Non-Surgical Management of Cord Compression in Tuberculosis: A Series of Surprises

Abstract

Study DesignProspective study.PurposeWe present a series of 50 patients with tuberculous cord compression who were offered systematic non-surgical treatment, and thereby, the author proposes that clinico-radiological soft tissue cord compression is not an emergency indication for surgery.Overview of LiteratureSpinal cord compression whether clinical or radiological has usually been believed to be an indication for emergency surgery in spinal tuberculosis.MethodsFifty adults were prospectively studied at our clinic for spinal cord compression due to tuberculous spondylitis, between May 1993 and July 2002. The inclusion criteria were cases with clinical and/or radiological evidence of cord compression (documented soft tissue effacement of the cord with complete obliteration of the thecal sac at that level on magnetic resonance imaging scan). Exclusion criteria were lesions below the conus level, presence of bony compression, severe or progressive neurological deficit (<than Frankel grade C) and children below the age of maturity. All patients were treated with a fixed, methodically applied non-surgical protocol including hospital admission, antitubercular medications, baseline somatosensory evoked potentials and a regular clinico-radiological follow-up.ResultsAt the time of presentation, 10 patients had a motor deficit, 18 had clinically detectable hyper-reflexia and 22 had normal neurology. Forty-seven of the 50 patients responded completely to non-operative treatment and healed with no residual neurological deficit. Three patients with progressive neurological deficit while on treatment were operated on with eventual excellent recovery.ConclusionsRadiological evidence of cord compression and early neurological signs need not be an emergency surgical indication in the management of spinal tuberculosis.

The Role of Steroids in a Child with Spinal Pre-Extensively Drug-Resistant Tuberculosis

“…Epidural soft tissue swelling consisting of pus, granulation tissue, and edema may subside and resolve completely with antitubercular medicines alone. 10 Similarly, our patient had an epidural abscess but showed clinical improvement with just ATT and steroids. In drug-resistant TB patients, the adjuvant use of corticosteroids has been shown not to increase mortality when the patient is on an effective regimen.…”

Demographics of tuberculosis of spine and factors affecting neurological improvement in patients suffering from tuberculosis of spine: a retrospective analysis of 312 cases

“…10,11 Combination of conservative treatment in the form of anti-tubercular drugs and operative intervention such as simple decompression and stabilization has been reported to result in good clinical outcome in patients presenting with mild-to-moderate deficit. [12][13][14] Although there are limited studies regarding factors affecting neurological recovery in tuberculosis of spine, delay in starting treatment, cord compression, spinal extension of abscess and involvement of more than two vertebras were considered bad prognostic factors in medically treated patients of spinal tuberculosis according to one study. 15 Other studies have stated young age and surgical intervention as a favorable prognostic factor.…”

Computed Tomography–Guided Catheterization Drainage to Cure Spinal Tuberculosis With Individualized Chemotherapy

“…7,8 An abscess, sequestrum, or the formation of a sinus tract are taken as relative surgical indications for spinal TB. 9 Surgery can greatly improve a patient's quality of life such that patients are able to undertake activities that were previously discontinued, and long-term confinement to a bed is no longer needed. Recently, the combination of anti-TB chemotherapy and a single posterior midline approach for screw-rod fixation and debridement through the sacrospinalis muscle outer cross-window to treat multiple segmental thoracolumbar spinal TB was shown to improve lesion clearance and drainage.…”