Skip to main content

Advertisement

SpringerLink
Log in

Is decompressive surgery the only treatment option? A case series of patients with spinal tuberculosis in advanced pregnancy

  • Original Article
  • Published:
European Spine Journal Aims and scope Submit manuscript

Abstract

Purpose

To present cases of spinal tuberculosis in advanced pregnancy treated on anti-tuberculous drug regimen with successful outcome and proposing alternative paradigm to surgical decompression. A case series of five patients in stages of advanced pregnancy with neurologic deterioration and spinal tuberculosis were reported and treated.

Methods

Five patients with backache in advanced stages of pregnancy were reported. Patients were diagnosed as cases of spinal tuberculosis on further imaging studies. Patients were treated and followed up till complete clinical and radiological recovery.

Results

Four out of five patients were treated conservatively on ATT and rest. One patient underwent decompression without instrumentation. All patients recovered neurologically. There were foetal complications in two cases with foetal demise. One patient who underwent surgical decompression had preterm labour with still birth, apparently due to adverse reactions with anaesthetic drugs.

Conclusion

Spinal tuberculosis in pregnancy is a rare occurrence. Hesitation in performing radiographs complicates the outcome with delay in diagnosis and neurological compromise. There are no clear guidelines for treatment of such cases. Conservative treatment with ATT in pregnant patients may be a viable approach. Neurological compromise does not mandate surgical decompression, which in itself is not devoid of complications. Concern of foetal complications is high in surgical treatment.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Singh H, Singh J, Abdullah BT, Matthews A (2002) Tuberculous paraplegia in pregnancy treated by surgery. Singap Med J 43(5):251–253

    Google Scholar 

  2. Jana N, Vasishta K, Saha SC, Ghosh K (1999) Obstetrical outcome among women with extrapulmonary tuberculosis. N Engl J Med 341:645–649

    Article  CAS  PubMed  Google Scholar 

  3. Lowenstein L, Solt I, Fischer D, Drugan A (2004) Spinal tuberculosis with paraplegia in pregnancy. Isr Med Assoc J 6:436–437

    PubMed  Google Scholar 

  4. Toppenberg KS, Hill DA, Miller DP (1999) Safety of radiographic imaging during pregnancy. Am Fam Phys 59(7):1813–1818

    CAS  Google Scholar 

  5. Badve SA, Ghate SD, Badve MS et al (2011) Tuberculosis of spine with neurological deficit in advanced pregnancy: a report of three cases. Spine J 11(1):e9–e16. doi:10.1016/j.spinee.2010.11.003

    Article  PubMed  Google Scholar 

  6. Khatri GR, Freiden TR (2000) Status and prospects of tuberculosis control in India. Int J Tuberc Lung Dis 4:193–200

    CAS  PubMed  Google Scholar 

  7. Association of Physicians of India (API) (2006) Consensus Expert Committee. API TB Consensus Guidelines Management of pulmonary tuberculosis, extra-pulmonary tuberculosis and tuberculosis in special situations. J Assoc Phys India 54:219–234

    Google Scholar 

  8. James MA (2007) Use of the medical research council muscle strength grading system in the upper extremity. J Hand Surg 32(2):154–156. doi:10.1016/j.jhsa.2006.11.008

    Article  Google Scholar 

  9. Maynard FM, Bracken MB, Creasey G et al (1997) International Standards for Neurological and Functional Classification of Spinal Cord Injury. American Spinal Injury Association. Spinal Cord 35:266–274

    Article  PubMed  Google Scholar 

  10. Shellock FG, Kanal E (1991) Policies, guidelines, and recommendations for MR imaging safety and patient management. SMRI Safety Committee. J Magn Reson Imaging 1(1):97–101. doi:10.1002/jmri.1880010114

    Article  CAS  PubMed  Google Scholar 

  11. Kaul R, Chhabra HS, Kanagaraju V et al (2016) Antepartum surgical management of Pott’s paraplegia along with maintenance of pregnancy during second trimester. Eur Spine J 25(4):1064–1069. doi:10.1007/s00586-015-4045-4

    Article  PubMed  Google Scholar 

  12. Colmenero JD, Jimenez-Mejias ME, Reguera JM et al (2004) Tuberculous vertebral osteomyelitis in the new millennium: still a diagnostic and therapeutic challenge. Eur J Clin Microbiol Infect Dis 23(6):477–483. doi:10.1007/s10096-004-1148-y

