Intervertebral focal surgery for the treatment of non-contiguous multifocal spinal tuberculosis

Shi, Jiandang; Wang, Zili; Geng, Guangqi; Niu, Ningkui

doi:10.1007/s00264-011-1478-1

Cited by 17 publications

(19 citation statements)

References 19 publications

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“…[ 4 , 15 , 16 ] Polley and (2009) [ 1 ] reported that there was a higher incidence of neurology in the noncontiguous group (75%) compared to the rest of our group (58.5%). Shi et al [ 12 ] adopted complete debridement, deformity correction, graft fusion, and internal fixation for patients with noncontiguous multifocal spinal TB. A total of 29 cases achieved satisfactory deformity correction and the correction angle loss, having a significant recovery from kyphosis and neurologic symptoms.…”

Section: Discussionmentioning

confidence: 99%

“…Meanwhile, surgery is an efficient treatment for patients with spinal TB that manifests as kyphotic deformity, neurological deficit, or a huge abscess and postoperative nutritional support is also important. [ 1 , 4 , 11 , 12 ] Polley and Dunn [ 1 ] stated that those patients with skip lesions are more prone to develop neurological complications than the rest cases indicating a high incidence of surgical intervention. Identification of noncontiguous vertebral TB, symptomatic or not, however, is important because it can influence the decision of surgical intervention, the number of levels instrumented and may dictate the need for bracing of levels not surgically treated.…”

Section: Introductionmentioning

confidence: 99%

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Skipped multifocal extensive spinal tuberculosis involving the whole spine

Yan

et al. 2018

Medicine

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Rationale:Skipped multifocal extensive spinal tuberculosis (TB) involving the whole spine is very rare. So far, only 3 cases have been reported.Patient concerns:We report a rare case of skipped multifocal extensive TB involving the whole spine of a 33-year-old Chinese male. The patient had been asymptomatic until his symptom was significantly aggravated, which caused him to have difficulty in walking and sleeping. The whole spinal computed tomography (CT) scan showed multifocal worm-eaten and osteolytic bony destruction spread over noncontiguous multilevel vertebral involvement in cervical, thoracic, lumbar, and sacral. In addition, the patient presented with low back pain, progressive fever, night sweats, and weight loss. An open biopsy was undergone indicating granulomatous inflammation after thorough radiographic examinations and laboratory investigations, which to our knowledge have been rarely reported by the published medical reference literature.Dignoses:It was initially diagnosed as lymphoma, multiple myeloma, or a metastatic disease by the radiologist. Final pathology confirmed it as an atypical form of spinal TB, which is extremely rare.Interventions:The patient with no progressive severe neurological symptoms, spinal deformity, or a huge abscess was put on a combination of anti-TB treatment and discharged in an improved state to continue medication for a total of 12 months.Outcomes:This article is a case report, no outcomes.Lessons:Multifocal extensive spinal TB involving the whole spine is rarely reported in the literature, which presents with atypical presentations and imaging features. It is noticeable that the possibility of TB is considered for any skip lesions involving the spine cautiously. Meanwhile, careful physical examination, trials of anti-TB treatment, and using the whole spine MRI routinely also play an important role in the diagnosis and treatment of this disease.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Skipped multifocal extensive spinal tuberculosis involving the whole spine

Yan

et al. 2018

Medicine

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“…Posterior-only approach is associated with relatively better clinical outcome in both adult and elderly population, but its feasibility is subjective to the accessibility of the distant focus, the degree of bone destruction, and the associated risk of injuring the iliac vessels, aorta, abdominals contents, and the spinal cord [6][7][8] . In cases with atypical presenting features where TB involved the posterior column or presented as non-contiguous lesions, multifocal, surgical approaches need to involve complete debridement with combinedanterior-posterior approaches 9,10 . Apart from the conventional surgical procedures mentioned above, some authors have also proposed new surgical techniques to treat conditions with certain characteristics.…”

Section: Discussionmentioning

confidence: 99%

Surgical treatment of tuberculosis of spine: Nepalese experience

Bijukachhe

Sutterlin

2019

Grande Med. J.

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Introduction : Spinal tuberculosis treatment goal is eradication of the disease, neurological protection, and deformity prevention. Accepted indications for conservative or surgical management of the disease are still lacking. The purpose of this study was to classify disease based on pre- and post-treatment clinical and radiological criteria to help management. Material and methods : Out of 101 patients, retrospectively reviewed between 2007 and 2015, seventy adult patients (44 males, mean age 29 years, range 16-76) were included in the study. Patients were evaluated clinically for pain, deformity and neurological status while radiological evaluation included sagittal deformity, vertebra destruction and number of vertebrae involvement. 60 patients underwent surgery (abscess drainage, 2; anterior radical debridement and fusion, 12; anterior debridement + posterior instrumentation, 26; posterior instrumentation, 20) All patients were given anti-tuberculous treatment for 12 months. Mean follow up period was 44.9 months (range: 6-108 months). Result: Pre-treatment pain (Visual analogue score, VAS 0-10, mean 7.52) improved by 0.99 at last follow up. Number of vertebrae involved ranged from 1 to 15 (mean 4.2). 38 patients had obvious clinical deformity with Cobb angle mean 36.6° (range 10°-130°). Deformity was corrected at mean of 17.5° (range: -60° to 90°) at last follow up. There were two ASIA A, eight ASIA B, five ASIA C, four ASIA D and 51 patients with ASIA E neurology at the time of presentation. One patient with ASIA A neurology remained same even after decompression while other patient died on the day of surgery. Out of 8 patients with ASIA B neurology six patients improved to ASIA E, one patient remained same and one patient deteriorated to ASIA A. In ASIA C group, three patients improved to ASIA E. One patient deteriorated to ASIA A. All four patients with ASIA D neurological status improved to ASIA E. And all 51 patients with pre-operative ASIA E status remained same but one deteriorated to ASIA C. Eight patients had deformity progression, two patients had deep vein thrombosis, two patients had superficial wound infection and one patients had recurrent cold abscess. Two patients died due to associated co-morbidities. Based upon the clinical and radiological pre- and post-operative findings; Uncomplicated spines were managed conservatively or with abscess drainage (USG or CT – guided). Complicated spines were managed with posterior instrumentation and complex spines were managed with anterior / posterior procedure (posterior only approach) Conclusion: Based upon the outcome of treatment of spinal tuberculosis, conservative treatment results in healing of the disease process with residual deformity while surgical treatment in selected cases results in early pain alleviation, spinal balance, neurologic protection and eventually early return to work.

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“…Ultralong segmental spinal TB may result from the onset of disease because of the doctors' incomplete understanding or delayed surgical treatment during the patient's first visit [3][4][5]. The wide scope of the lesions and the number of vertebrae involved make it difficult to cure these patients.…”

Section: Introductionmentioning

confidence: 97%