Atypical forms of spinal tuberculosis

Abstract

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.

Atypical intradural spinal tuberculosis: report of three cases

“…1 Spinal TB is the most common form of osteoarticular TB. 8 The present paper reports three cases of atypical spinal TB with pure intradural involvement, which have been recently documented in the literature: [3][4][5][6] arachnoiditis with intramedullary abscess, arachnoiditis with syrinx, and arachnoiditis with subdural empyema, without epidural involvement. Since such types of involvement are uncommon or less reported, these cases should be considered as nonclassical or atypical spinal TB.…”

“…While the clinical manifestations and radiological features of classical spinal TB are well known and the diagnosis is readily made, 1,2 some atypical forms have been reported, [3][4][5][6] which may prevent early recognition of the disorder and accurate diagnosis. These atypical forms of spinal TB should be kept in mind in order to establish an early diagnosis and treatment, which otherwise may result in irreversible neurological sequela.…”

Tuberculosis of the spine (Pott's disease) presenting as ‘compression fractures’

“…Several studies have also reported atypical presentations of spinal tuberculosis on radiography, including disease con®ned to only one vertebra or disease con®ned to the neural arch with complete sparing of adjacent vertebrae and intervertebral disc. 19 The other unusual site of involvement has been destruction of lateral aspects of vertebral bodies along with the neural arch. This rare form of disease is associated with rapid onset of paraplegia and has only been reported in one of 123 patients with spinal TB.…”

Noncontiguous spinal tuberculosis: incidence and management

“…Skeletal TB is 10% of this, of which spinal TB accounts for approximately 50%. This gives an incidence of between 1 and 2% for osteoarticular TB and 0.5-1% for spinal TB [15].…”