Tuberculosis of spine with neurological deficit in advanced pregnancy: a report of three cases

Badve, Siddharth A; Ghate, Sushant D; Badve, Manasi H.; Rustagi, Tarush; Macchiwala, Tauseef; Parekh, Aseem N.; Shah, Shrenik V.

doi:10.1016/j.spinee.2010.11.003

Cited by 12 publications

(22 citation statements)

References 45 publications

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“…Badve et al . pointed out that early decompression in patients with spinal tuberculosis and complete paraplegia had better prognosis in relation to the neurological recovery and deformity progression 29. We obtained neurologic improvement in 12 patients out of 26 patients with neurologic involvement of our series.…”

Section: Discussionsupporting

confidence: 50%

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The role of debridement and reconstruction of sagittal balance in tuberculous spondylitis

Gökçe

Öztürkmen

Mutlu

et al. 2012

IJOO

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Background:An accepted comprehensive clinical approach to the deformed spine with tuberculous infection is still lacking. We aimed to determine the usage of a staged algorithm in the treatment of kyphotic spine with tuberculous infection and to present the clinical results of the patients treated with the help of this protocol.Materials and Methods:54 patients (28 females, 26 males) with a mean age of 39.2 (22-76) years. Preoperative, early postoperative, and followup clinical and radiologic results were evaluated retrospectively. The patients were classified into Kaplan A (kyphotic deformity <30°), Kaplan B (kyphotic deformity 30°-60°) and Kaplan C (kyphotic deformity >60°). They were operated by posterior instrument with anterior debridment (Kaplan A), debridment with anterior bone grafting (Kaplan B) and anterior column resection and bone grafting in Kaplan C.Results:Tuberculous involvement were seen at more than one level in 40 patients and paraspinal abscess were detected in 31. Preoperative focal kyphotic deformity was reconstructed with an average of 19 (9-38) degrees. Twenty-six patients had neurologic compromise with different severities and 12 of them improved after the surgical intervention. Improvement in work ability and pain status was detected in 52% and 61% of the patients, respectively. Wound complications responding to medical care were detected in nine patients. Initial kyphotic deformity was found as an important parameter in selecting the surgical procedure.Conclusion:Regarding resected amount of infected osseous material, as planned preoperatively, have resulted with better concordance between anterior and posterior column heights and better sagittal alignment. We could correct kyphosis and improve sagittal balance with staged algorithm as used by us.

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Section: Discussionsupporting

confidence: 50%

“…Jain reported that prompt treatment including combination of conservative therapy and surgical decompression can reverse paralysis and minimize the potential disability resulting from Pott's paraplegia 28. Surgical treatment options resulted with improvement in the degree of impairement 1329. Badve et al .…”

Section: Discussionmentioning

confidence: 99%

The role of debridement and reconstruction of sagittal balance in tuberculous spondylitis

Gökçe

Öztürkmen

Mutlu

et al. 2012

IJOO

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“…The included studies were 10 case reports [14][15][16][17][18]20,[26][27][28][29] and six case series reporting on 18 individual patients. 19,[22][23][24][25] The search strategy is detailed in Data S1.…”

Section: Review Process For the Development Of The Evidence-based Cmentioning

confidence: 99%

“…21 Even though these cases were reported in developed countries, the patients are considered to have originally come from developing countries which are TB-endemic. The other 15 cases were reported in Africa 16,19,23,26,28,29 and India, 24,25 both of which are known TB-endemic regions of the world.…”

Section: Demographic Information Of Reviewed Case Studiesmentioning

confidence: 99%

Spinal tuberculosis: A systematic review of case studies and development of an evidence‐based clinical guidance tool for early detection

Louw

Tawa

Niekerk

et al. 2019

Evaluation Clinical Practice

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Rationale, aims, and objectives: Despite research being done on spinal tuberculosis, diagnosing this condition at an early stage remains problematic due to its insidious onset and the varying symptoms being associated. Most individuals present to the health care facility with either simple back pain at an early stage or neurological complications at a later stage, when spinal compression and vertebral collapse have occurred as a result of delayed diagnosis. The prevention of secondary complications is therefore dependent on early recognition and diagnosis. The objective of this review was to identify common clinical patterns in case presentations and develop an evidence-based clinical guidance tool to assist clinicians in the early identification of spinal tuberculosis. Method: A comprehensive literature search was conducted for published spinal tuberculosis case studies, which yielded 28 cases after critical appraisal. Data from the studies were categorized in order to assist with a factor analysis and the development of an evidence framework for screening and diagnosing spinal tuberculosis. An evidence-based clinical guidance tool was then designed from the data obtained. Results: Factors associated with spinal tuberculosis and frequently reported symptoms and physical signs with which the patient could present upon assessment were identified. Options for investigations at primary, secondary, and tertiary levels were also identified. Conclusion: Through the use of an evidence-based clinical guidance tool, the clinician could be guided in the early suspicion and management of individuals with spinal tuberculosis and prevention of secondary complications.

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“…Three case reports on managing SCI in pregnant women in their second trimester reported successful outcomes with early surgeries and continuation of the pregnancies [3][4][5]. One case series [6] with three patients of advanced pregnancy and SCI had poor fetal and maternal outcomes with conservative management. Emergency cesarean delivery and the surgical stabilization of the spine in this series resulted in improved neurology of the mothers, but the newborns had low birthweight and APGAR score (Table 3).…”

Section: Sci During Pregnancymentioning

confidence: 99%

Acute traumatic cervical spinal cord injury in a third-trimester pregnant female with good maternal and fetal outcome: a case report and literature review

Pedaballe

Chhabra

Tandon

et al. 2018

Spinal Cord Ser Cases

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Background: The management of acute traumatic cervical spine injury in a third-trimester pregnancy is challenging with risks involved for both the mother and the fetus. We report one such case that was managed successfully with good maternal and fetal outcomes. Case presentation: A 30 years female, gravida 2, para 1, living 1 at 31 weeks 5 days of pregnancy, met with a RTA and was diagnosed with AIS B C4-C5 extension compression spinal cord injury (SCI) with a viable fetus. Closed reduction of C4-C5 dislocation was achieved through controlled cervical traction. Having involved the patient in informed decision-making, anterior cervical discectomy and fusion (ACDF) was performed under general anesthesia (GA), with obstetrician, as well as neonatologist available in the operation theater. The pregnancy was uneventful in the post-operative stage. A healthy baby was delivered at 36 weeks of gestation through cesarean section. At final follow-up review of 12 months the patient was ambulatory without support and was able to perform most of the regular activities independently. Discussion: The significant risk of a spontaneous delivery with GA posed the dilemma of either managing the injury conservatively through bed rest, continuing the pregnancy till its term and then opting for surgical stabilization after delivery or opting for surgical stabilization of the spine immediately, with a view for early mobilization and rehabilitation. A successful outcome of traumatic cervical SCI in third-trimester pregnancy can be achieved by multidisciplinary (anesthetist, obstetrician, neonatologist, spine surgeon, and physiatrist) team, and timely surgical spinal stabilization, followed by early comprehensive rehabilitation.

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Tuberculosis of spine with neurological deficit in advanced pregnancy: a report of three cases

Cited by 12 publications

References 45 publications

The role of debridement and reconstruction of sagittal balance in tuberculous spondylitis

The role of debridement and reconstruction of sagittal balance in tuberculous spondylitis

Spinal tuberculosis: A systematic review of case studies and development of an evidence‐based clinical guidance tool for early detection

Acute traumatic cervical spinal cord injury in a third-trimester pregnant female with good maternal and fetal outcome: a case report and literature review

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