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PubMed2006

Anterior debridement and bone grafting of spinal tuberculosis with one-stage instrumentation anteriorly or posteriorly.

Between 2000 and 2004, 40 cases (average age 38, range 16-65 years) of spinal tuberculosis were treated with anterior debridement and iliac bone graft with one-stage anterior or posterior instrumentation in our unit. All patients received at least 2 weeks of regular antituberculous chemotherapy before surgery. We followed up all patients for 12-48 months (mean 22 months). Local symptoms of all patients were relieved significantly 1-3 weeks postoperatively; 23 of 25 cases (92%) with neurogical deficit had excellent or good clinical results. Erythrocyte sedimentation rates (ESR) returned from 51 mm/h to 32 mm/h (average) two weeks postoperatively. Kyphosis degrees were corrected by a mean of 16 degrees . Fusion rate of the grafting bone was 72.5% one year postoperatively and 90% two years postoperatively. Severe complications did not occur. We therefore believe that patients undergoing anterior debridement and iliac bone grafting with one-stage anterior or posterior instrumentation achieve satisfactory clinical and radiographic outcomes.

Adolescent↗
PubMed2006

Spinal cord compression from spinal tuberculosis in a child.

Tuberculosis in children most frequently involves the pulmonary system. Spinal tuberculosis is very rare and insidious in children. We present a 1-year-old girl who was brought to our clinic with complaints of a bulge on her back and weakness in the feet. She was investigated with magnetic resonance imaging and at the thoracic level which revealed vertebral destruction and para- and perispinal abscess. Computed tomography of the lungs showed tuberculous lesions. The child's mother gave a post history of recovered lung tuberculosis. Due to appearance paraparesis secondary to vertebral destruction, we removed the abscess and infected bone and reconstruction was carried out with fibular allograft anteriorly. Tuberculosis bacilli were isolated from the postoperative biopsy culture. In this study, we evaluated the methods of diagnosis and treatment of spiral tuberculosis according to the studies and publications which have been done previously.

Epidural Abscess↗
PubMed1994

A single stage posterior approach and rigid fixation for preventing kyphosis in the treatment of spinal tuberculosis.

STUDY DESIGN: The authors employed a new mode of treatment for spinal tuberculosis consisting of single stage posterior instrumentation and fusion without anterior debridement. Ten patients were operated upon in this manner. Chemotherapy was instituted 2 weeks preoperatively and continued for a mean period of 11 months. Cotrel-Dubousset or a comparable system was used for fixation. OBJECTIVES: Patients were followed for 3 monthly intervals with serial anteroposterior and lateral x-rays, erythrocyte sedimentation rate, physical examination, and patients' self reports. The mean follow up period was 24.2 months (range, 17-36 months). METHODS: Measurement of kyphosis angle in the lateral x-ray view was used to evaluate treatment. RESULTS: Only a 3.4 degrees mean loss of correction was observed over the follow-up period. All patients were satisfied. CONCLUSION: Our results show that posterior rigid fixation and chemotherapy provide satisfactory stabilization, reduce surgical morbidity, and prevent development of late kyphosis in selected patients with Pott's disease of the thoracolumbar spine.

Antitubercular Agents↗
PubMed1991

The role of computerised tomography in the management of spinal tuberculosis.

Computerised axial tomography of the spine has been carried out in 56 patients with spinal tuberculosis; the extent of the bone and soft tissue involvement, spinal canal encroachment and neural compression were demonstrated. This accurate information made it possible to lay down guide lines for conservative and surgical management.

Adolescent↗
PubMedDate not supplied

Stablization of the spine in the surgical treatment of severe spinal tuberculosis in children.

This is a 5- to 10-year survey of 160 children, all with severe surgically-treated spinal tuberculosis. The treatment consisted of: anterior spinal fusion alone, anterior with posterior fusion, posterior fusion alone and posterior with anterior fusion. The results indicate that in the less severe cases, where an abscess is not evident on plain radiographs, psoterior fusion alone can be of value in the growing spine. In severe cases, especially where an abscess is seen, the combined approaches give the best results. The risk of posterior fusion alone is an unsatisfactory, long term neurological outcome in too many patients. The combined procedure of anterior fusion with posterior fusion is the treatment of choice for all immature spines with this disease.

