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PubMed2002

[Transpedicular instrumentation and interbody fusion for spinal tuberculosis].

OBJECTIVE: To evaluate the surgical outcomes of spinal tuberculosis treated with transpedicular instrumentation and interbody auto-grafting. METHODS: Thirty-four patients of thoracolumbar tuberculosis were treated with transpedicular instrumentation, radical focus resection and interbody auto-grafting, combined with 6- or 9-month antituberculous medication from October 1996 to November 1998. All patients were followed-up prospectively for 3 to 5 years postoperatively. RESULTS: The back pain and tuberculous symptoms were relieved about one week postoperatively. The erythrocyte sedimentation rate came back to normal level from 4 to 6 weeks postoperatively. The solid interbody arthodesis was achieved from 4 to 6 months postoperatively. All patients were cured of tuberculous lesions in spinal column or in other region, and there were no tuberculous recurrence. In 12 patients, average preoperative kyphosis angle was 24 degrees (range 10 degrees approximately 32 degrees ), and that was 9 degrees (range 5 degrees approximately 13 degrees ) immediately after surgery. The average correction of kyphotic deformity was 15 degrees and was maintained unchanged in follow-up period postoperatively. Nine patients who had type-C or type-D neurological lesions, according to Frankel gradation, had complete recovery one year postoperatively. CONCLUSION: In spinal tuberculous operation, transpedicular instrumentation and interbody fusion are essential in providing rigid stabilization of spinal column, correcting or preventing kyphotic deformity, accelerating focus healing up and shortening chemotherapy period. Transpedicular instrumentation is necessary in short segments fixation and preserving functional unit of spine.

Adult↗
PubMed1989

Anterior spinal tuberculosis: paraplegia following laminectomy.

Of 16 patients with anterior spinal tuberculosis treated in this unit during the period 1979-1984, five presented with neurological complications following laminectomy at another hospital. After the decompressive laminectomy all five patients developed an increasing kyphosis, and four of the five patients had deteriorated neurologically. They were transferred to our unit where the four with neurological deterioration underwent surgical stabilisation. This paper illustrates the dangers of posterior spinal surgery in the presence of anterior disease.

Adult↗
PubMed1990

[Changes in the levels and composition of glycolipids in various sections of the spinal cord of patients with spinal tuberculosis].

The post mortem content and composition of cerebrosides, sulfocerebrosides and gangliosides found in different sections of the spinal marrow of the healthy persons and 5 patients with spinal tuberculosis were analysed. It was shown that the changes in the content of gangliosides were varying in the lesion focus of different patients. In all patients with chronic tuberculous spondylitis, a significant drop in the content of cerebrosides (myelin markers) and sulfocerebrosides in the lesion focus, as compared with controls, was detected. There were some changes found in the content of cerebrosides and gangliosides in the spinal marrow lesion focus, which are also typical of the disease associated with demyelination of the nervous system. The findings suggest that identification of blood anti-cerebroside antibodies in patients with spinal tuberculosis allows one to make an early diagnosis of abnormalities in the cellular structures of nervous tissue in this form of the disease and to predict its course.

Cerebrosides↗
PubMed2007

Prediction of deformity in spinal tuberculosis.

Tuberculosis of the spine may cause kyphosis, which may in turn cause late paraplegia, respiratory compromise, and unsightly deformity. Surgical correction therefore may be considered for large or progressive deformities. We retrospectively analyzed clinical and radiographic parameters to predict the final kyphotic angle in spinal tuberculosis and to identify patients at risk of unfavorable outcomes at an early stage of the disease when surgery may be indicated. Unfavorable outcome was defined as progression of 10 degrees or greater and/or a final angle of 40 degrees or greater. We analyzed 53 patients with active spinal tuberculosis located in the thoracic (T1 to T10) and thoracolumbar spine (T11 to L2) and with initial kyphotic angles less than 40 degrees. We calculated the indexed total bone height loss, a value of 1 being the equivalent of the loss of a total vertebral body. There were no independent predictors. A bone height loss greater than 0.3 on the initial radiograph in combination with a thoracolumbar location indicated a 38% chance of unfavorable outcome versus only a 3% chance of unfavorable outcome when bone height loss was 0.3 or less in combination with a thoracic location. We present a simple and clinically useful algorithm for predicting kyphosis in spinal tuberculosis.

Adolescent↗
PubMed1999

Neurological complications of spinal tuberculosis in children.

