Posterior Spinal Cord Compression

Acharya, Shankar; Ratra, Gurdeep Singh

doi:10.1097/01.brs.0000229805.10506.19

Cited by 6 publications

(5 citation statements)

References 12 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…MRI is the imaging of choice for detailed evaluation of posterior spinal destruction, identification of granuloma or granulation tissues, paravertebral inflammation/abscess, epidural abscesses, and spinal cord compression (22). Sometimes the clinical features of posterior spinal TB resemble extradural malignancy, and cross-sectional imaging, especially MRI, can differentiate the two (23).…”

Section: Discussionmentioning

confidence: 99%

“…Ultimately, this atypical posterior spinal TB results in spinal cord or cauda equina compression (7). Its unusual imaging features can result in a delay in its diagnosis and management (16). Therefore, early diagnosis of atypical posterior spinal TB can be sought with MRI, which helps in early surgical intervention in required patients, resulting in dramatic neurological recovery.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Magnetic resonance imaging evaluation of posterior spinal tuberculosis: a cross-sectional study

et al. 2020

View full text Add to dashboard Cite

Background Isolated posterior spinal (element) tuberculosis (TB) is uncommon compared to classical anterior spinal or para-discal TB. Here, we report magnetic resonance imaging (MRI) findings of posterior spinal TB in 19 patients without involvement of the vertebral body and intervertebral disc. Purpose To evaluate the MRI findings in isolated posterior spinal (element) TB. Material and Methods Clinical and MRI data of 19 patients of isolated posterior spinal TB were retrospectively evaluated. Results Of the 19 patients, group A comprised 4 (21%) patients with rapid onset lower limb weakness and pyramidal signs while group B comprised 15 (79%) patients without any neurological deficit. Lumbar vertebrae commonly affected 9 (47.4%) patients followed by dorsal vertebrae in 8 (42.1%) patients and cervical vertebrae in 2 (10.5%) patients. The pedicle was most commonly involved in 12 (63.2%) patients followed by the lamina in 11 (58%) patients, and spinous process and facet joint in 6 (31.6%) patients each. Extra-spinal inflammation/pyomyositis/paraspinal abscess was found in 13 (68.4%) patients followed by epidural abscess 3 (15.8%) patients and both extra spinal inflammation and epidural abscess in 3 (15.8%) patients (15.8%). Compressive cord myelopathy was observed in 4 (21%) patients, where three patients underwent emergency decompression laminectomy and the remaining 16 patients were treated conservatively with anti-tubercular therapy. Conclusion Initial diagnosis of isolated posterior element TB is challenging and requires a high index of suspicion. Early diagnosis of isolated posterior spinal TB is important as early treatment may be beneficial and decreases patient morbidity.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Magnetic resonance imaging evaluation of posterior spinal tuberculosis: a cross-sectional study

et al. 2020

View full text Add to dashboard Cite

show abstract

“…Among spinal TB, isolated intraspinal TB with absence of vertebral destruction and with neural deficit is less than 5%. The cause for spinal TB with posterior elements involved is that hematogenous spreading occurs via venous pathway [15]. The posterior external venous plexuses of vertebral veins anastomose freely with other vertebral venous plexuses and constitute the final pathway for infection to reach the neural arch in this atypical form of spinal TB [15].…”

Section: Discussionmentioning

confidence: 99%

“…The cause for spinal TB with posterior elements involved is that hematogenous spreading occurs via venous pathway [15]. The posterior external venous plexuses of vertebral veins anastomose freely with other vertebral venous plexuses and constitute the final pathway for infection to reach the neural arch in this atypical form of spinal TB [15]. Turgut [16] postulated that the infection originated from pelvic organs initially and then disseminated haematogenously to involve more superior areas of the spine.…”

