Spinal tuberculosis: a diagnostic and management challenge. J Neurosurg

Department of Neurological Surgery, University of Minnesota Hospital and Clinic, Minneapolis, USA.
Journal of Neurosurgery (Impact Factor: 3.74). 09/1995; 83(2):243-7. DOI: 10.3171/jns.1995.83.2.0243
Source: PubMed


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.

24 Reads
  • Source
    • "Indications for surgery in spinal tuberculosis (TB) have been widely debated over the years [1,2,3,4,5,6,7,8,9,10,11,12,13,14,15]. The indications for urgent surgical intervention in spinal TB vary from neurologic deficit due to spinal cord compression (clinical or radiological) [16] to spinal instability. In developing countries, there is a gross mismatch between the disease burden and the surgical facilities that are available. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Study DesignProspective study.PurposeWe present a series of 50 patients with tuberculous cord compression who were offered systematic non-surgical treatment, and thereby, the author proposes that clinico-radiological soft tissue cord compression is not an emergency indication for surgery.Overview of LiteratureSpinal cord compression whether clinical or radiological has usually been believed to be an indication for emergency surgery in spinal tuberculosis.MethodsFifty adults were prospectively studied at our clinic for spinal cord compression due to tuberculous spondylitis, between May 1993 and July 2002. The inclusion criteria were cases with clinical and/or radiological evidence of cord compression (documented soft tissue effacement of the cord with complete obliteration of the thecal sac at that level on magnetic resonance imaging scan). Exclusion criteria were lesions below the conus level, presence of bony compression, severe or progressive neurological deficit (<than Frankel grade C) and children below the age of maturity. All patients were treated with a fixed, methodically applied non-surgical protocol including hospital admission, antitubercular medications, baseline somatosensory evoked potentials and a regular clinico-radiological follow-up.ResultsAt the time of presentation, 10 patients had a motor deficit, 18 had clinically detectable hyper-reflexia and 22 had normal neurology. Forty-seven of the 50 patients responded completely to non-operative treatment and healed with no residual neurological deficit. Three patients with progressive neurological deficit while on treatment were operated on with eventual excellent recovery.ConclusionsRadiological evidence of cord compression and early neurological signs need not be an emergency surgical indication in the management of spinal tuberculosis.
    Asian spine journal 06/2014; 8(3):315-21. DOI:10.4184/asj.2014.8.3.315
  • Source
    • "The fascinating feature of this research was that all participants who had lumbosacral region involved on MRI also have thecal compression. In contrast to other studies which showed anterior and posterior vertebral body destruction together, our finding showed anterior to be most commonly implicated [28]. The debris, pus and granulation from the bone destruction leads to one of the most dreaded complication of this disease known as paraplegia although pus formation was a common finding in this study but surprisingly paraplegia was not that common [29]. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Spinal tuberculosis presents in various pathological patterns. The clinical presentation and often the management depend on exact pathological findings. Objective of study was to evaluate the Pathology of spinal tuberculosis as depicted by MRI findings in 119 consecutive cases of spinal TB.Methodology: It was a cross sectional and observational study conducted at Civil Hospital, Karachi from July 2010 to December 2012.Total numbers of participants were 119. Diagnosis was based on positive histopathology results along with the supportive evidence in MRI. A pre-structured questionnaire was constructed to record the data. Study was ethically approved by Institutional Review Board of Dow University of Health Sciences. Sample size was calculated by using Open-EPI software. All the data was entered and analyzed through SPSS 19.Result: There were 119 patients who participated in this study out of which 52 were males and 67 were females. Most common level was Dorso-lumbar (33.6%) and 87.5% of them had spondylodiscitis while 90% had cord compression. All 6 (100%) patients who had their upper- dorsal region affected had gibbus formation while all those patients having lumbosacral region involved had thecal compression 4 (100%). Most common mode of treatment used in patients having Spinal TB at Lumbar region was conservative (86.2%). MRI findings were mostly shadowed with features such as disc destruction and thecal or cord compression. MRI scan could be used for early detection of spinal TB which can reduce disability and deaths in patients. Major clinical findings in spinal TB were fever, Para paresis and back pain.
    International Archives of Medicine 03/2014; 7(1):12. DOI:10.1186/1755-7682-7-12 · 1.08 Impact Factor
    • "Historically, this interval was at least 12 months on average, decreasing to between 3 and 6 months in the recent era. Presentation depends upon stage of the disease, site of the disease, presence of complications such as neurologic deficit, abscesses or sinus tracts, and constitutional symptoms such as weakness, loss of appetite, loss of weight, evening rise of temperature, and night sweats generally occur before the symptoms related to the spine manifest.[24] Clinical findings included back pain, paraparesis, kyphosis, sensory disturbance, and bowel and bladder dysfunction.[24] "
    [Show abstract] [Hide abstract]
    ABSTRACT: Spinal tuberculosis (TB) or Pott's spine is the commonest extrapulmonary manifestation of TB. It spreads through hematogenous route. Clinically, it presents with constitutional symptoms, back pain, tenderness, paraplegia or paraparesis, and kyphotic or scoliotic deformities. Pott's spine accounts for 2% of all cases of TB, 15% of extrapulmonary, and 50% of skeletal TB. The paradiscal, central, anterior subligamentous, and neural arch are the common vertebral lesions. Thoracic vertebrae are commonly affected followed by lumbar and cervical vertebrae. Plain radiographs are usually the initial investigation in spinal TB. For a radiolucent lesion to be apparent on a plain radiograph there should be 30% of bone mineral loss. Computed tomographic scanning provides much better bony detail of irregular lytic lesions, sclerosis, disc collapse, and disruption of bone circumference than plain radiograph. Magnetic resonance imaging (MRI) is the best diagnostic modality for Pott's spine and is more sensitive than other modalities. MRI frequently demonstrates disc collapse/destruction, cold abscess, vertebral wedging/collapse, marrow edema, and spinal deformities. Ultrasound and computed tomographic guided needle aspiration or biopsy is the technique for early histopathological diagnosis. Recently, the coexistence of human immunodeficiency virus infections and TB has been increased globally. In recent years, diffusion-weighted MRI (DW-MRI) and apparent diffusion coefficient values in combination with MRI are used to some extent in the diagnosis of spinal TB. We have reviewed related literature through internet. The terms searched on Google scholar and PubMed are TB, extrapulmonary TB, skeletal TB, spinal TB, Pott's spine, Pott's paraplegia, MRI, and computed tomography (CT).
    North American Journal of Medical Sciences 07/2013; 5(7):404-411. DOI:10.4103/1947-2714.115775
Show more