- 作者：Sarat P. Ch ; ra ; Ajit Singh ; Nishant Goyal ; Rajender K. Laythalling ; Manmohan Singh ; Sharad S. Kale ; Manish S. Sharma ; Ashish Suri ; Pankaj Singh ; Ajay Garg ; Chitra Sarkar ; Manjari Tripathi ; Bhawani S. Sharma ; Ashok K. Mahapatra
- 关键词：Antitubercular chemotherapy ; Paraplegia ; Spinal deformity ; Spinal tuberculosis ; Surgery ; Tubercular spondylitis ; Vertebral collapse
- 刊名：World Neurosurgery
- 出版年：2013
- 出版时间：July-August, 2013
- 年：2013
- 卷：80
- 期：1-2
- 页码：190-203
- 全文大小：6823 K
Objective
To describe management and outcome in a large cohort of patients with spinal tuberculosis (TB).Methods
Of 212 patients with spinal TB treated between January 1999 and June 2011, 179 patients were included in the study (¡Ý6 months follow-up; mean age, 34.8 years; age range, 10-75 years). The cohort was divided into two groups (n?= 89 and n?= 90); group I was treated from 1999-2003, and group II was treated from 2004-2011.
Results
The study cohort comprised 93 male patients. Mean age was 34.8 years ¡À 7.2 (range, 10-75 years). Mean duration of symptoms was 2.4 months. Sensorimotor deficits were present in 167 patients (93.5 % ; 74 patients were paraplegic), pain was present in 156 patients (87 % ), bladder involvement was present in 127 patients (71.7 % ), and extraspinal TB was present in 36 patients (22.3 % ). Of patients, 92 % were receiving prior chemotherapy; one fifth of these patients were on second-line chemotherapy. Thoracic spine involvement was most common (n?= 86; 57 % ), followed by cervical spine (n?= 50; 29 % ), craniovertebral junction (n?= 22; 15 % ), and lumbosacral spine (n?= 20; 10.5 % ). Surgery was performed in 146 patients (68 % instrumented fusions and 16 % circumferential fusions). Mean follow-up was 20.2 months (range, 6-60 months). Sensorimotor deficits improved in 89 % of patients, pain improved in 71 % , bladder symptoms improved in 88 % , and paraplegia improved in 77 % . Patients in group II had a higher incidence of cord compression (P < 0.01), severe vertebral body collapse (P < 0.001), and paraplegia (P < 0.001). Group II patients underwent more instrumented surgeries (P < 0.01), especially circumferential fusions (P < 0.001). The improvement in paraplegia was better after 2004 (group II). Bladder symptoms correlated with the timing of surgery (P < 0.1).
Conclusions
Medical treatment of spinal TB is the mainstay; however, radical, instrumented surgeries should be offered when indicated. The presence of paraplegia should not preclude surgery. A practical management paradigm is also suggested.