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PubMed2005

Dorsolumbar junction spinal tuberculosis in an infant: case report.

The treatment of spinal tuberculosis is a challenging and controversial problem. The authors present the rare case of an 8-month-old infant with dorsolumbar junction tuberculosis. The child did not sit or stand and a hump was noted on his back. Radiological evaluations demonstrated destruction by a tuberculous abscess of the T-12 and L-1 vertebral bodies, extending into the psoas muscles and spinal canal. In addition to medical therapy, radical debridement and grafting were performed via an anterolateral approach. The follow-up period was 2 years. The difficulties in the management of spinal tuberculosis in infants are discussed.

Bone Transplantation↗
PubMed1995

A pain in the neck in pregnancy: cervical spinal tuberculosis.

This paper describes a case of spinal tuberculosis diagnosed at 29 weeks' gestation in a primigravid Indian woman. The report illustrates the primary problems in suspecting disease, recognizing the diverse clinical presentations and initiating investigations to confirm the diagnosis. In most cases, M. tuberculosis, once recognized and appropriately treated, should result in an excellent prognosis.

Adult↗
PubMed2001

[Spinal tuberculosis: early surgical treatment combined with medical treatment].

BACKGROUND: Spinal tuberculosis can produce kyphosis with neurologicaldeficit, despite antibiotic treatment. When there is no response to medical treatment, the recommended procedure is debridementand interbody fusion with bone autograft. The biological characteristicsof Mycobacterium tuberculosis do not prevent osteosynthesisof the infected bone from being performed. PATIENTS AND METHOD: Five patients with spinal tuberculosis and neurological deficitunderwent debridement, interbody fusion and anterior osteosynthesisin addition to medical treatment. In order to ensure stability, posterior fusion was also performed in three patients. All 5 patientsdisplayed weakness and paralysis of their lower extremities, two patients suffered an L4 radiculopathy, one developed paraparesiaand one was excluded due to a short follow-up. Mean value of vertebralkyphosis was 22,8 degrees and mean follow-up was 3,1 years. RESULTS: No patient had septic loosening or progression of the disease. Correction of kyphosis was 104,5% postoperatively and 80,5% atthe end of follow-up. All patients, apart from one with an L4radiculopathy, exhibited neurological recovery. CONCLUSIONS: Anterior instrumentation allows spinal decompression, septic focusdebridement, deformity correction and autologous bone grafting. In severe kyphotic flattening, it is advisable to associate alimited posterior arthrodesis. When pathological fractures appearor there is no response to antibiotic treatment, the combinationof medical and surgical treatment improves patients' outcome.

Adult↗
PubMed1993

Spinal tuberculosis: atypical observations at MR imaging.

PURPOSE: To evaluate atypical magnetic resonance (MR) imaging features of spinal tuberculosis. MATERIALS AND METHODS: Between 1990 and 1993, five of 11 consecutive patients with spinal tuberculosis (two men and three women, aged 30-57 years) had MR findings more suggestive of neoplasm than infection. One patient, a European immigrant, had acquired immunodeficiency syndrome (AIDS). RESULTS: Areas involved with tuberculosis were hypointense on T1-weighted images and hyperintense on T2-weighted images, and became enhanced with gadopentetate dimeglumine. In two patients, tuberculosis affected only a single vertebral body without paraspinal abscesses or involvement of the end plates and disk spaces. In two other patients, only a single spinous process was replaced with tuberculous abscess. In the remaining patient, the sacrum and multiple lower lumbar vertebrae were affected, but the intervertebral disk spaces were not affected. More typical findings of spinal tuberculosis include destruction of two adjacent vertebral bodies and opposing end plates, destruction of intervening disk space, and/or occurrence of paravertebral abscesses. CONCLUSION: Neither clinical examination nor MR findings may be reliable in helping differentiate spinal infections from one another or from neoplasm. Adequate biopsy is essential for early diagnosis and prompt treatment.

Abscess↗
PubMed1987

Atypical forms of spinal tuberculosis.

