Aims. Spinal tuberculosis (TB) remains an important concern. Although spinal TB often has sequelae such as myelopathy after treatment, the predictive factors affecting such unfavourable outcomes are not yet established. We investigated the clinical manifestations and predictors of unfavourable treatment outcomes in patients with spinal TB. Patients and Methods. We performed a multicentre retrospective cohort study of patients with spinal TB. Unfavourable outcome was defined according to previous studies. The prognostic factors for unfavourable outcomes as the primary outcome were determined using multivariable logistic regression analysis and a linear mixed model was used to compare time course of inflammatory markers during treatment. A total of 185 patients were included, of whom 59 patients had unfavourable outcomes. Results. In multivariate regression analysis, the factors associated with unfavourable outcome were old age (odds ratio (OR) 2.51; 95% confidence interval (CI) 1.07 to 5.86; p = 0.034), acid-fast bacilli (AFB) smear positivity in specimens obtained through biopsy (OR 3.05; 95% CI 1.06 to 8.80; p = 0.039), and elevated erythrocyte sedimentation rate (ESR) at the end of treatment (OR 3.85; 95% CI 1.62 to 9.13; p = 0.002). Patients with unfavourable outcomes had a significant trend toward higher ESR during treatment compared with patients with favourable outcome (p = 0.009). Duration of anti-TB and surgical treatment did not affect prognosis. Conclusion. Elevated ESR at the end of treatment could be used as a marker to identify spinal TB patients with a poor prognosis. Patients whose ESR is not normalized during treatment, as well as those with old age and AFB smear positivity, should be aware of unfavourable outcomes. Cite this article: Bone Joint J 2019;101-B:1542–1549

Specific and rapid detection methods for spinal tuberculosis, with sufficient sensitivity in HIV-1 co-infected individuals, are needed, to ensure early initiation of appropriate treatment to prevent physical disability and neurological fallout. In addition, understanding the systemic and local pathophysiology of spinal tuberculosis, and its interaction with HIV-1 infection, is crucial to guide future therapeutic interventions. We prospectively enrolled adult patients presenting with signs and symptoms of suspected spinal tuberculosis, at Groote Schuur Hospital, between November 2020 and December 2021. TB diagnostic testing was performed on open and CT-guided spinal biopsies using Xpert MTB/RIF Ultra compared to gold standards TB culture and histology. A highly sensitive droplet digital PCR assay for detecting and quantifying Mycobacterium tuberculosis complex (MTBC) and HIV-1 DNA was tested. Plasma inflammatory proteins were measured to assess systemic inflammation. Xpert Ultra had a high sensitivity of 94.7% and specificity of 100% for STB against TB culture and histology in both open and CT-guided biopsy samples. The ddPCR assay confirmed TB detection in 94% of patients with positive Xpert Ultra results. Four patients with negative TB diagnostic results had MTBC DNA detected by ddPCR. HIV-1 DNA was detected in the spinal tissues from all HIV-1-infected patients. MTBC DNA levels were significantly higher in HIV-1-co-infected spinal tissue samples (p< 0.01). We identified four biomarkers significantly associated with higher bacterial burden at the disease site (p< 0.01). Xpert Ultra and MTBC ddPCR improve the detection of STB. DdPCR can be utilized as an additional, highly sensitive tool for detecting and quantifying Mtb, in pathological samples that may be paucibacillary. These findings provide novel diagnostic and pathophysiologic insight into STB, in the context of HIV-1 infection, and provide rationale to include these tests in hospital and research settings for patients from communities burdened by TB and HIV-1