Abscess↗
PubMed1999

Anterior instrumentation for the treatment of spinal tuberculosis.

BACKGROUND: Kyphosis and neurological impairment are the major residual problems of spinal tuberculosis after the microorganism has been eradicated with use of appropriate medications. Spinal instrumentation is needed to support anterior strut grafts in patients who have kyphosis that affects more than two levels. Most surgeons use posterior instrumentation. Anterior instrumentation, despite its advantages, has not been widely accepted, partly because of concerns about introducing foreign material into infected tissue. The purpose of the current study was to address those concerns. METHODS: Twenty-two patients who had tuberculosis of the spine with moderate-to-severe localized kyphosis and sixteen patients who had more than two involved levels had stabilization with anterior instrumentation. Antituberculous medication was used postoperatively according to a standardized regimen. The patients were followed to determine if there was any recurrence of the disease and if the correction had been maintained. RESULTS: The twenty-two patients who had involvement of one or two levels had an average correction of the deformity of 64 percent (range, 58 to 90 percent), and the sixteen patients who had more than two levels of involvement had an average correction of 81 percent (range, 75 to 97 percent). The correction was maintained in twenty-one patients, the maximum loss was 3 degrees in sixteen, and one patient died on the second postoperative day. There was no recurrence of the disease. CONCLUSIONS: We believe that anterior instrumentation is more effective than posterior instrumentation for reducing the deformity and stabilizing the vertebral column in patients who have kyphosis related to tuberculosis of the spine.

Adolescent↗
PubMed1980

Atypical forms of spinal tuberculosis.

Thirteen patients, aged 7 to 45 years, have been treated for atypical forms of spinal tuberculosis at the Neurological Centres at Benghazi and Lahore. All presented with signs and symptoms of compression of the spinal cord or cauda equina, ranging from paraesthesiae and increasing weakness to paraplegia and loss of sphincter control. None of them showed visible or palpable spinal deformity nor the typical radiographic appearance of destruction of the intervertebral disc and the two adjoining vertebral bodies. These atypical cases fell into two well-defined groups: those with involvement of the neural arch only, with associated intraspinal cold abscesses, and those with involvement of a single vertebral body, resulting in its collapse and a radiographic appearance similar to that in secondary carcinoma of the vertebral body. The correct treatment in these two groups was diametrically opposed. Tuberculous disease of the neural arch was best traced by laminectomy; concertina collapse of a single vertebral body required cost-transversectomy and resection of the transverse process, the pedicle, and the portion of the vertebral body that was encroaching on the spinal canal.

Abscess↗
PubMed1991

Spinal tuberculosis: a five-year review of cases at the National Tuberculosis Centre.

We reviewed 31 cases (19 males and 12 females) of spinal tuberculosis seen at the National Tuberculosis Centre from 1985 to 1989. The mean age was 35.4 years. The predominant clinical feature was backache (90.3%), while neurological features were found in 30.9%. An elevated erythrocyte sedimentation rate (in 80.0%) and a positive Mantoux test (in 70.9%) served as useful investigations. Spinal x-ray was abnormal in all cases, the lumbar spine being most commonly involved. Bacteriological or histopathological confirmation was obtained in only 29.0% of cases. The mainstay of treatment was anti-tuberculous chemotherapy with surgery being performed in 41.9% of patients.

Adult↗
PubMed1986

Spinal tuberculosis presenting with abdominal symptoms--a report of two cases.

We present two unusual cases of tuberculosis of the spine presenting with abdominal symptoms; both patients underwent exploratory laparotomy before the true nature of the diagnosis became known. The diagnosis of spinal tuberculosis was evident on the pre-operative abdominal radiographs but this was overlooked.

Adult↗
PubMed1976

Spinal tuberculosis treated by antituberculous chemotherapy and radical operation.