Twenty-three patients with atypical forms of spinal tuberculosis treated between 1975 and 1985, are described. All presented with signs and symptoms of compression of the spinal cord or cauda equina, ranging from paraesthesiae and increasing weakness of extremities 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 forms constituted about 12 percent of all the cases of spinal tuberculosis seen (a total of 190 cases); and fell into three well-defined groups: those with the involvement of neural arch only; those with the involvement of a single vertebral body; and, those without bony involvement. The correct surgical approach in these groups was found to be different: spinal cord compression caused by the tuberculous disease of the neural arch was best treated by laminectomy; whereas single vertebral body disease required an anterior or anterolateral approach. Spinal computerized tomography was helpful in defining the extent of disease and planning the surgical approach. Histological confirmation of tuberculosis was obtained in all the cases and acid fast bacilli (A.F.B.) were found in, and cultured from, the biopsy specimens of 18 cases.

Adolescent↗
PubMed1993

Evaluation of the risk of instrumentation as a foreign body in spinal tuberculosis. Clinical and biologic study.

The risk of persistence and recurrence of infection in posterior spinal instrumentation surgery for spinal tuberculosis was studied clinically and microbiologically. Eleven patients with thoracic, thoracolumbar, and lumbar spinal tuberculosis treated by debridement, anterior fusion, and combined posterior instrumentation surgery were analyzed. Seven patients had tuberculosis in both anterior and posterior spinal elements. There were no cases of persistence or recurrence of infection after surgery, and instrumentation provided immediate stability and protected against development of kyphotic deformity. The adherence properties of Mycobacterium tuberculosis to stainless steel (SUS 316) was evaluated experimentally. The results showed that posterior instrumentation surgery was not a hazard to spinal tuberculosis infection when combined with radical debridement and intensive anti-tuberculosis chemotherapy.

Adult↗
PubMed1998

[Analysis of reasons failed focal debridement in 109 patients with spinal tuberculosis].

OBJECTIVE: To explore reasons failed focal debridement in treating spinal tuberculosis patients and methods to cope with them. METHOD: One hundred nine patients with spinal tuberculosis who failed initial focal debridement from 1987 to 1996 were reviewed. RESULT: The reasons of operational failure were found to be the use of unreasonable regimens and existence of drug resistant strains; inappropriate operational indication, approach and treatment during operation; lesions involving several vertebrae, skipping destruction and complicating with other kinds of extrapulmonary tuberculosis. CONCLUSION: The key to successful treatment of the disease is to choose appropriate operative indication and approach, discard spinal cord pressure and rebuild spinal stability on the basis of reasonable chemotherapy regimen.

Adolescent↗
PubMed2005

[Application of freeze-dried cancellous allograft in treatment of spinal tuberculosis].

OBJECTIVE: To investigate the efficacy of freeze-dried cancellous allograft in the treatment of spinal tuberculosis. METHODS: From January 1999 to August 2004, there were 31 cases of spinal tuberculosis who underwent surgery. The freeze-dried cancellous allograft was used as grafting material in all the cases. The cancellous allograft was packed in a titanium mesh cage or an artificial vertebrae, and then used as a strut graft anteriorly to implant into the bone defect after the radical debridement, and the instrumentation was done. RESULTS: Twenty-three cases were followed up 1.5 years to 5 years (3.7 years on average), and bony fusion was achieved in 21 cases 6 months later. In 2 cases ceasing antituberculous therapy after 2 months of operation, the local recurrence was obvious. The loosened screw was noticed in one of these two cases, who had tuberculosis in lumbar spine. When antituberculous therapy continued, the bony fusion was observed in these two cases 12 months later. No further position change of the instrument was noticed in the patient carrying loosened screw, but the kyphosis of the thoracolumbar spine aggravated. CONCLUSION: Freeze-dried cancellous allograft could be used in the treatment of spinal tuberculosis. To achieve good results of allograft incorporation and remodeling, the rigid instrumentation should be performed, postoperative antituberculous therapy is also important.

Adolescent↗
PubMed2005

Characteristics of patients with spinal tuberculosis in a French teaching hospital.