Spinal tuberculosis is one of the most common presentations of skeletal tuberculosis. It is one of the major health issues of developing countries as it is associated with significant morbidity and mortality. Pott's paraplegia is a dreaded complication which can result in permanent neurological deficit, unless treated by timely intervention. We evaluated the efficacy of transpedicular decompression and functional recovery in patients of spinal tuberculosis with neurological deficit. A cohort of 23 patients (15 males and 8 female) with diagnosed spinal tuberculosis and having an average age of 37.5±8.4 years, satisfying our inclusion and exclusion criteria's and giving written informed consent were recruited in our study. All patients were managed by transpedicular decompression and fusion with posterior instrumentation. All the patients were followed up clinically, radiologically and hematologically. Patients were followed up at every six weeks for 4 months and thereafter at three monthly intervals to assess the long term outcomes and complications. Neurological evaluation was done by Frankel grading. Functional outcome was assessed by Visual Analog Score (VAS) and Owestry Disability Index score (ODI score). All the patients were followed for a minimum of 27 months. At the final follow-up, there was a statistically significant improvement in VAS score and ODI score. Out of 23 patients, all except three patients showed neurological recovery. We observed that transpedicular decompression is safe and effective approach for management of spinal tuberculosis as it allows adequate decompression of spinal cord while pedicular instrumentation provides stable spinal fixation and helps in early rehabilitation

Summary. There is little consensus regarding the regime for treatment of tuberculosis of spine, although WHO has laid down guidelines couple of years back classifying spinal tuberculosis in Category 1. This study proves the efficacy of WHO regime in spinal tuberculosis by clinico-radiological evaluation. Introduction. The medical fraternity is divided over the duration of chemotherapy in cases spinal tuberculosis. WHO clearly recommend spinal tuberculosis under Category I, but not accepted by most clinicians. Patient and Methods. In this prospective study during the period between August 2005 and July 2012, a total of 76 cases were diagnosed and evaluated clinico-radiologically to test the efficacy of WHO protocol (2HRZE+4HR) in our hospital with a mean follow up of 50 months (30 – 80 months). Results. Spinal tuberculosis was seen in 56% of all osteoarticular tuberculosis. Maximum population was between 11–50 years, females were involved more than males (66%), and regional distribution was different in males (Lumbar) and females (Thoracic). Skip and multifocal lesions were seen in 13% (6 cases), more common in immune compromised cases. Pain was the most common symptom (95%) followed by constitutional symptoms. Radiographic changes were nonspecific, appear late and suggestive of tuberculosis in 53%case, MRI is very useful in diagnosing in 95% cases especially when X ray is contributory. ESR is useful tool for follow up of patients, elevated in 94%cases. Results were evaluated on clinical, hematological and radiological basis. Of the total 64cases (after dropouts, lost in follow up, mortality), 50 patients (78%) received treatment for 6 months and14 cases for more than 6months (P value<0.001). No MDR cases were present. In 50 patients fall in ESR at the end of 2 months was found to be statistically significant (P value<0.05) and hence were given a treatment for 6 months, the fall at the end of 6 months was highly significant (P value<0.001). In rest of the 14 cases the duration of treatment was given for more than 6 months as the trend of fall of ESR was not significant. MRI changes were assessed in the form of osteitis, osteitis with discitis, abscess formation and granulation tissue on initiation of treatment, completion of treatment and 6 months after completion of treatment. Conclusion and Discussion. The experience shows that spinal tuberculosis is common in a tertiary health care centre in India with diagnosis possible by combination of clinical evaluation and radiological evaluation. Statistical significance was found in clinical symptoms, ESR trends and MRI evaluation in cases receiving 6 months of chemotherapy. With this study, WHO short course chemotherapy was found to be effective in spinal tuberculosis, with no relapse over a period of 6 years