Neurological complications of thoracic and lumbar spinal tuberculosis were studied in 32 patients under the age of 16 years. The majority had lesions involving three or more vertebral bodies. Paraplegia occurred in 8 patients and was always associated with bladder and bowel dysfunction. Lesions located at T4/5 were most commonly accompanied by paraplegia. Deterioration of the neurological status was related to the degree of spinal stenosis, whereas the degree of kyphosis was of less importance. Radiculopathy is rare in children with Pott's disease.

Adolescent↗
PubMed1996

Spinal tuberculosis: a report of five cases and a review.

Spinal tuberculosis (TB) is an uncommon occurrence in developed countries. We present five cases of spinal TB illustrating some of the problems that can be encountered in clinical practice. Delay in diagnosis due to physicians unawareness of TB as a diagnostic possibility in patients with persistent back pain was observed in two patients. A high clinical index of suspicion is, therefore, needed for diagnosis. Tuberculin skin testing was positive in four patients. Computed tomography (CT) has become the examination of choice. It allows precise location of lesions and their extension to paraspinal soft tissue. Furthermore, abscess aspiration and biopsy specimens can be obtained under CT guidance. Magnetic resonance imaging in patients with neurological involvement may provide better information than CT. Definitive diagnosis depending on histological examination, smear and culture of biopsy material, however, may be difficult to obtain. In three patients, diagnosis was based on clinical presentation and response to therapy. Antituberculosis chemotherapy was highly effective in curing all patients. Management of patients should be ensured by experts in antituberculosis chemotherapy, usually chest physicians.

Adult↗
PubMed2001

Multifocal extensive spinal tuberculosis (Pott's disease) involving cervical, thoracic and lumbar vertebrae.

An unusual case is reported of a 53-year-old woman presenting with spinal tuberculosis involving cervical, thoracic and lumbar vertebrae. The patient originally presented with progressive quadriparesis, fever, night sweats and weight loss. Imaging studies demonstrated vertebral body destruction with and without paraspinal and/or intraspinal abscess in cervical, thoracic and lumbar regions. The laboratory studies confirmed the diagnosis of Pott's disease and the patient was placed on anti-tuberculosis chemotherapy. The anterior approach was used for removal of the infected necrotic material, bone grafting and instrumentation, in both cervical and thoracic vertebrae. The postoperative course was uneventful and the patient made an excellent neurological recovery. The present report is of the first published case of an extensive spinal tuberculosis involving cervical, thoracic and lumbar spine.

Antitubercular Agents↗
PubMed1992

Radiological features during and following treatment of spinal tuberculosis.

A retrospective study was performed in order to document the sequence and time scale of radiological changes occurring during the healing of spinal tuberculosis. 28 episodes occurred in 26 patients, of whom only two were Caucasian. All demonstrated good response to conventional chemotherapy. Soft-tissue masses increased in size for up to 1.5 months and took about 12 months to resolve. Bone destruction was seen in all cases and progressed in 70% of patients, whilst on treatment. There was loss of vertebral body height in 79%, which progressed for up to 14 months; any recovery of height was a very late feature. Sclerosis was seen at presentation in 52% and developed in most of the remaining patients within 5 months of instigating treatment. It progressed for up to 14 months and took, on average, 31 months to return to normal. Reduction in disc height was commonly seen and the vertebrae fused in three-quarters of those affected, the time of onset of fusion being very variable. To manage patients with spinal tuberculosis, an appreciation of the variability of radiological changes that can occur during treatment is necessary.

Adolescent↗
PubMed2006

Single-stage transpedicular decompression and posterior instrumentation in treatment of thoracic and thoracolumbar spinal tuberculosis: a retrospective case series.

OBJECTIVE: We compare the surgical results of single-stage posterior surgical procedure performed at a single institute with those of anterior procedure, and propose single-stage posterior surgical approach, laminectomy and posterior decompression with transpedicular instrumentation as an alternative operative method for thoracic and thoracolumbar spinal tuberculosis. METHODS: From January 2001 to December 2004, 10 patients (group 1) who had less bone destruction or poor medical condition were treated with posterior decompression and transpedicular instrumentation that was supplemented with posterolateral bone fusion and chemotherapy. Seven patients (group 2) who had greater bone destruction were treated with anterior decompression, bone fusion, and anterior instrumentation. Except one case who expired, all patients were followed up for average 18 months (6 mo to 3.5 y). RESULTS: Spinal tuberculosis was completely cured and the grafted bones were fused in all 16 patients. The visual analog scale and Frankel grade improved in all cases. There was no persistence or recurrence of infection possibly related to the instrumentation. There were no differences in the radiological results in both groups. The kyphosis was significantly corrected after surgical management. However, the loss of correction also occurred considerably in both groups. CONCLUSIONS: The posterior decompression with transpedicular instrumentation can be an alternative treatment method of less-involved spinal tuberculosis especially for patients in early phase of bone destruction or ones with mild kyphosis.