Section: Discussionmentioning

confidence: 99%

Isolated extradural tuberculous granuloma of the cervical spine: a case report

et al. 2011

View full text Add to dashboard Cite

Introduction Isolated intraspinal extradural tuberculous granuloma (IETG) without radiological evidence of vertebral involvement is uncommon, especially rare in cervical spine. Materials and methods We report a case of cervical IETG without bone involvement in a patient with neurological deficit. The patient suffered from progressive neurological dysfunction. MRI of cervical spine revealed an intraspinal extradural mass, and the spinal cord was edematous because of the compression. Thus C2-C4 laminectomy was performed and extradural mass was excised. Results The excised extradural mass was confirmed to be tuberculous granuloma through pathologic examination. Antituberculous drugs were administrated with a regular follow-up. Excellent clinical outcomes were achieved. Conclusions The isolated IETG, although a rare entity, should be considered in the differential diagnosis of the intraspinal mass, especially in patients with spinal cord compression and a history of tuberculosis. If there is a progressing neurological deficit, a combination of surgical and anti-tuberculous treatment should be the optimal choice.

show abstract

“…High incidence of tuberculosis in association with HIV infection has added another dimension to this problem [3,4]. Emergence of HIV and increase in international human migration has again increased the interest in the developed countries, from where it was once considered eradicated [5].…”

Section: Introductionmentioning

confidence: 99%

Posterior Spinal Tuberculosis: A Review

Kumar¹

2017

Mycobact Dis

View full text Add to dashboard Cite

Natural history of posterior spinal tuberculosis has been described. Classifications of the posterior spinal tuberculosis disease process and principles of management based upon the clinical behavior of the disease has been highlighted and emphasized. A thorough review of literature was conducted with the aim to provide the clinicoradiological correlation of the natural history of posterior spinal tuberculosis in described. Management strategy is developed based upon the severity of the clinical behavior of the disease. In anterior spinal tuberculosis, motor fibers are compressed first as they are placed anterior to the sensory tracts in the spinal cord. The sensory fibers are therefore involved in late stages. Ironically, in posterior spinal tuberculosis when compression is predominantly from the posterior aspect of the cord, we again find that motor fibers are involved prior to the sensory fibers. This is in contradiction to the general belief. It is difficult to offer any simple explanation to this apparent paradox. In general, motor fibers are considered more susceptible to pressure effect, whereas sensory fibers are more susceptible to ischemia.That is why in compression paraplegia, signs and symptoms of motor loss appear prior to the sensory loss, as collaterals prevent ischemia for quite some times. In posterior spinal tuberculosis when compression is from the posterior aspect of the cord, at first pressure is exerted on the column of cerebrospinal fluid (CSF) surrounding the cord and gets transmitted to the ligamentum denticulatum. Motor fibers in the close vicinity, get pulled and show early involvement. Secondly, in compression from the posterior aspect of the cord, the cord is displaced anteriorly and anteriorly placed motor fibers are compressed against the anterior wall of the bony spinal canal causing early motor fiber functional loss. Therefore similar classification of paraplegia predominantly based upon the progressive motor weakness is valid for paraplegia noted following posterior spinal tuberculosis. Neurological deficit grading based management is developed. Grade 1 and 2, conservative treatment, grade 3, gray zone and grade 4, operative treatment is emphasized. The five stages of natural history of tuberculosis of spine have been developed from the clinician's point of view. However, indications of surgery are different than what are described for the anterior spinal tuberculosis. Principles of management with role of rest, braces, chemotherapy and surgery are discussed. Management of posterior spinal tuberculosis of spine, in general, it is no different than management of soft tissue tuberculosis, in HIV negative or positive patients. Role of surgery is very different than anterior spinal tubercolosis. Management of posterior spinal tubercular paraplegia, is simple, logical, efficient and easy to understand and remember by any orthopedic/treating surgeon.

show abstract

Posterior Spinal Cord Compression

Abstract: Posterior cord compression due to nontuberculous causes frequently mimics the picture of Koch's both clinically and radiologically. Prognosis of surgical decompression is good in tuberculous compression but not in other cases.

Cited by 6 publications

References 12 publications

Magnetic resonance imaging evaluation of posterior spinal tuberculosis: a cross-sectional study

Magnetic resonance imaging evaluation of posterior spinal tuberculosis: a cross-sectional study

Isolated extradural tuberculous granuloma of the cervical spine: a case report

Posterior Spinal Tuberculosis: A Review

Contact Info

Product

Resources

About