Instrumentation in Spinal Tuberculosis is a controversial issue. The introduction of Pedicle screws in spinal fixation offered a new dimension to the management of this difficult problem. We operated on 127 patients with Spinal Tuberculosis between 1990 and 2000. Between 1990 and 1995, we treated 45 patients in the traditional manner with anterior decompression and strut grafting. During this period we encountered an unacceptably high rate of complications, such as graft collapse, progression of deformity and pseudoarthrosis. Between 1995 and 2000, we adopted the practice of anterior radical surgery combined with instrumentation, and employed this approach in 82 patients. Of these:. 18 patients underwent surgery at dorsal vertebral level, 30 at dorsolumbar level, and 34 at lumbar level. Our experience has enabled us to develop a protocol in the management of these patients depending on:. a/ the level of vertebral involvement (cervicodorsal/ dorsolumbar/ lumbar),. b/ the presence of single or multilevel disease, and. c/ location of disease in the spinal columns. In Dorsal lesions involving less than two consecutive levels with no deformity, we performed anterior procedure only. In multilevel dorsal lesions with no deformity we did anterior followed by posterior surgery. In Dorsal lesions with deformity we performed Back-Front-Back procedure. In single level Dorsolumbar lesion we did anterior procedure only. In presence of multisegment involvement with or without deformity we did Back-Front-Back procedure. In Lumbar lesion with anterior and middle column involvement without deformity anterior surgery was performed. In presence of all column involvement with deformity we did anterior followed by posterior surgery. With the use of instrumentation we achieved satisfactory results in terms of correction of deformity. We were also able to carry out extensive debridement (with anticipation of gaining stability with instrumentation), thereby clearing infection locally and effecting neurological improvement in all our cases. There were a few minor complications in our second (instrumented) group. No major complications (death, deep secondary infection or deterioration of the neurology), occurred in this group. We conclude that Instrumentation in Spinal Tuberculosis is safe. It allows the surgeon to debride the tissues safely and to stabilise the spine and thus prevent deformity. Instrumentation also allows early mobilisation. The radical debridement leads to a reduction in recurrence of infection at the operative site

Introduction. Pulmonary Tuberculosis (TB) can be detected by sputum cultures. However, Extra Pulmonary Spinal Tuberculosis (EPSTB), diagnosis is challenging as it relies on retrieving a sample. It is usually discovered in the late stages of presentation due to its slow onset and vague early presentation. Difficulty in detecting Mycobacterium Tuberculosis bacteria from specimens is well documented and therefore often leads to culture negative results. Diagnostic imaging is helpful to initiate empirical therapy, but growing incidence of multidrug resistant TB adds further challenges. Methods. A retrospective analysis of cases from the Infectious Disease (ID) database with Extra Pulmonary Tuberculosis (EPTB) between 1. st. of January 2015 to 31. st. of January. Two groups were compared 1) Culture Negative TB (CNTB) and 2) Culture Positive TB (CPTB). Audit number was. Results. 31 cases were identified with EPSTB. 68% (n=21) were male. 55% (n=17) patients were Asian, (19% (n=6) were black and 16% (n=5) were of white ethnicity. 90.4% (n=28) patients presented with isolated spinal TB symptoms. No patient had evidence of HBV/HCV/HIV infections. CPTB Group was 51.6% (n=16) compared to CNTB Group with 48.4% (n=15) 48% (15) lumbar involvement, 42% (13) thoracic and 10% (3) cervical. 38.7% (12) patients presented with late neurology, equally in both groups. 56% CPTB patients showed signs of vertebral involvement on plain radiograph compared to 13.3% in CNTB patients. 68.7% CPTB patients had pathological changes or paraspinal collections seen on CT scan compared to 53.3% of CNTB patients. 81% of CPTB showed positive MRI findings compared to 86% in CNTB. Both groups were treated with Anti-TB medications according to local guidelines. 83% patients were followed up till the end of the treatment course. 22.5% (n=7) patients had Ultrasound guided aspiration. 29% (n=9) patients underwent surgical intervention. 3 patients had Laminectomy for decompression. 6 patients underwent Spinal Decompression and Fixation due to extensive bone destruction. No mortality occurred. Conclusion. TB continues to be a growing problem in the developed world with high numbers of patients travelling from endemic regions. 75% of our cases were from Asian or Black ethnicity. The thoracolumbar region was most commonly effected (90%). Approximately 50% of cases of extrapulmonary spinal TB were culture negative. Neurological deficit occurred in 40% patients and 30% of patients required surgery. Standard anti-TB treatment was however effective in all cases with no significant drug resistant variants noted. MRI and CT imaging remain the superior diagnostic tests in the presence of high CN EPSTB

