Posterior spinal cord compression: outcome and results.

Department of Orthopaedics, Sir Ganga Ram Hospital, New Delhi, India.
Spine (Impact Factor: 2.3). 09/2006; 31(17):E574-8. DOI: 10.1097/01.brs.0000229805.10506.19
Source: PubMed


Prospective, comparative study of neurologic outcome in patients with posterior extradural cord compression.
To compare the results of surgical decompression in patients presenting with neurologic deficit due to posterior element tuberculosis with those due to other causes.
Posterior cord compression is a relatively uncommon entity with not much literature published on it.
Over a period of 5 years, 14 patients with extradural posterior cord compression with neurologic deficit were divided into two etiologic groups: 9 patients had Koch's and 5 had other pathologies. All these cases were surgically decompressed posteriorly and the results compared.
While results of surgery in patients with Koch's were good, with 7 of the 9 patients showing full recovery, outcome in patients with compression due to other causes (tumor/pyogenic infection) was not very satisfactory even after adequate mechanical decompression, with 3 of the 5 cases remaining paraplegic even after surgery.
Posterior cord compression due to nontuberculous causes frequently mimics the picture of Koch's both clinically and radiologically. Prognosis of surgical decompression is good in tuberculous compression but not in other cases.

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    ABSTRACT: Isolated intraspinal extradural tuberculous granuloma (IETG) without radiological evidence of vertebral involvement is uncommon, especially rare in cervical spine. We report a case of cervical IETG without bone involvement in a patient with neurological deficit. The patient suffered from progressive neurological dysfunction. MRI of cervical spine revealed an intraspinal extradural mass, and the spinal cord was edematous because of the compression. Thus C2-C4 laminectomy was performed and extradural mass was excised. The excised extradural mass was confirmed to be tuberculous granuloma through pathologic examination. Antituberculous drugs were administrated with a regular follow-up. Excellent clinical outcomes were achieved. The isolated IETG, although a rare entity, should be considered in the differential diagnosis of the intraspinal mass, especially in patients with spinal cord compression and a history of tuberculosis. If there is a progressing neurological deficit, a combination of surgical and anti-tuberculous treatment should be the optimal choice.
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