Extensive Involvement of the Dorsal Spine by Tuberculous Infection and Surgical Treatment with Percutaneous Spinal Instrumentation

Abstract

Purpose: Tuberculosis can be responsible for extensive spinal lesions. Despite the efficacy of medical treatment surgery is indicated to avoid or correct significant deformity, instability and neurological involvement.The authors present a clinical case of total dorsal spine involvement with posterior and anterior major abscess, discussing the management options and outcome obtained.Clinical case: 24 years old male patient, admitted with severe dorsal pain and fluctuating posterior left hemithorax mass with no neurological impairment. CT-Scan and MRI showed extensive lytic lesions from T2 to T12 with gross instability in T8-T9.The patient was surgically treated after 15 days of antibiotic therapy, having a continuous drainage from the left posterior hemithorax superinfected with Staphylococcus aureus. A posterior percutaneous unilateral T5-T12 pedicular instrumentation plus anterior debridement and T7-T10 arthrodesis with vascularized rib graft was performed. Left pedicular instrumentation was postponed to the third week to allow healing of the superinfected area over the left hemithorax where skin was all detached from rib cage. At 24 months follow up, the patient regained complete and normal functional activity with no recurrence of infection, showing a solid fusion over the thoracic area with no deformity.Discussion: Extensive involvement and pyogenic abscess superinfection makes this case a significant therapeutic challenge. In our opinion, anterior-posterior surgery and staged posterior percutaneous instrumentation were favourable related with the excellent outcome.