The main goal is to provide insight into spinal tuberculosis from a Dutch perspective: to establish the size of the problem in the Netherlands, analyse the reasons for misdiagnosis, assess optimal treatment, verify if this is truly optimal, establish the effect of surgery, and find out when surgery is needed. We made an analysis of the increase in Bone and Joint Tuberculosis (BJTB) in the Netherlands during the recent years. Between 1993 and 2000 a total of 532 cases of BJTB were found. Univariate analysis showed that the increase in incidence was restricted to non-Dutch people from endemic areas. It is important to note that only 15% of BJTB patients in our series also suffered from pulmonary TB. In our study a lengthy delay by both patients and doctors was found for BJTB (mean period 32 weeks), probably explained by a low index of suspicion and declining expertise. We report a previously undescribed misdiagnosis and subsequent mistreatment with radiation for tuberculosis of the spine in two patients. Both patients were misdiagnosed as having malignancies, without sufficient material for histological and culture examination. Both received radiotherapy, both experienced growth of the lesion, and in one of the patients the neurological deficit increased and did not reverse after initiation of the proper TB treatment. The main reasons for misdiagnosis of spinal TB are low incidence, low index of suspicion, declined expertise, and accepted failed biopsy. Radiotherapy locally aggravates tuberculous spinal lesions. There is no uniform advice in the literature regarding the duration of chemotherapeutic treatment for spinal tuberculosis. A review of the literature from 1978 (after the introduction of Pyrazinamide) to 2000 was performed. The relapse rate of 2% for the patients that had > 6 months chemotherapy is low, as is the relapse rate of 0% for patients with 6 months treatment. We concluded that the duration of chemotherapy for spinal tuberculosis can be 6 months. Subtherapeutic concentrations intralesional may result in selection of a resistant bacterial population and lead to treatment failure. Intralesional drug concentrations were below Minimal Inhibitory Concentration (MIC) values in 0/15 patients for ISO, 2/13 for RIF, and 8/9 for PYR. In 5/8 patients receiving all three drugs both RIF and PYR had Cmax:MIC ratios < 4, indicating intralesional subtherapeutic drug levels. Drainage is advised as additional therapy for patients with pleural effusion or psoas abscesses; it reduces the intralesional bacterial load and shortens the time of resolution of the lesions. A Cochrane systematic review was performed with the aim to compare chemotherapy to chemotherapy plus surgery in the treatment of spinal TB. There were no statistically significant differences between the treatment and control group for kyphosis and bony fusion. There were no significant differences in neurology, but some patients from the control group had an operation (change of allocated treatment) for persisting deficit. Chemotherapy is the critical factor in the management of tuberculosis of the spine. Routine surgery is not indicated. Surgery has a role in subgroups of patients for orthopaedic or neurological reasons: large or progressive kyphosis, and progressive or persistent neurological deficit. We evaluated radiographic and clinical parameters as early predictors for the final kyphosis angle in spinal TB to identify the patients at risk for developing severe or progressive kyphosis. Univariate analysis revealed no significant independent predictors. Multivariate analysis showed that bone loss < 0.3 in combination with a thoracic localisation indicated 97% chance of favourable outcome. A simple and clinically useful algorithm for early prediction of kyphosis in spinal TB is presented

