Atypical Spinal Tuberculosis

Pande, Ketan C; Babhulkar, Sudhir

doi:10.1097/00003086-200205000-00010

Cited by 70 publications

(66 citation statements)

References 28 publications

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“…MRI scanning is extremely useful for assisting in the diagnosis and surgical planning, but is by no means diagnostic. Confusion, particularly with metastatic malignancy, is possible and a tissue diagnoses is still essential [1,8,9,16].…”

Section: Resultsmentioning

confidence: 99%

“…3 demonstrating atlanto-axial and sub-axial involvement intervening disc space, often accompanied by a paravertebral soft tissue shadow. Atypical radiographic features are described by Pande et al: centrosomic (single isolated body), which may progress to vertebrae plana and be confused with malignancy; ''ivory vertebrae''; isolated neural arch involvement; circumferential or pan-vertebral involvement, which causes significant instability; and multiple vertebral disease, which may be in continuity or noncontiguous [16,18]. In a study of 103 cases by Pertuiset et al [18], pathology consistent with spinal TB was evident on plain films in 94% of patients.…”

Section: Discussionmentioning

confidence: 99%

“…This is a recognised atypical form of spinal TB known as ''extradural tuberculomas'' or ''spinal tumour syndrome'' [3,16]. There was a second intraosseous lesion in L2 on MRI and at follow-up there were bony changes evident on the plain radiographs.…”

Section: Discussionmentioning

confidence: 99%

“…There are a number of proposed mechanisms of spinal TB involvement: the valveless venous system; arterial seeding; lymphatic spread; direct invasion from adjacent viscera/nodes and via spread along soft tissue planes [8,16,20,21].…”

Section: Discussionmentioning

confidence: 99%

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Noncontiguous spinal tuberculosis: incidence and management

2009

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Tuberculosis (TB) has a worthy reputation as one of the great mimickers in medicine with a multitude of clinical pictures and variations. Noncontiguous spinal TB is described as atypical and case reports are published as rarities in the mainstream academic journals. The aim of the study was to asses the incidence and review of the management of non-contiguous spinal TB. We identified 16 cases of noncontiguous spinal TB from a single surgeon series of 98 patients, who were managed surgically between 2001 and 2006. These were diagnosed on whole spine MRI. This represents the largest series reported in literature to date and is higher than the expected incidence. Case notes and imaging were retrospectively reviewed in an attempt to ascertain if there were any parameters to differentiate this group from the rest of the TB spine population. Our incidence of noncontiguous spinal TB is 16.3%. There was a higher incidence of neurology in the noncontiguous group (75%) compared to the rest of our group (58.5%). Non-contiguous TB was not found to be a manifestation of HIV, MDR TB or of chronicity in our series. Most noncontiguous lesions were evident on plain radiology. Noncontiguous spinal TB is common in areas of high prevalence such as South Africa. Despite being frequently missed initially, noncontiguous involvement is evident on plain radiography and simply requires a higher index of suspicion. When investigating spine TB patients, simple radiology of the entire spine is mandatory. If available, a full spine sagittal MRI is extremely useful in identifying noncontiguous lesions. Treatment of noncontiguous tuberculosis is as for standard spinal TB cases in our unit with similar outcomes, but care needs to be taken in surgical planning as patients may have multiple areas of neurological compromise.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Noncontiguous spinal tuberculosis: incidence and management

2009

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“…1 Admission anteroposterior (left) and lateral (right) plain radiographs of the spine demonstrating Grade IV posterior listhesis of the L2 vertebra over L3 (arrows) and scoliosis advanced stages of disease as in our case, progressive vertebral collapse leads to spinal instability with kyphosis, gibbus formation, and neurologic sequelae. Single vertebral involvement in tuberculosis is extremely rare [5], and posterior listhesis of a vertebra has never been associated with tuberculosis in the current literature. Further, of the thirteen reported cases of coexisting spinal tuberculosis and anterolisthesis [6][7][8][9], in only three instances did tuberculosis definitely predate the development of anterolisthesis [7,9].…”

Section: Diagnostic Imaging (Figs 1 2 3)mentioning

confidence: 91%

Posterior listhesis of a lumbar vertebra in spinal tuberculosis

Kirkman

Sridhar²

2010

Eur Spine J

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The management of spinal tuberculosis, especially in children, is controversial. In children, vertebral destruction is more severe than adults because of the cartilaginous nature of their bone. Modern chemotherapy has significantly decreased mortality in spinal tuberculosis, but morbidity remains high. Without early surgery, patients can develop severe kyphosis leading to respiratory insufficiency, painful costopelvic impingement and paraplegia. Lumbar kyphosis results in early degenerative lumbar canal stenosis and is cosmetically unacceptable. We report a paediatric case of atypical spinal tuberculosis demonstrating the need for early surgical intervention to prevent significant spinal instability and neurologic deficit. A 12-year-old girl presented with increasing ambulatory difficulty and double incontinence 4 months after initiating treatment for pulmonary tuberculosis. There was no history of traumatic injury. Examination revealed severe lower limb neurologic deficit, with hypotonia, areflexia, marked sensory loss, and grade 0/5 power in both lower limbs. Plain radiographs and magnetic resonance imaging (MRI) demonstrated grade IV posterior listhesis of the L2 vertebral body over L3, cauda equina compression and bilateral psoas abscesses. Erosion of both the body and pedicle of L2 was observed. Both serology and pus drained from the psoas abscesses were negative for microorganisms. The patient underwent an L2 vertebrectomy via a left retroperitoneal approach. A titanium cage packed with autologous bone graft was inserted, and the spine was stabilized by fixation with screw and rods. Histopathology confirmed a diagnosis of tuberculosis. Eighteen months following the procedure, the patient has regained some power in her right leg and has completed her course of anti-tuberculous chemotherapy, but remains wheelchair-bound. To our knowledge, this is the first reported case of posterior listhesis secondary to spinal tuberculosis. Here, we discuss the possible management options in such a case, and the indications for surgery. As the global HIV/AIDS epidemic causes a resurgence in tuberculosis, increased awareness among the medical community regarding the atypical presentations of spinal tuberculosis is necessitated; both in the developing world where advanced clinical presentations are common, and in the developed world where spinal tuberculosis is an oftenneglected diagnosis.

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