Is decompressive surgery the only treatment option? A case series of patients with spinal tuberculosis in advanced pregnancy

Abstract

Spinal tuberculosis in pregnancy is a rare occurrence. Hesitation in performing radiographs complicates the outcome with delay in diagnosis and neurological compromise. There are no clear guidelines for treatment of such cases. Conservative treatment with ATT in pregnant patients may be a viable approach. Neurological compromise does not mandate surgical decompression, which in itself is not devoid of complications. Concern of foetal complications is high in surgical treatment.

Spinal tuberculosis: A systematic review of case studies and development of an evidence‐based clinical guidance tool for early detection

“…Fever and cough on the other hand were comparatively less prevalent among the patients while some of the reviewed studies did not provide patient information about the constitutional symptoms, and it is therefore difficult to ascertain whether these symptoms were absent or merely not recorded. this review shows that a cold abscess may not be necessarily present in most STB patients as it was only reported in three 20,23,25 cases. Three of the cases 23,25,28 had a combination of four different signs, while five cases 23,25,26 had three signs, and the majority (42%) had two signs.…”

“…54% of the cases in this review had positive findings for STB on MRI. 14,17,18,[22][23][24][25] CT-Scan 100 NR Common destructions are fragmentary, osteolytic, subperiosteal, and localized CT guided spinal tissue biopsy was confirmatory in diagnosing STB in five of the reviewed cases. 14,17,21,22 Unlike haematological tests which are non-specific to STB, tissue biopsy is more deterministic and can reliably be recommended.…”

“…Three of the cases 23,25,28 had a combination of four different signs, while five cases 23,25,26 had three signs, and the majority (42%) had two signs. [15][16][17][18][22][23][24][25]27,29 On the other hand, only two cases 20,21 had a single sign while none was symptom free.…”

“…The included studies were 10 case reports [14][15][16][17][18]20,[26][27][28][29] and six case series reporting on 18 individual patients. 19,[22][23][24][25] The search strategy is detailed in Data S1.…”

“…21 Even though these cases were reported in developed countries, the patients are considered to have originally come from developing countries which are TB-endemic. The other 15 cases were reported in Africa 16,19,23,26,28,29 and India, 24,25 both of which are known TB-endemic regions of the world.…”