Introduction and Aims: Instrumentation in spinal tuberculosis is a controversial issue. The introduction of Pedicle screws in spinal fixation offered a new dimension to the management of this difficult problem. Method: We operated on 147 patients with spinal tuberculosis between 1990 and 2001. Between 1990 and 1995, we treated 45 patients in the traditional manner with anterior decompression and strut grafting. We encountered an unacceptably high rate of complications, such as graft collapse, progression of deformity and pseudoarthrosis. Between 1995 and 2001, we adopted the practice of anterior radical surgery combined with instrumentation (mesh cages and modem multi-segment hook/screw system), and employed this approach in 102 patients. Of these: 28 patients underwent surgery at dorsal vertebral level, 35 at dorsolumbar level, and 39 at lumbar level. Results: Our experience has enabled us to develop a protocol in the management of these patients depending on a) the level of vertebral involvement (cervicodorsal/dorsolumbar/lumbar); b) the presence of single or multilevel disease; and c) location of disease in the spinal columns. In dorsal lesions involving less than two consecutive levels with no deformity, we performed anterior procedure only. In multilevel dorsal lesions with no deformity we did anterior followed by posterior surgery. In dorsal lesions with deformity we performed Back-Front-Back procedure. In dorsolumbar lesions with single-level disease we did anterior procedure only. In the presence of multi-segment involvement with or without deformity we did Back-Front-Back procedure. In lumbar lesions with anterior and middle column involvement without deformity we performed anterior surgery only. In lumbar lesions with all column involvement with deformity we performed anterior and posterior surgery. With the use of instrumentation we achieved satisfactory results in terms of correction of deformity. We were also able to carry out extensive debridement (with anticipation of gaining stability with instrumentation), thereby clearing infection locally and effecting neurological improvement in all our cases. There were a few minor complications in our second (instrumented) group. No major complications (death, deep secondary infection or deterioration of the neurology) occurred in this group. Conclusion: We conclude that instrumentation in spinal tuberculosis is safe. It allows the surgeon to debride the tissues safely and to stabilise the spine and thus prevent deformity. Instrumentation also allows early mobilisation. The radical debridement leads to a reduction in recurrence of infection at the operative site

This paper reviews 46 consecutive spinal tuberculosis patients who underwent spinal surgery at a state facility over 2.5 years. The 21 male and 25 female patients ranged in age from 18 months to 67 years, with 19 patients under the age of 18 years. On presentation the mean ESR was 69 (15 to 140) and the white cell count normal. Axial pain and weakness were the most common complaints. There was often a delay of more than a month to presentation. Five patients were HIV positive. Histological and microbiological examination confirmed tuberculosis in 40 patients. There were seven cervical cases, eight lumbar and 31 thoracic. Six patients had additional non-contiguous spinal involvement. There was one radicular syndrome and 30 patients had neurological deficits. Anterior and posterior surgery was done on 22 patients. There were eight anterior only procedures, seven posterior only, six costotransversectomies and three biopsies. In addition two revision anteriors were done. Allograft struts were used in 16 and autograft in 13. Anterior instrumentation was employed in 11, posterior in six and none in 11. There were two deaths. Two grafts required early revision and one rotated but was accepted. Postoperative neurological recovery was noted from one day to 3 months, and typically by one month. All children regained normal neurological status. Spinal tuberculosis is a common cause of neurological deficit and surgery has to suit the specific case. There is still a valuable role for surgery without instrumentation, especially in the paediatric group. Despite extensive destruction, one can expect full neurological recovery

Introduction and aims: Instrumentation in Spinal Tuberculosis is a controversial issue. The introduction of Pedicle screws in spinal fixation offered a new dimension to the management of this difficult problem. Method: We have operated on 147 patients with Spinal Tuberculosis between 1990 and 2001. Between 1990 and 1995 we treated 45 patients in the traditional manner with anterior decompression and strut grafting. During this period we encountered an unacceptably high rate of complications, such as graft collapse, progression of deformity and pseudoarthrosis. Between 1995 and 2001 we adopted the practice of anterior radical surgery combined with instrumentation (mesh cages and modern multisegment hook/screw system), and employed this approach in 102 patients. Of these: 28 patients underwent surgery at dorsal vertebral level, 35 at dorsolumbar level, and 39 at lumbar level. Our experience has enabled us to develop a protocol in the management of these patients depending on:. The level of vertebral involvement (cervico-dorsal/ dorsolumbar/lumbar),. The presence of single or multilevel disease and. Location of disease in the spinal columns. In dorsal lesions involving less than two consecutive levels with no deformity, we performed anterior procedure only. In multilevel dorsal lesions with no deformity we did anterior followed by the posterior surgery. In dorsal lesions with deformity we performed Back-Front-Back procedure. In dorsolumbar lesions with single level disease we did anterior procedure only. In presence of multisegment involvement with or without deformity we did Back-Front-Back procedure. In lumbar lesions with anterior and middle column involvement without deformity we performed anterior surgery only. In lumbar lesions with all column involvement with deformity we performed anterior and posterior surgery. Results: With the use of instrumentation we achieved satisfactory results in terms of correction of deformity. We were also able to carry out extensive debridement (with anticipation of gaining stability with instrumentation), thereby clearing infection locally and effecting neurological improvement in all our cases. There were a few minor complications in our second (instrumented) group. No major complications (death, deep secondary infection or deterioration of the neurology), occurred in this group. Conclusion: We conclude that Instrumentation in Spinal Tuberculosis is safe. It allows the surgeon to debride the tissues safely and to stabilise the spine and thus prevent deformity. Instrumentation also allows early mobilisation. The radical debridement leads to a reduction in recurrence of infection at the operative site