OBJECTIVE: To investigate the characteristics of patients managed for spinal tuberculosis at the rheumatology department of the Tours Teaching Hospital, France, between 1986 and 2003. METHODS: Retrospective chart review. The incidence, epidemiology, clinical features, imaging study findings, and diagnostic procedures were recorded. RESULTS: The annual incidence of spinal tuberculosis was stable throughout the study period. There were 24 patients, 15 women and nine men with a mean age of 61 years; 15 patients were of French descent, three were of Portuguese descent, two were Asian, and four were North-African. Risk factors consisted of alcohol abuse in one patient, diabetes in two patients, glucocorticoid therapy in two patients, and a history of tuberculosis in six patients; none of the patients had AIDS. The cervical spine was involved in two patients, the thoracic spine in 11 patients, and the lumbar spine in 12 patients. Mean time from symptom onset to diagnosis was 4.3 months (range, 1-12 months). Percutaneous vertebral biopsy established the diagnosis in 16 of the 20 patients who underwent this procedure. CONCLUSION: The annual incidence of spinal tuberculosis remained unchanged throughout the study period and was not influenced by immigration or the AIDS epidemic. The typical patient was an elderly Caucasian woman of French descent. Reactivation of untreated or inadequately treated tuberculosis was probably the main mechanism.

Aged↗
PubMed2002

[Anterior vertebrectomy and plating for spinal tuberculosis].

OBJECTIVE: To study the effect of anterior vertebrectomy, bone grafting and plating in the treatment of spinal tuberculosis. METHODS: Between February 1998 and August 2000, 12 patients with spinal tuberculosis were operated with anterior vertebrectomy, bone grafting and plating. Evaluation including bone fusion rate, correction of deformity and status of spinal lesion was carried out. RESULTS: In an average of ten months, spinal tuberculosis was completely cured and solid bone fusion had taken place in all 12 patients. The time for bone fusion averaged 5.8 months and the average angle of correction of kyphosis was 16 degrees. CONCLUSIONS: Anterior plating following vertebrectomy and bone grafting offers a complete removal of lesion and decompression of the spinal canal as well as reconstruction of spinal stability. Early rehabilitation and an increased curative rate can be expected through this procedure.

Adult↗
PubMedDate not supplied

[Spinal tuberculosis. Epidemiologic and diagnostic aspects: a study of 28 clinical observations].

OBJECTIVE: To rapidly diagnose spinal tuberculosis in order to improve its prognosis. METHODS: A retrospective study of 28 clinical observations of patients treated in the neurosurgery department of Yopougon's University Teaching Hospital during a 7-year period (January 1994-December 2000). The diagnosis of spinal tuberculosis was established based on clinical, radiological microbiological and histologic arguments. RESULTS: The mean age of the patients is 40 years (from 5 to 75 years of age). The typical spondylodiscitis was the commonest form observed (22 cases) with paravertebral abcess (4 cases). Retropharyngeal abcess was noted in two cases. One case of spondylitis was observed. In two cases, there were a spondylodiscal lesion associated with neural arch lesion. CT scan was helpful in determining the extent of the lesions whereas standard radiography was normal. CONCLUSION: The diagnosis is difficult because of the atypical form of spinal tuberculosis. These forms need differential diagnosis with spine tumors.

Adolescent↗
PubMed1998

[Comparison of three antituberculous drugs in serum and cold abscesses of patients with spinal tuberculosis].

OBJECTIVE: Pharmacokinetics of INH, RFP and OFLX in serum and cold abscesses of patients with spinal tuberculosis was analyzed to provide reference to choosing clinical therapeutic regimen. METHOD: The aspiration specimens of abscesses and venous blood were collected from 8 patients with spinal tuberculosis at 0.5, 0.75, 1.0, 1.5, 2.0, 4.0, 6.0, 9.0, 12.0, 16.0 and 24.0 h after administration of antituberculous drugs. The specimens were assessed by high performance liquid chromatography (HPLC). The data were processed with software 3P87. RESULT: The Cmax of INH, RFP and OFLX in serum were 10.87 +/- 7.09 micrograms/ml, 9.98 +/- 3.53 micrograms/ml, and 5.29 +/- 0.72 micrograms/ml, while the Cmax of INH, RFP and OFLX in cold abscesses were 2.84 +/- 1.63 micrograms/ml, 0.57 +/- 0.26 microgram/ml and 3.19 +/- 1.29 micrograms/ml respectively. CONCLUSION: After administration, the Cmax of INH and OFLX in the cold abscesses of patients with spinal tuberculosis, reached the level beyond their MIC and appeared and disappeared more slowly than that in the serum; RFP was not easy to permeate into the cold abscesses, the Cmax of RFP in the cold abscesses just reached its MIC.

