Use of Hartshill rectangle with sublaminar wiring for posterior stabilization of D7-D9 tubercular spondylodiscitis with paraplegia: a cost effective treatment


  • Tanmay Anil Avhad Department of Orthopaedics, TNMC and BYL Nair Charitable Hospital, Mumbai, Maharashtra, India
  • Vanksha Shrivastava Department of Orthopaedics, TNMC and BYL Nair Charitable Hospital, Mumbai, Maharashtra, India
  • Siddharth Gunay Department of Orthopaedics, TNMC and BYL Nair Charitable Hospital, Mumbai, Maharashtra, India
  • Ankush Misal Department of Orthopaedics, TNMC and BYL Nair Charitable Hospital, Mumbai, Maharashtra, India
  • Saurabh Bhangde Department of Orthopaedics, TNMC and BYL Nair Charitable Hospital, Mumbai, Maharashtra, India



Spinal tuberculosis, Hartshill cage, Hartshill rectangle, Sublaminar wiring, Decompression, Tuberculosis


Tuberculosis presents a significant health challenge, with extrapulmonary cases comprising 15-20%. Spinal tuberculosis often leads to neurological deficits, requiring surgical intervention such as Hartshill system fixation. Various posterior instrumentation methods are employed, with sublaminar wiring pioneered by Luque and enhanced by Dove's Hartshill system for superior biomechanical performance. This case underscores Hartshill system's efficacy in stabilizing the spine post-tubercular destruction, offering a cost-effective alternative to pedicle screws. An 18-year-old presented with 6-month upper back pain, progressing weakness in lower limbs, weight loss, and fever. Radiographs revealed D7-D9 vertebral destruction, leading to kyphosis. MRI showed paradiscal bony destruction and abscess, suggestive of tubercular spondylodiscitis. Surgery with Hartshill rectangle and sublaminar wiring provided kyphosis correction. Post-operative Gene-Xpert confirmed tuberculosis. Mobilization and chemotherapy led to limb power restoration within 3 months, with ongoing rehabilitation and consolidation of affected segments with complete recovery by eight months. Instrumented stabilization in spinal TB prevents kyphosis and graft complications; Hartshill loop rectangle and sublaminar wire fixation, cost-effective and suitable for resource-poor settings, offer comparable outcomes to pedicle screws, enabling hybrid fixation, especially in low-income countries.


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