Spinal tuberculosis at the posterior element of spinal column: Case report

Shim, Hyeong-Ki; Cho, Hyung-Lea; Lee, Sang-Ho

doi:10.1016/j.clineuro.2014.05.021

Cited by 3 publications

(3 citation statements)

References 9 publications

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“…2 It is disseminated through the intercostal arteries, lumbar arteries and the vertebral venous plexus (Batson's plexus). 3 Tuberculosis causes the development of granulomatous inflammation that is characterised by the infiltration of lymphocytes and epithelioid cells. These cells may combine to form large Langhans-type giant cells and ultimately lead to caseating necrosis of the affected tissue, resulting in cold abscess formation.…”

Section: Discussionmentioning

confidence: 99%

Isolated Unilateral Facet Tuberculosis of the Lumbar Spine: A Case Report

Chan,

Sin,

Tam

2024

Hong Kong Journal of Radiology

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Section: Discussionmentioning

confidence: 99%

Isolated Unilateral Facet Tuberculosis of the Lumbar Spine: A Case Report

Chan,

Sin,

Tam

2024

Hong Kong Journal of Radiology

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“…Early radiological diagnosis of posterior element TB is difficult even in high-burden regions, resulting in delayed diagnosis and even misdiagnosis in some cases. 12 This is compounded by the fact that spinal TB is characterized by a paucibacillary state, rendering them also difficult to prove by microbiological isolation of the causative agent. 6 , 11 As illustrated in this case report, the diagnosis is often based solely on histopathological findings consistent with granulomatous infection, such as the presence of epithelioid granulomas, caseation necrosis, lymphocytic infiltration, and/or presence of Langhans-type giant cells, which is seen in up to 56% of spinal TB cases.…”

Section: Discussionmentioning

confidence: 99%

Lumbar facet cyst tuberculosis: a rare cause of cauda equina compression. Illustrative case

Pedro¹,

Torio²,

Rivera

et al. 2021

Journal of Neurosurgery: Case Lessons

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BACKGROUNDSpinal tuberculosis may present in atypical form to involve only the posterior spinal element with relative sparing of the anterior vertebral body and intervertebral disc. Recognition of this unusual pattern is important to avoid delay in diagnosis and treatment.OBSERVATIONSThe authors report a case of a 59-year-old woman with right-sided radiculopathy and motor weakness. Her lumbosacral magnetic resonance imaging showed a large heterogeneous cyst arising from the right L4–5 facet joint. Laminectomy with excision of the cyst was performed. During surgery, the cyst contained cheese-like material that, on histopathological examination, revealed focal aggregates of tuberculous granuloma. Postoperatively, the patient recovered remarkably with no interval development of instability or any deformity.LESSONSFacet cyst tuberculosis is rare but should be considered in the differential diagnosis in patients coming from endemic regions. Laminectomy with excision of the cyst along with concurrent antitubercular chemotherapy is a safe and durable treatment option in this case.

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“…Posterior-only approach is associated with relatively better clinical outcome in both adult and elderly population, but its feasibility is subjective to the accessibility of the distant focus, the degree of bone destruction, and the associated risk of injuring the iliac vessels, aorta, abdominals contents, and the spinal cord [6][7][8] . In cases with atypical presenting features where TB involved the posterior column or presented as non-contiguous lesions, multifocal, surgical approaches need to involve complete debridement with combinedanterior-posterior approaches 9,10 . Apart from the conventional surgical procedures mentioned above, some authors have also proposed new surgical techniques to treat conditions with certain characteristics.…”

Section: Discussionmentioning

confidence: 99%

Surgical treatment of tuberculosis of spine: Nepalese experience

Bijukachhe

Sutterlin

2019

Grande Med. J.

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Introduction : Spinal tuberculosis treatment goal is eradication of the disease, neurological protection, and deformity prevention. Accepted indications for conservative or surgical management of the disease are still lacking. The purpose of this study was to classify disease based on pre- and post-treatment clinical and radiological criteria to help management. Material and methods : Out of 101 patients, retrospectively reviewed between 2007 and 2015, seventy adult patients (44 males, mean age 29 years, range 16-76) were included in the study. Patients were evaluated clinically for pain, deformity and neurological status while radiological evaluation included sagittal deformity, vertebra destruction and number of vertebrae involvement. 60 patients underwent surgery (abscess drainage, 2; anterior radical debridement and fusion, 12; anterior debridement + posterior instrumentation, 26; posterior instrumentation, 20) All patients were given anti-tuberculous treatment for 12 months. Mean follow up period was 44.9 months (range: 6-108 months). Result: Pre-treatment pain (Visual analogue score, VAS 0-10, mean 7.52) improved by 0.99 at last follow up. Number of vertebrae involved ranged from 1 to 15 (mean 4.2). 38 patients had obvious clinical deformity with Cobb angle mean 36.6° (range 10°-130°). Deformity was corrected at mean of 17.5° (range: -60° to 90°) at last follow up. There were two ASIA A, eight ASIA B, five ASIA C, four ASIA D and 51 patients with ASIA E neurology at the time of presentation. One patient with ASIA A neurology remained same even after decompression while other patient died on the day of surgery. Out of 8 patients with ASIA B neurology six patients improved to ASIA E, one patient remained same and one patient deteriorated to ASIA A. In ASIA C group, three patients improved to ASIA E. One patient deteriorated to ASIA A. All four patients with ASIA D neurological status improved to ASIA E. And all 51 patients with pre-operative ASIA E status remained same but one deteriorated to ASIA C. Eight patients had deformity progression, two patients had deep vein thrombosis, two patients had superficial wound infection and one patients had recurrent cold abscess. Two patients died due to associated co-morbidities. Based upon the clinical and radiological pre- and post-operative findings; Uncomplicated spines were managed conservatively or with abscess drainage (USG or CT – guided). Complicated spines were managed with posterior instrumentation and complex spines were managed with anterior / posterior procedure (posterior only approach) Conclusion: Based upon the outcome of treatment of spinal tuberculosis, conservative treatment results in healing of the disease process with residual deformity while surgical treatment in selected cases results in early pain alleviation, spinal balance, neurologic protection and eventually early return to work.

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Spinal tuberculosis at the posterior element of spinal column: Case report

Cited by 3 publications

References 9 publications

Isolated Unilateral Facet Tuberculosis of the Lumbar Spine: A Case Report

Isolated Unilateral Facet Tuberculosis of the Lumbar Spine: A Case Report

Lumbar facet cyst tuberculosis: a rare cause of cauda equina compression. Illustrative case

Surgical treatment of tuberculosis of spine: Nepalese experience

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