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.
[Show abstract][Hide abstract] ABSTRACT: OBJECTIVE: to present our experience on the surgical treatment of spinal tuberculosis and to compare our data to the recent literature. METHODS: a retrospective evaluation of patients who underwent surgical procedure to treat the disease was done. We analyzed the type of surgery, neurological status and angle of kyphosis before the surgery and after twelve months. The neurological status was determined by the Frankel scale modified by ASIA. The kyphotic deformity was measured using the Cobb method. We identified 23 patients with confirmed diagnosis of tuberculosis of the spine. Thirteen individuals in this group were operated. Three patients were excluded and ten participated in the study. RESULTS: most of the patients underwent decompression, anterior and/or posterior fusion by combined or posterior approach. Six patients presented neurological deficit at the time of diagnosis. Two of these six were children and presented with Pott's disease on admission. Three patients presented complete recovery of the motor function of their legs. One patient had neurological status aggravated after the surgery due to bacterial resistance at the administration of four different drugs and to tuberculous meningitis. Regarding to the kyphosis, the mean focal kyphotic angle in the beginning of the follow up was 26,7º (0º to 90º) and 21,2º (0º to 50º) at the end of the study. The mean regional kyphotic angle was 24,10º (-27º to +60º) in the beginning and 21º(-33º to +65º) at the end of the follow-up. There was a decrease of the mean focal and regional kyphosis of 5,7º and 3,1º, respectively. We did not observe important kyphotic angle increase in any operated patient at the end of the study. CONCLUSION: The surgical treatment was efficient to prevent kyphosis progression. The neurological deficit associated with spinal tuberculosis was critical in children.
[Show abstract][Hide abstract] 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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