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Abstract
Spondylitis TB is an infection of Mycobacterium TB involving the spine. The course
of spondylitis TB is relatively indolent (without pain), thus early diagnosis is challenging.
This study was conducted to evaluate the clinical presentation and the goal of surgery
in twelve patients who had been operated for spondylitis tuberculosis (TB) in the
Department of Neurosurgery, Faculty of Medicine, Universitas Padjadjaran–Dr. Hasan
Sadikin Hospital, Bandung, Indonesia between May 2012–2013 were reviewed
retrospectively. This study analized the medical records of patients operated in our
center. A clinical examination, spinal X-Ray, computed tomography scans were obtained
before and after the operation is examined. Final diagnosis was based on histological
characteristics and polymerase chain reaction (PCR) result of the Mycobacterium TB
bacteria. The chief complaint of spondylitis TB patients admitted or consulted to our
center is lower limb weakness. There were 12 cases of spondylitis TB (5 women and 7
men with a ratio of 1: 1.4). The average age was 34.3 (the youngest patient was 17
years old and the oldest was 56 years) with a standard deviation ± 9.9. The infected
spines are: one patient in the cervical, eight patients in thoracal and three patients in
lumbar. The chief complaint of spondylitis TB patients admitted or consulted is lower
limb weakness (83.3%). Gibbus is observed in 83.3% of patients. Anterior cervical
discectomy and fusion was performed in 1 case and posterior was used in 11 cases.
A comprehensive history taking, along with correct sampling using various imaging
modalities and PCR, will certainly lead to the diagnosis of spondylitis TB. It must be
noted that neurological deficit due to spinal tuberculosis is reversible in majority of
cases, especially if decompression is achieved promptly.
Cite this article: Faried A, Hidayat I, Yudoyono F, Dahlan RH, Arifin MZ (2015) Spondylitis Tuberculosis in Neurosurgery Department Bandung Indonesia.
JSM Neurosurg Spine 3(3): 1059.
Faried et al. (2015)
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Central
The infected spine are: one patient in the cervical, eight patients
in thoracal and three patients in lumbar. The chief complaint
of spondylitis TB patients admitted or consulted is lower limb
weakness (83.3%). Gibbus is observed in 83.3% of patients.
ACDF was performed in 1 case and posterior was used in 11
cases (Table 1). Diagnosis is based on histological characteristic
(hematoxylin and eosin staining) and laboratory tests using PCR;
the DNA samples were amplified using primers IS6110 with
product result 123 base pairs (bp). Forward and reverse primer
IS6110 consists of:
IS6110 forward: (5’ – CCT GCG AGC GTA GGC GTC GG– 3’)
SURGICAL CONSIDERATIONS
Indications for surgery in acute spondylitis TB [7,8].
1. Progressive neurologic deficit.
2. Progressive increase of spinal deformity (more than
±40⁰ of segmental kyphosis, anteroposterior or lateral
translation).
3. Conservative treatments futile including point 1 and 2
above.
4. Severe pain due to abscess or spinal instability.
5. Uncertain diagnosis: this could be an inability to obtain
microbiological diagnosis from microscopy, culture or
even via detection of mycobacterium DNA using PCR.
Patients were operated in prone position under general
anesthesia. Septic and aseptic and draping was performed, the Figure 2 T1-weighted and T2-weighted sagittal MRI images of
operation site marking was then infiltrated with 10 ml of 1% thoracic spine showing destruction due to spinal TB of thoracal 7-8
xylocaine with adrenaline to minimize bleeding. A posterior (T7-T8) with some preservation of the disc (A and B). T2-weighted
axial and coronal MRI of same patient showing paravertebral abcess
midline approach was commonly used. The dissection was
(C and D).
carried out in the subperiosteal plane to allow decent bony part
identification. In the patient with cold abscess (Figure 2), the
posterolateral extra pleural (costotransversectomy) approach
was used to decompress the cord and remove necrotic materials
within the body and disc using curettes, and paraspinal abscess
was drained. The spine was stabilized using transpedicular
screw and rod system (Figure 3), the wound was closed layer by
layer after securing haemostasis without a drain. Surrounding
muscles were injected with 20 mg of bupivacaine to reduce post-
operative pain and muscle spasm. Anterior surgery (anterior
cervical discectomy and fusion; ACDF) was performed in one
case (Table 1).
RESULTS
There were 12 cases of spondylitis TB in this study (five
women and seven men with a ratio of 1: 1.4). The average age of
the patients was 34.3 (the youngest patient was 17 years old and Figure 3 Intra-operative photograph of bilateral partial laminectomy
the oldest was 56 years) with a standard deviation (SD) ± 9.9. (A). Abcess lesion following debridement (B).
Central
Central