    Article  CAS  PubMed  Google Scholar 

  13. Khoo LT, Mikawa K, Fessler RG (2003) A surgical revisitation of Pott distemper of the spine. Spine J 3(2):130–145. doi:10.1016/S1529-9430(02)00410-2

    Article  PubMed  Google Scholar 

  14. Jain AK, Dhammi IK, Prashad B et al (2008) Simultaneous anterior decompression and posterior instrumentation of tuberculous spine using an anterolateral extrapleural approach. J Bone Jt Surg Br 90:1477–1481

    Article  CAS  Google Scholar 

  15. Dai LY, Jiang LS, Wang W, Cui YM (2005) Single-stage anterior autogenous bone grafting and instrumentation in the surgical management of spinal tuberculosis. Spine 30:23429

    Google Scholar 

  16. Yilmaz C, Selek HY, Gurkan I et al (1999) Anterior instrumentation for the treatment of spinal tuberculosis. J Bone Jt Surg Am 81:1261–1267

    Article  CAS  Google Scholar 

  17. Ha KY, Kim YH (2016) Late onset of progressive neurological deficits in severe angular kyphosis related to tuberculosis spondylitis. Eur Spine J 25(4):1039–1046. doi:10.1007/s00586-015-3997-8 (Epub 2015. PMID: 25987452)

    Article  PubMed  Google Scholar 

  18. Benli I, Acaroglu E, Akalin S et al (2003) Anterior radical debridement and anterior instrumentation in tuberculosis spondylitis. Eur Spine J 12:224–234

    PubMed  Google Scholar 

  19. Ciliberti BJ, Goldfein J, Rovenstine EA (1954) Hypertension during anaesthesia in patients with spinal cord injuries. Anaesthesiology 15:273–279

    Article  CAS  Google Scholar 

  20. Chilkoti GT, Mohta M, Duggal S, Saxena AK (2016) Anaesthetic concerns of a pregnant patient with Pott’s spine for spine surgery in prone position. Indian J Anaesth 60(7):518–519

    Article  PubMed  PubMed Central  Google Scholar 

  21. Mhuireachtaigh RN, O’Gorman DA (2006) Anesthesia in pregnant patients for nonobstetric surgery. J Clin Anesth 18:60–66

    Article  Google Scholar 

  22. Crawford JS, Lewis M (1986) Nitrous oxide in early human pregnancy. Anaesthesia 41:900–905

    Article  CAS  PubMed  Google Scholar 

  23. Jenkins TM, Mackey SF, Benzoni EM, Tolosa JE, Sciscione AC (2003) Non-obstetric surgery during gestation: risk factors for lower birthweight. Aust N Z J Obstet Gynaecol 43(1):27–31. doi:10.1046/j.0004-8666.2003.00001.x

    Article  PubMed  Google Scholar 

  24. Hawkins JL, Koonin LM, Palmer SK, Gibbs CP (1997) Anesthesia-related deaths during obstetric delivery in the United States, 1979–1990. Anesthesiology 86(2):277–284. doi:10.1097/00132586-199712000-00031

    Article  CAS  PubMed  Google Scholar 

  25. Su LL, Chong YS (2006) Common modalities for routine antepartum foetal monitoring: are they evidence-based? Singap Med J 47(10):830–835

    CAS  Google Scholar 

  26. Kiran NS, Vaishya S, Kale SS et al (2007) Surgical results in patients with tuberculosis of the spine and severe lower-extremity motor deficits: a retrospective study of 48 patients. J Neurosurg Spine 6:320–326

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Orthopedics, LTMMC and LTMGH, Sion, Mumbai, 400022, India

    Ashok K. Rathod, Vishwajeet Singh & Hemant Singh

  2. Department of Orthopedics, G S Medical College and KEM Hospital, Mumbai, India

    Prateek Patil

Authors
  1. Ashok K. Rathod
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Vishwajeet Singh
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Prateek Patil
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Hemant Singh
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Vishwajeet Singh.

Ethics declarations

Conflict of interest

All authors declared that they have no potential conflict of interest.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Rathod, A.K., Singh, V., Patil, P. et al. Is decompressive surgery the only treatment option? A case series of patients with spinal tuberculosis in advanced pregnancy. Eur Spine J 26, 3170–3177 (2017). https://doi.org/10.1007/s00586-017-5143-2

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00586-017-5143-2

Keywords

Search

Navigation