Spinal TB

Babaji

The 7th AINC

Discussions:

Spinal tuberculosis: role of surgery
Khaled abdeen, Ahmed G Azab, Hisham Abo Rahma , Medhat Elsawy (Egypt)

Question

Spinal tuberculosis: role of surgeryKhaled abdeen, Ahmed G Azab, Hisham Abo Rahma , Medhat Elsawy (Egypt)

Dear Prof Abdeen,
Excellent presentation on a topic which become more and more interesting in our practice.
Is there a certain cut-off for kyphotic deformity above which you would suggest surgical treatment?
Many thanks,

Mr Nikolaos G. Tzerakis
Stoke-on-Trent, UK

Question

Dear Dr Abdeen
What's your opinions about time of surgery in paraplegic patients? I had patient operated 15 days after paraplagia and good response to decompretion and fixation.

Best regards
Farzad Sadlou Parizi
Yard
Iran

Answer

Dear Prof Farzad Sadlou Parizi

I agree with your plan 10-14 days after the start of antimocobial therpy as less oedema.

Khaled Abdeen
Alexandria, Egypt

Question

Dear Prof Abdeen and Prof Parizi,

The clinical challenge I recently had was a patient with progressive neurological deficit and a picture on the MR suspicious of Tb but there was no time to do a biopsy and wait for the results.

I opted to operate on the patient -posterior deompression/fixation- and establish the diagnosis. She did not improve and the diagnosis was eventually Tb . She is severely paraparetic but not paraplegic.
She is now on the appropriate antibiotics.

Have you got any cases from your experience improving at a later stage after the operation/stabilisation/decompression following the antibiotic treatment?

Many thanks,

Nikolaos G Tzerakis
Stoke-on-Trent, UK

Answer

Dear Professor Tzerakis,
Some of patients had a good response and improved gradually especially in cold abscess patients. I hope your patient improved gradually with rehabilitation and continue medical therapy , one of patient improved with medical therapy alone.

Farzad Sadlou Parizi
Yazd
Iran

Comment

About a 2 years ago ,I operated on 67 years young patient with TB spine with epidural extension and cold abcess who was paraplegia for 48 hours with posterior instrumented fusion with decompression and anti TB ....few month later he was walking again with a cane
Great group
Enjoyed every case

Mohammed Homoud
Riyadh, Kingdom of Saudi Arabia

Comment

Dear Prof Mohammed Hamoud

I agree with the better neurolgical outcome after decompression, fixation and a full couse of antituberclar drugs.

Posterior approach is good option for old age but for younger patitents, we consider anterior column reconstruction .

Dr Khaled Abdeen
Alexandria, Egypt

(The e-mail address to contribute your questions and comments is: neurosurgeryresearch@jiscmail.ac.uk)

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