The familiar picture of spinal tuberculosis is one of destruction of adjacent vertebral bodies and of the intervening disc. There are, however, other patients without these radiographic changes and with no clinical deformity who present with symptoms and signs of compression of the spinal cord or cauda equina. These patients fall into two different groups: those with tuberculosis of the neural arch; and those with extra-osseous extradural tuberculosis. Both may require laminectomy, but whereas the first has bony involvement and a cold abscess, the second has neither

1. The long-term results in thirty-one cases of spinal tuberculosis treated by the ambulant method are reviewed. The method has been shown to be successful in early cases

1. The results are recorded of radical excisional surgery for spinal tuberculosis in eighty-five patients. 2. Clinically satisfactory results were obtained in 97 per cent of seventy-one patients followed up. Radiologically the disease was deemed to be cured in 71 per cent of cases. 3. The average period of rest after operation was three and a half months, and the average hospital stay was five and a half months. 4. Total recovery from paraplegia occurred in 84 per cent of patients so affected

Thirteen patients, aged 7 to 45 years, have been treated for atypical forms of spinal tuberculosis at the Neurological Centres at Benghazi and Lahore. All presented with signs and symptoms of compression of the spinal cord or cauda equina, ranging from paraesthesiae and increasing weakness to paraplegia and loss of sphincter control. None of them showed visible or palpable spinal deformity nor the typical radiographic appearance of destruction of the intervertebral disc and the two adjoining vertebral bodies. These atypical cases fell into two well-defined groups: those with involvement of the neural arch only, with associated intraspinal cold abscesses, and those with involvement of a single vertebral body, resulting in its collapse and a radiographic appearance similar to that in secondary carcinoma of the vertebral body. The correct treatment in these two groups was diametrically opposed. Tuberculous disease of the neural arch was best traced by laminectomy; concertina collapse of a single vertebral body required cost-transversectomy and resection of the transverse process, the pedicle, and the portion of the vertebral body that was encroaching on the spinal canal

Purpose of the study: Pott’s disease of the cervical spine is exceptional. We collected 27 cases over a period of 30 years. Material and methods: Mean patient age was 21 years. Male gender predominated. Most patients consulted because of cervical pain and 50% presented neurological disorders. Mean duration of symptoms was 14 months. A peri-spinal abscess was found in ten patients. The posterior cervical spine was affected in most patients and four presented suboccipital involvement. There was associated lung disease in two-thirds of the patients. Standard anti-tuberculosis chemotherapy was given associated with traction alignment in twelve patients to correct for kyphosis or associated spinal dislocation. Surgery was reserved for major bone destruction leading to instability or neurological disorders resistant to medical treatment. Results: Mean follow-up was five years. The anatomic result after medical or surgical treatment was characterized by vertebral fusion in all patients. There were three serious neurological complications after surgery. Improvement was achieved in eleven of the twelve patients with inaugural neurological complications