Adult↗
PubMed1996

[Current aspects of spinal tuberculosis. Apropos of 10 cases].

Between 1990 and 1993 we observed 10 cases of spinal tuberculosis. Magnetic resonance imaging largely contributed to diagnosis and detection of early neurological complications. Medical treatment is essential and must be given for a sufficient duration. Indications for surgery are exceptional and are usually reserved for severe neurological complications.

Adult↗
PubMed2005

The treatment of spinal tuberculosis: a retrospective study.

BACKGROUND: There are conflicting guidelines and variations in clinical practice in the management of bone tuberculosis (TB), including spinal TB. A case who received 6 months of treatment in line with current British Thoracic Society (BTS) guidelines, and subsequently relapsed, prompted a survey of treatment and outcomes of spinal and other bone TB. METHODS: A retrospective study examining the clinical features, treatment duration and outcome of patients presenting with spinal and other bone TB to the Leeds Teaching Hospitals National Health Service Trust, between 1998 and 2002. RESULTS: Forty-two patients were identified. Notes from 34 patients with spinal TB and four patients with TB of other bones were reviewed. Of eight patients who received 6 months of therapy, five relapsed. Of 30 patients who received treatment for 9 months or longer, none relapsed (P < 0.05). CONCLUSION: Six months of treatment, as currently recommended by the BTS, may be inadequate for bone TB, including spinal TB.

Antitubercular Agents↗
PubMed2006

Non-contiguous multifocal spinal tuberculosis involving cervical, thoracic, lumbar and sacral segments: a case report.

MAIN PROBLEM: There are only a few cases reported with non-contiguous spinal tuberculosis in the literature. Most of these patients have only two non-contiguous lesions, and in almost all of these cases, surgical treatment is required. METHODS: A 17-year-old girl with non-contiguous multifocal spinal tuberculosis involving cervical, thoracic, thoracolumbar, lumbar and sacral segments is reported. The patient presented with systemic tuberculosis symptoms and signs, and progressive paraparesis. RESULTS: The patient was treated with antituberculous drug therapy and was operated twice for thoracolumbar and cervical spinal lesions. She made an excellent neurological recovery. CONCLUSIONS: In the patients with non-contiguous spinal involvement, there is a high percentage of requirement of surgical treatment. This may be due to "fulminant" behaviour of the disease in these patients. Early surgical treatment of the cases with large abscesses and systemic tuberculosis may provide early improvement, and must probably be the first treatment modality after general support to the patient.

Adolescent↗
PubMedDate not supplied

[Spinal tuberculosis (Pott's disease) associated to psoas abscess: report of two cases and a literature review].

Tuberculosis is one of the most important infectious disease worldwide, with 3,9 million reported cases in the world in 2002. The skeletal form is responsible for 3% of the total number of cases, with 50% of these due to spinal tuberculosis. The psoas abscess is a rare clinical entity with approximately 12 cases per year described in the medical literature and has in the Mycobacterium tuberculosis , one of its etiologic agents. The objective of this work is to report two cases of spinal tuberculosis associated with psoas abscess attended at our service, as well as a review of the literature.

Adult↗
PubMed2003

Atypical intradural spinal tuberculosis: report of three cases.

OBJECTIVE: To report three cases of intradural spinal tuberculosis (TB) by calling attention to atypical forms of spinal TB. SETTING: A University Hospital, Istanbul, Turkey. METHODS: Histopathological, radiological, surgical and physical examination findings of three patients with spinal TB were retrospectively reviewed. RESULTS: Based on histopathological, surgical and radiological findings, diagnosis of intramedullary abscess had been made in the first case and early and late phases of arachnoiditis in the other two patients, respectively. The clinical outcome was evaluated as satisfactory for the patient with intramedullary abscess who had been treated with medical and surgical interventions. The remaining two patients with arachnoiditis, who had been treated by shunting or simple decompression, had a relatively less favorable clinical outcome. CONCLUSION: Spinal TB, in its atypical forms, is a rare clinical entity and low index of suspicion on the part of the surgeon may result in misdiagnosis such as neoplasm. In cases presenting with an intraspinal mass lesion, possibility of a tuberculous abscess and/or a granuloma should be considered in the differential diagnosis.

