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Child's Nervous System

, Volume 21, Issue 1, pp 19–26 | Cite as

Spinal tuberculosis: with reference to the children of northern India

  • Raj KumarEmail author
Invited Paper

Abstract

Background

Tuberculosis is a necrotizing bacterial infection with protean manifestation and wide distribution. There has been a great fall in the prevalence of tuberculosis in the United States since 1990, although the impact of acquired immunodeficiency syndrome (AIDS) has increased the resurgence of tuberculosis (TB). Spinal tuberculosis is the commonest form of skeletal tuberculosis. In this article, an overview of spinal tuberculosis and the personal experience of 19 children with spinal tuberculosis are presented. All the children required surgical intervention, because they manifested neurological deficit.

Pathogenesis and clinical features

The spinal tuberculosis is a result of hematogenous dissemination from primary focus in the lungs or the lymph nodes. The central type of vertebral tuberculosis spreads along with Batson’s plexus of veins, while paradiscal infection spreads through the arteries. The anterior type of vertebral body tuberculosis results from the extension of the abscess beneath the anterior longitudinal ligament and periosteum. Two types of bone and joint tuberculosis are recognized: the caseous, exudative type with abscess formation, which is more common in children, and the granular type is frequent in adults. Only 7 of the 19 children had an abscess, while 10 manifested mainly granulation tissue. Although spinal tuberculosis is an extradural disease, 2 children had intramedullary granulomas and presented a tumor-like syndrome as rare manifestations. It was interesting to encounter intradural granulation and organized intradural granuloma causing cord compression in 2 children. A frank abscess with clumping of nerve roots was encountered in the cauda of another child without vertebral involvement. There is a controversy regarding the age predilection of the disease; it is documented that it is a disease of adults in affluent countries, and a disease of the first three decades in other regions.

Diagnosis

Magnetic resonance imaging is extremely useful in diagnosing the difficult and rare sites of disease like the craniovertebral junction. It detects the marrow changes, exudative and granulation types, extra- and intradural disease, and radiological response to treatment in the early follow-up period around 6–8 weeks.

Treatment

Opinion varies regarding the operative indication for Pott’s spine. A large group of surgeons perform debridement and decompression in all cases, irrespective of neurological involvement. Others perform operative decompression only in those patients who do not respond to chemotherapy. We did surgical interventions in children with moderate to severe neurological deficits manifesting radiological compression of their neuraxis. Depending on the site of involvement and type of disease the surgical approach was decided in individual cases. Two children with healed Pott’s spine also required surgery because of their spinal deformations, which caused gradual neurological deficits and pain in both. Prognosis depends on many factors; the magnitude of cord compression, duration of neural complication, age and general condition of patient. Fifteen of our children made a remarkable recovery. Children with paraplegia also made an excellent recovery of their strength and sensations.

Keywords

Pediatric Pott’s spine Spinal tuberculosis 

Notes

Acknowledgement

The author is extremely grateful to Mr A.P. Dhar Dwivedi, Department of Neurosurgery, SGPGIMS, Lucknow, for secretarial assistance.

References

  1. 1.
    Tuli SM (1997) Epidemiology and prevalence. In: Tuberculosis of the skeletal system, 2nd edn. Jaypee, New DelhiGoogle Scholar
  2. 2.
    Smoker WRK (1994) Craniovertebral junction: normal anatomy, craniometry and congenital anomalies. Radiographics 14:255–257PubMedGoogle Scholar
  3. 3.
    Moon MS (1997) Tuberculosis of the spine. Controversies and a new challenge. Spine 22:1791–1797CrossRefPubMedGoogle Scholar
  4. 4.
    Krishanan A, Patkar D, Patankar T, Shah J, Prasad S, Bunting T, Castillo M, Mukherji SK (2001) Craniovertebral junction tuberculosis: a review of 29 cases. Comput Assist Tomogr 25:171–176CrossRefGoogle Scholar
  5. 5.
    Doqulu F, Baykaner MK, Onk A, Celik B, Ceviker N (2003) Cervical tuberculosis in early childhood. Childs Nerv Syst 19:192–194PubMedGoogle Scholar
  6. 6.
    Turgut M (2001) Multifocal extensive spinal tuberculosis (Pott’s disease) involving cervical, thoracic and lumbar vertebrae. Br J Neurosurg 15:142–146CrossRefPubMedGoogle Scholar
  7. 7.
    Kumar R, Chandra A (2003) Gluteal abscess: manifestation of Pott’s spine. Neurol India 51:87–88PubMedGoogle Scholar
  8. 8.
    Nomura S, Akimura T, Kitahara T, Nogami K, Suzuki M (2001) Surgery for expansion of spinal tuberculoma during antituberculous chemotherapy. Pediatr Neurosurg 35:153–157CrossRefPubMedGoogle Scholar
  9. 9.
    Akman S, Sirvanci M, Talu U, Gogus A, Hamzauglu A (2003) Magnetic resonance imaging of tuberculous spondylitis. Orthopedics 26:69–73PubMedGoogle Scholar
  10. 10.
    Andronikou S, Jadwat S, Douis H (2002) Patterns of disease on MRI in 53 children with tuberculosis spondylitis and the role of gadolinium. Pediatr Radiol 32:798–805CrossRefPubMedGoogle Scholar
  11. 11.
    Murphy KJ, James A, Brunberg, Quint DJ, Jazanjian PH (1998) Spinal cord infection: myelitis and abscess formation. Am J Neuroradiol 19:341–348PubMedGoogle Scholar
  12. 12.
    Naim-Ur-Rahman, Jamjoom A, Jamjoom ZAB, Al-Tahan AM (1997) Neural arch tuberculosis: radiological features and their correlation with surgical findings. Br J Neurosurg 11:32–38CrossRefPubMedGoogle Scholar
  13. 13.
    Narlawar RS, Shah JR, Hahesh K, Pimple, Patkar T, Patankar T, Castillo M (2002) Isolated tuberculosis of posterior elements of spine: magnetic resonance imaging finding in 33 patients. Spine 27:275–281Google Scholar
  14. 14.
    Jin D, Ou D, Chen J, Zhang H (2004) One stage anterior interbody autografting and instrumentation in surgical management of thoracolumbar spinal tuberculosis [abstract]. Eur Spine J 13:114CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag 2004

Authors and Affiliations

  1. 1.Department of NeurosurgerySanjay Gandhi Post Graduate Institute of Medical SciencesLucknow 226014India

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