Objective: To compare the presentation, diagnosis and treatment of spinal tuberculosis in two cities, one in the UK, and one in Malaysia. Design: Retrospective comparison over a five-year period from June 1995. The Centres studied were the Royal Orthopaedic and Queen Elizabeth Hospitals, Birmingham (UK), and the Kuala Lumpur General Hospital (KL), Malaysia. Subjects: There were 80 patients (29 females, mean age 42) in the KL group, and 19 patients (8 females, mean age 45) in the UK group. Outcome measures: Frankel grading before and after treatment were measured for both groups. Results: KL patients had higher rates of immunocompromise, and had fewer spinal levels involved, 2.1 compared with 2.6 (p-−0.04). There were 65 procedures, 58 positive ZN stains, and 65 positive cultures as compared with 24, 2 and 9 in Birmingham respectively. Improvement in Frankel grading was seen in four patients in UK (5 grades), and in 17 patients in KL (29 grades). Conclusions: Although the two groups exhibited similar demographics, the rate of immunocompromise-related tuberculosis, severity of neurological deficit, and type of surgery undertaken differed significantly. Reasons for the difficulty in identifying the tubercle bacillus in Birmingham are discussed

Tuberculosis (TB) remains endemic in many parts of the developing world and is increasingly seen in the developed world due to migration. A total of 1.3 million people die annually from the disease. Spinal TB is the most common musculoskeletal manifestation, affecting about 1 to 2% of all cases of TB. The coexistence of HIV, which is endemic in some regions, adds to the burden and the complexity of management.

This review discusses the epidemiology, clinical presentation, diagnosis, impact of HIV and both the medical and surgical options in the management of spinal TB.

Cite this article: Bone Joint J 2018;100-B:425–31.

We compared the usefulness of radiography, CT and MRI in 25 children with spinal tuberculosis. Radiography provided most of the information necessary for diagnosis and treatment. Axial CT was the most accurate method for visualising the posterior bony elements. Sagittal MRI best showed the severity and content of extradural compression and helped to differentiate between an abscess and fibrous tissue. The main value of CT and MRI is in the preoperative evaluation of the small proportion of patients who require surgical treatment for paraplegia

Introduction and aim:. With up to 70% of adults with tuberculosis in Sub-Saharan Africa infected with human immunodeficiency virus (HIV), severe spinal tuberculosis presents a different set of clinical and surgical challenges. To overcome the disadvantages of various traditional techniques, particularly in patients who are HIV-positive with opportunistic pulmonary pathology, and to obviate the need to violate the diaphragm in the lower thoracic and upper lumbar spine, a posterior vertebral column resection through a single posterior approach was proposed. The aim of this study is to report on the early results of the single-stage posterior only vertebral column resection. Method:. A total of 12 patients (10 females and 2 males) seen at CMJAH between January 2007 and January 2011 underwent a single-stage posterior only posterior vertebral column resection, and were retrospectively reviewed. The indications for PVCR are essentially the same as those for 360 degrees decompression and fusion. The mean follow-up period was 15.8 months (range 5 to 44 months). Results:. Eleven allografts and 1 autograft were placed centrally and secured. The kyphosis correction averaged 17.83 degrees (range 0 to 45 degrees); with no loss of correction at last follow-up. The mean number of vertebrae removed was 1.325 (0.75 to 2) with the mean instrumented levels of 3.8 (2 to 7). The mean duration of surgery was 266.6 minutes (140 to 415 mins), the mean intra-operative blood loss was 712.5 mls (350–2100 mls). No loosening or breakage of screws occurred. The mean Frankel neurology grading at last follow-up was D (B to E). Conclusion:. Early results of single-stage only PVCR are gratifying, particularly in patients with decreased pulmonary functions who will not withstand to adverse effects of anterior surgery and 2 stage-surgery. It is an effective surgical technique but technically demanding procedure with possible risks of major complications

Nineteen patients with thoracic or thoracolumbar spinal tuberculosis and neurological deficits were treated by anterior debridement, decompression and vascularised rib grafting, followed, either during the same procedure or 14 days later, by multilevel posterior osteotomies, instrumentation and fusion. Surgery was performed under cover of four-drug antituberculosis chemotherapy, given for 12 months. The average pre-operative kyphotic angulation of 56 degrees was reduced to 27 degrees postoperatively and 30 degrees at the latest follow-up (3 degrees loss of correction). Radiological fusion between the vascularised rib graft and the vertebrae was seen after an average of 3.3 months. Eighteen patients (95%) had normal neurological function at 14 months, and the other could walk with the aid of crutches