Tuberculosis of the thoracic spine

Abstract

In spinal tuberculosis MRI can clearly demonstrate combinations of anterior and posterior lesions as well as pedicular involvement. We propose a classification system, using information provided by MRI, to help to plan the appropriate surgical treatment for patients with thoracic spinal tuberculosis. We describe a series of 47 patients, divided into four groups, based on the surgical protocol used in the management. Group A consisted of patients with anterior lesions which were stable with no kyphotic deformity, and were treated with anterior debridement and strut grafting. Group B comprised patients with global lesions, kyphosis and instability who were treated with posterior instrumentation using a closed-loop rectangle with sublaminar wires, and by anterior strut grafting. Group C were patients with anterior or global lesions as in the previous groups, but who were at a high risk for transthoracic surgery because of medical and possible anaesthetic complications. These patients had a global decompression of the cord posteriorly, the anterior portion of the cord being approached through a transpedicular route. Posterior instrumentation was with a closed-loop rectangle held by sublaminar wires. Group D comprised patients with isolated posterior lesions which required posterior decompression only.An understanding of the extent of vertebral destruction can be obtained from MRI studies. This information can be used to plan appropriate surgery. Tuberculosis causes three million deaths each year, and 90 million new cases have been diagnosed in the last ten years.

A new classification and guide for surgical treatment of spinal tuberculosis

“…Although clinical and radiological findings are clear in tuberculosis of the spine, making an early and definite diagnosis is not yet easy, because disease progression is slow and insidious. Due to this difficulty in the early diagnosis of the disease, several patients have received treatments like non-steroid anti-inflammatory drugs, physical therapy, a corset, etc., prior to correct diagnosis [21,23,25].…”

“…CT-controlled biopsy and abscess drainage also aid in making the diagnosis [7]. Due to these technical advances, cases with severe deformity and complications (gibbosity, paraplegia) are seen less frequently today [21,23,24].…”

“…There are only two spinal tuberculosis classifications in the literature. One of them is associated with posterior spinal tuberculosis and the other with thoracic spinal tuberculosis [20,23]. Both have not presented an adequate method for forming a consensus on the management of spinal tuberculosis.…”

Article Commentary: Spinal Tuberculosis

“…Due to this difficulty, many patients in the early stages of the disease receive treatments, such as nonsteroidal anti-inflammatory drugs, physical therapy, or a corset (spinal support), prior to correct diagnosis. 6,7…”

Perfiles epidemiológico y clínico de la tuberculosis osteoarticular: estudio observacional en el Hospital Universitario San Vicente de Paúl, de Medellín, 1994-2004

“…El tiempo de evolución antes del diagnóstico, reportado por autores de países desarrollados, es de 7.2 meses para la forma espinal; en nuestro estudio encontramos un tiempo más prolongado, de 8.9 meses, lo que podría deberse a la falta de sospecha de este diagnóstico por parte de los médicos generales y además a las condiciones socioeconómicas y políticas de la población colombiana que han dificultado el acceso de estos pacientes a la atención médica y a las pruebas diagnósticas oportunas; por eso, cuando los pacientes llegan a la consulta ortopédica ya tienen un cuadro de larga evolución sin mejoría a pesar de haber recibido varios tratamientos. [17][18][19] Llama la atención que en la TB osteoarticular extraespinal diversos informes muestran un promedio de 8.7 meses para el diagnóstico y en nuestro estudio fue de 3.5 meses. Esto podría deberse a que al ser remitidos los pacientes al HUSVP generalmente ya han recibido múltiples tratamientos sin mejoría en otras instituciones, por lo que esta enfermedad se sospecha desde el ingreso y además porque, a diferencia de la TB espinal, las manifestaciones clínicas de la forma extraespinal son muy precoces.…”