DIAGNOSTIC AND THERAPEUTIC DIFFICULTIES IN THE NEUROSURGICAL MANAGEMENT OF POTT’S DISEASE IN MADAGASCAR

Introduction: Pott’s disease or spinal tuberculosis is feared by its neurological damages. The study aimed to indicate and solve the diagnostic and therapeutic problems met in its neurosurgical management. 
 Methods: It was a retrospective study conducted during 3 and half years (2015-2018) about 
 36 patients from three neurosurgical centers in Madagascar: CHUJRA, CENHOSOA and CHU FIANARANTSOA. 
 Results: Pott’s disease had an incidence of 10 cases/year. The mean age was 37 years and the sex ratio was 0.9. Most of the patients came from rural regions (65%). The average of consultation delay was about 16 months. Neurological deficits were observed at 69.4 % and complete paraplegic at 47.2 % at the beginning of hospitalization. The delay of consultation upper to 6 months was significantly correlated in the paraplegia (p-value = 0,002). Spinal injuries had shown by MRI only in 19.4 % and by a spinal CT in 69.4 %. Over 83.3 % of patients needed a neurosurgical intervention while only 52.8 % were able to be operated. Anterior approach offered best results with 83.3 % of neurological recuperation in 3 months. Conclusion: The insidious installation of the disease, the diagnostic delay, the pecuniary insufficiency, the expensive cost of MRI and surgical implants are the main difficulties met in neurosurgical management of Pott’s disease. Anterior approach is the surgical technique the most adapted to the advanced Pott’s disease.