Between 1956 and 1968, 208 patients with spinal tuberculosis healed by chemotherapy with and without surgical intervention. Two vertebral bodies were affected in 82 patients, one in 23 cases, more than 4 in 70 patients. Sixty-one patients had neural involvement at the time of admission, 42 of them an incomplete or complete paraplegia. All patients were treated by triple-drug chemotherapy. Chemotherapy and bed rest alone was sufficient for 76 patients. Surgical intervention was indicated in 132 cases. Debridement was carried out in 33 cases, debridement and spinal fusion was performed in 18 cases, anterolateral decompression of the spinal cord alone was employed in 15 cases, and together with spinal fusion recommended in 15 cases. Minor surgical procedures were made necessary in 8 cases. The indications for surgery were: (1) unfavorable response to conservative treatment during 3 months, (2) Pott's paraplegia showing no signs of recovery by conservative treatment, (3) Pott's paraplegia developing during conservative treatment (4) cases with unstable spinal lesions, and (5) cases with paravertebral abscesses and sinuses. Complete or good recovery occurred in 61 out of 76 conservatively treated patients. Forty-two out of 61 patients with neural involvement made a complete or a good recovery, 31 being patients with paraplegia. No improvement was noted in 16 cases with neural involvement, and 2 had progression of the neurological signs. A complete recovery was noted in 101 out of 132 operatively treated patients, a good recovery in 21, and no improvement in 9 patients with paraplegia. One patient died; 141 patients returned to their former work, 30 of whom were recovered paraplegics. Fifteen had retired because of advanced age. Modern treatment begins with triple-drug chemotherapy and bed rest for 3 months. If the response is unsatisfactory, debridement or debridement with spinal fusion is carried out as soon as possible. Anterolateral decompression is applied in cases with paraplegia.

Adolescent↗
PubMed1990

Spinal tuberculosis with neurological deficit. Treatment with anterior vascularised rib grafts, posterior osteotomies and fusion.

Nineteen patients with thoracic or thoracolumbar spinal tuberculosis and neurological deficits were treated by anterior debridement, decompression and vascularised rib grafting, followed, either during the same procedure or 14 days later, by multilevel posterior osteotomies, instrumentation and fusion. Surgery was performed under cover of four-drug antituberculosis chemotherapy, given for 12 months. The average pre-operative kyphotic angulation of 56 degrees was reduced to 27 degrees postoperatively and 30 degrees at the latest follow-up (3 degrees loss of correction). Radiological fusion between the vascularised rib graft and the vertebrae was seen after an average of 3.3 months. Eighteen patients (95%) had normal neurological function at 14 months, and the other could walk with the aid of crutches.

Adolescent↗
PubMed2006

Spinal tuberculosis in a 14-year-old immigrant in the Netherlands.

We present a case of Pott's disease, where the patient presented with neurological impairment due to vertebral granulomatous necrosis, needing immediate decompression and later stabilizing and reconstructive orthopaedic surgery, in order to create awareness for TB in general, especially this forgotten form of spinal tuberculosis.

Adolescent↗
PubMed2006

Spinal tuberculosis: a longitudinal study with clinical, laboratory, and imaging outcomes.

OBJECTIVES: To study imaging changes associated with spinal tuberculosis (ST) over time and evaluate their association with clinical and laboratory data. METHODS: Between 1997 and 2004, patients with proven ST in our institution were prospectively enrolled and treated for 1 year. Clinical and laboratory data were collected at baseline and every 3 months. Computed tomography (CT) and magnetic resonance imaging (MRI) were performed at baseline. MRI was performed at least twice during treatment and at the end of treatment. RESULTS: Nineteen patients were enrolled; neurological signs were present at baseline in 14 patients (74%). Initial MRI/CT findings comprised (in percentages of patients) the following: paravertebral abscesses (100/100); intradiscal abscesses (47/0); and epidural abscesses (82/24) with spinal cord compression (64/18) or radicular compression (36/0). Edema of the vertebral body was observed on initial MRI in all the patients. Full follow-up data were available for 15 patients: all were cured with a mean follow-up of 25 months after the end of treatment. Weight gain was nearly maximal at 6 months, and pain relief was achieved within 9 months. C-reactive protein returned to normal after 3 months. On MRI, all epidural abscesses disappeared within 9 months; paravertebral abscesses disappeared after 3, 6, and 12 months in 45, 50, and 85% of patients, respectively. Vertebral body signal converted to a fatty signal in 75% of cases at 12 months. CONCLUSIONS: Significant imaging abnormalities can persist after successful treatment of ST. These findings suggest that MRI need not be repeated in patients with clinical and laboratory improvement.

