country
Abstract
Introduction: Tuberculosis is still a major public health issue in low and middle income countries worsened by the HIV/AIDS pandemic and social precarity. Delayed diagnosis of Pott's disease is frequently observed in our environment, leading to neurological complications and spinal deformities despite improved equipment. The objective of this study is to reveal the difficulties encountered in the surgical management of this disease in our working setting, and to report our results. Method: This was a descriptive, retrospective, multicenter analysis including all patients with surgical treatment for Pott's disease between January 2015 and July 2021 in 5 neurosurgical centers in Senegal. Results: During our study period, of the 212 patients operated on for Pott’s disease, the average age was 38.8 ± 11.1 years, with extremes of 10 and 65 years, 58.9% of whom were male, with a sex ratio of 1.3. Spinal pain was the main reason for consultation (62.2%), with an average time to consultation of 9.3 months. Patients had poor overall condition (47.1%), spinal symptoms (85.3% of cases) and neurological deficits (35.8%). Thoracic localization was the most frequent, at 43.8%. Histological diagnosis was made in 74% of cases. The indications for surgery was neurological deficit, signs of spinal instability or deformity. All patients, in addition to 12 months anti-tuberculosis treatment, underwent surgery with a mean time to surgery of 21.2 days. The posterior approach was the most common, 92.4%. Neurological improvement was observed in 76.3% of patients after one year, with vertebral fusion in all. Mortality was 1.8% (4 patients). Conclusion: Pott's disease remains a topical pathology in Senegal. This study shows that surgery provides good results despite the delay in diagnosis and the difficulties of management linked to the low socio-economic status of patients.