Adult↗
PubMed2002

Spinal tuberculosis: report of an atypical presentation.

A 24-year-old woman was treated by the authors for an atypical form of spinal tuberculosis. The patient had simultaneous involvement of T1, T7, and the right ilium. At the T7 level, the anterior and posterior vertebral elements were involved. These findings closely mimicked spinal malignancies. There was no evidence of pulmonary tuberculosis. A biopsy confirmed tuberculosis and the patient was treated successfully with antituberculosis therapy. It is important to be aware that spinal tuberculosis can mimic spinal malignancy.

Adult↗
PubMed1987

Spinal tuberculosis--the commonest cause of non-traumatic paraplegia in Papua New Guinea.

A retrospective study was undertaken of 53 cases of non-traumatic paraplegia admitted to two major hospitals in Papua New Guinea (PNG) from 1975-1982; 19 of these cases were examined. The mean age of the patients was 29 years (range: 2-70 years). Spinal tuberculosis was the commonest cause of paraplegia (83%), followed by neoplasia (7.5%). Two cases of chronic idiopathic arachnoiditis were noted but nutritional myelopathy was not diagnosed. Thirty-one (70%) of the 44 tuberculosis patients responded to treatment and were ambulant at discharge but only 18% were known to have completed 18 months' chemotherapy and 23% defaulted. The introduction of short-term chemotherapy regimens using rifampicin should improve future management of spinal tuberculosis in PNG.

Adolescent↗
PubMed2005

Spinal tuberculosis with concomitant spondylolisthesis: coexisting entities or 'cause and effect'?

STUDY DESIGN: Report of three unusual cases of coexisting spondylolisthesis and tuberculosis in the same patient. OBJECTIVES: To document the rare occurrence and attempt to postulate the probable reasons for such an association. SETTING: Tertiary care teaching hospital in a developing country. METHODS: This communication reports the outcome of three cases where there was spondylolisthesis and spinal tuberculosis in the same patient. The probable reason for such an occurrence is discussed along with a literature review relevant to this topic. RESULTS: The cases responded favorably to conservative treatment with multidrug antitubercular chemotherapy and spinal braces. CONCLUSIONS: Association of spondylolisthesis and spinal tuberculosis is extremely rare. If the tubercular process is fulminant, spondylolisthesis secondary to destruction of posterior elements by the infective process can occur. Gross destruction of anterior elements secondary to tuberculosis in some patients may place excessive stresses on the posterior elements and may precipitate a spondylolisthesis even if there was no active infection in the posterior elements. However, there remains a distinct possibility that pars defect may have existed prior to infective pathology.

Adult↗
PubMed1995

Spinal tuberculosis: a diagnostic and management challenge.

The authors reviewed 29 cases of spinal tuberculosis treated from 1973 to 1993 with an average follow-up time of 7.4 years. Clinical findings included back pain, paraparesis, kyphosis, fever, sensory disturbance, and bowel and bladder dysfunction. Twenty-two patients (76%) presented with neurological deficit; 12 (41%) were initially misdiagnosed. Sixteen patients (55%) had predominant vertebral body involvement; nine had marked bone collapse with neurological compromise. Eleven individuals (39%) had intraspinal granulomatous tissue causing neurological dysfunction in the absence of bone destruction, and two (7%) had intramedullary tuberculomas. All patients received antituberculous medications: 13 were initially treated with bracing alone, eight underwent laminectomy and debridement of extra- or intradural granulomatous tissue, and eight underwent anterior, posterior, or combined fusion procedures. No patient with neurological deficit recovered or stabilized with nonoperative management. Thirteen patients were readmitted with progression of inadequately treated osteomyelitis; 12 (92%) of these required new or more radical fusion procedures. Anterior fusion failure was associated with marked preoperative kyphosis and multilevel disease requiring a graft that spanned more than two disc spaces. Courses of antibiotic medications shorter than 6 months were invariably associated with disease recurrence. It was concluded that 1) patients should receive at least 12 months of appropriate antituberculous therapy; 2) individuals with neurological deficit should undergo surgical decompression; 3) laminectomy and debridement are adequate for intraspinal granulomatous tissue in the absence of significant bone destruction; 4) when vertebral body involvement has produced wedging and kyphosis, aggressive debridement and fusion are indicated to prevent delayed instability and progression of disease.

Adolescent↗