Abscess↗
PubMed2006

[Different operation methods for thoracolumbar spinal tuberculosis].

OBJECTIVE: To compare the advantages and disadvantages among the conventional operative methods with the primary anterior debridement, intercentrum auto grafting, and anterior internal fixation method for the thoracolumbar spinal tuberculosis, and to discuss the applying principle. METHODS: Twenty-seven patients with thoracolumbar spinal tuberculosis were treated by the primary anterior debridement, intercentrum auto grafting, and anterior internal fixation, 8 patients were treated by focus debridement and intercentrum auto grafting operations, and the other 22 patients were treated by focus debridement from Feburary 1998 to July 2003, and we analysed the status of the grafting bone fused, the neural function resumed, the malformation rectified and the whole cure ratio. RESULTS: All patients were cured after the follow-up of 15.2 months averagely. Three thoracic spinal and 1 lumbar spinal tuberculosis patients who suffered local infection were cured by debridement and other managements. The time of beginning active movement postoperatively was shortened, and the degrees of kyphosis correction had increased in the anterior internal fixation group compared with the other two groups (P <0.05). But the cost and the bleeding resulted from operation had increased in the anterior internal fixation group compared with the other two groups (P <0.05). CONCLUSION: The conventional and the modern operation methods of thoracolumbar spinal tuberculosis have respective advantages and disadvantages, so that they can complement rather than replace each other.

Adolescent↗
PubMed2003

[Primary anterior internal fixation for the surgical management of thoracolumbar spinal tuberculosis].

OBJECTIVE: To discuss the effect of primary anterior debridement, interbody autografting, and anterior internal fixation on the surgical management of thoracolumbar spinal tuberculosis. METHODS: Ninety-one cases of thoracolumbar spinal tuberculosis were treated with primary anterior debridement, interbody autografting, and anterior internal fixation. RESULTS: All cases were treated without any recurrence after follow-up for an average of 13 months. Spinal fusion occurred in 3.7 months on average with 20 degree of kyphosis correction achieved after surgery and 95.5% of the patients obtained good results. CONCLUSION: Primary anterior debridement, interbody autografting, and anterior internal fixation for the surgical management of thoracolumbar spinal tuberculosis are safe and effective and play an important role in reconstruction of spinal stability.

Debridement↗
PubMed1996

Spinal tuberculosis in patients with human immunodeficiency virus infection: clinical presentation, therapy and outcome.

SETTING: Bellevue Hospital, a large public hospital in New York City. OBJECTIVE: To discern the clinical characteristics of spinal tuberculosis (Pott's disease) in patients with the human immunodeficiency virus (HIV). DESIGN: Review of all cases of spinal tuberculosis seen at the hospital from 1988 to 1995, with comparison of HIV-positive and HIV-negative cases. Chart reviews for all cases were performed and information regarding signs and symptoms, neurological findings, laboratory and radiographic data, medical and surgical treatment and eventual outcome were recorded. RESULTS: We collected 26 cases of tuberculosis of the spine between July 1988 and June 1995. Seven of our 26 patients (27%) were HIV seropositive. Six of these were PPD+ on presentation. When compared with HIV-negative patients, those with HIV and spinal tuberculosis had similar clinical presentations; most patients had a diagnosis made with percutaneous needle aspiration biopsy of clinically involved areas, and open procedures added little diagnostic information. Most were treated without surgery, and response to antituberculosis therapy was uniformly good. CONCLUSION: We conclude that clinical presentations of spinal tuberculosis are similar in HIV-positive and -negative patients, and good outcomes can be expected with regard to mycobacterial disease.

Adult↗