Abscess↗
PubMed2004

Spinal tuberculosis deserves a place on the radar screen.

Spinal involvement may be the first manifestation of tuberculosis and the problem that drives the patient to seek medical care. Spinal tuberculosis (often called Pott's disease) is by definition advanced disease, requiring meticulous assessment and aggressive systemic therapy. Physicians should keep the diagnosis in mind, especially in a patient from a group with a high rate of tuberculosis infection.

Disease Progression↗
PubMed1999

Spinal tuberculosis in adults. A study of 103 cases in a developed country, 1980-1994.

Spinal tuberculosis (TB) accounts for about 2% of all cases of TB. New methods of diagnosis such as magnetic resonance imaging (MRI) or percutaneous needle biopsy have emerged. Two distinct patterns of spinal TB can be identified, the classic form, called spondylodiscitis (SPD) in this article, and an increasingly common atypical form characterized by spondylitis without disk involvement (SPwD). We conducted a retrospective study of patients with spinal TB managed in the area of Paris, France, between 1980 and 1994 with the goal of defining the characteristics of spinal TB and comparing SPD to SPwD. The 103 consecutive patients included in our study had TB confirmed by bacteriologic and/or histologic studies of specimens from spinal or paraspinal lesions (93 patients) or from extraspinal skeletal lesions (10 patients). Sixty-eight percent of patients were foreign-born subjects from developing countries. None of our patients was HIV-positive. SPD accounted for 48% of cases and SPwD for 52%. Patients with SPwD were younger and more likely to be foreign-born and to have multiple skeletal TB lesions. Neurologic manifestations were observed in 50% of patients, with no differences between the SPD and SPwD groups. Of the 44 patients investigated by MRI, 6 had normal plain radiographs; MRI was consistently positive and demonstrated epidural involvement in 77% of cases. Bacteriologic and histologic yields were similar for surgical biopsy (n = 16) and for percutaneous needle aspiration and/or biopsy (n = 77). Cultures for Mycobacterium tuberculosis were positive in 83% of patients, and no strains were resistant to rifampin. Median duration of antituberculous chemotherapy was 14 months. Surgical treatment was performed in 24% of patients. There were 2 TB-related deaths. Our data suggest that SPwD may now be the most common pattern of spinal TB in foreign-born subjects in industrialized countries. The reasons for this remain to be elucidated.

Adolescent↗
PubMed1999

Atypical forms of spinal tuberculosis: case report and review of the literature.

OBJECTIVE: The object of this report is to highlight some of the less known atypical features of spinal tuberculosis (TB) in the hope of facilitating early diagnosis. Pure neural arch and sacral TB is rare and the co-existence of these two as widely separated skip lesions in the same patient is even rarer. CLINICAL PRESENTATION: An unusual case of tuberculous process affecting the sacrum as well as the neural arches of upper cervical vertebrae is presented. Neither the clinical features nor the imaging techniques, including radiography, bone scintigraphy, computed tomography, and magnetic resonance imaging, were helpful in establishing the diagnosis. The destructive lesion of the sacrum with a rectally palpable presacral mass was thought to be a chordoma or chondrosarcoma until the patient developed upper cervical cord compression with an extradural myelographic block. Development of this second destructive lesion involving the posterior spinal elements (the neural arch) led to a diagnosis of malignant spinal metastasis. The true diagnosis was only revealed by the histology of the solid tumor-like extradural mass in the upper cervical region and demonstration of acid-fast bacilli (AFB) in the lesion. Anti-TB chemotherapy resulted in complete resolution of sacral and cervical lesions as well as the neurologic deficits. CONCLUSION: Differential diagnosis of the obscure spinal lesion should include tuberculosis, specifically the atypical forms; especially because complete cure is possible with early treatment and neurologic morbidity is high in neglected cases.

Adult↗