Advertisement

European Spine Journal

, Volume 20, Issue 1, pp 1–5 | Cite as

Posterior listhesis of a lumbar vertebra in spinal tuberculosis

  • Matthew Anthony KirkmanEmail author
  • Krishnamurthy Sridhar
Grand Rounds

Abstract

The management of spinal tuberculosis, especially in children, is controversial. In children, vertebral destruction is more severe than adults because of the cartilaginous nature of their bone. Modern chemotherapy has significantly decreased mortality in spinal tuberculosis, but morbidity remains high. Without early surgery, patients can develop severe kyphosis leading to respiratory insufficiency, painful costopelvic impingement and paraplegia. Lumbar kyphosis results in early degenerative lumbar canal stenosis and is cosmetically unacceptable. We report a paediatric case of atypical spinal tuberculosis demonstrating the need for early surgical intervention to prevent significant spinal instability and neurologic deficit. A 12-year-old girl presented with increasing ambulatory difficulty and double incontinence 4 months after initiating treatment for pulmonary tuberculosis. There was no history of traumatic injury. Examination revealed severe lower limb neurologic deficit, with hypotonia, areflexia, marked sensory loss, and grade 0/5 power in both lower limbs. Plain radiographs and magnetic resonance imaging (MRI) demonstrated grade IV posterior listhesis of the L2 vertebral body over L3, cauda equina compression and bilateral psoas abscesses. Erosion of both the body and pedicle of L2 was observed. Both serology and pus drained from the psoas abscesses were negative for microorganisms. The patient underwent an L2 vertebrectomy via a left retroperitoneal approach. A titanium cage packed with autologous bone graft was inserted, and the spine was stabilized by fixation with screw and rods. Histopathology confirmed a diagnosis of tuberculosis. Eighteen months following the procedure, the patient has regained some power in her right leg and has completed her course of anti-tuberculous chemotherapy, but remains wheelchair-bound. To our knowledge, this is the first reported case of posterior listhesis secondary to spinal tuberculosis. Here, we discuss the possible management options in such a case, and the indications for surgery. As the global HIV/AIDS epidemic causes a resurgence in tuberculosis, increased awareness among the medical community regarding the atypical presentations of spinal tuberculosis is necessitated; both in the developing world where advanced clinical presentations are common, and in the developed world where spinal tuberculosis is an often-neglected diagnosis.

Keywords

Posterior listhesis Spinal tuberculosis Lumbar spine Vertebrae Pott’s disease 

Notes

Conflict of interest

None.

References

  1. 1.
    Tuli SM (2007) Tuberculosis of the spine: a historical review. Clin Orthop Relat Res 460:29–38PubMedGoogle Scholar
  2. 2.
    Kourbeti IS, Tsiodras S, Boumpas DT (2008) Spinal infections: evolving concepts. Curr Opin Rheumatol 20(4):471–479CrossRefPubMedGoogle Scholar
  3. 3.
    Tuli SM, Srivastava TP, Varma BP, Sinha GP (1967) Tuberculosis of spine. Acta Orthop Scand 38(4):445–458CrossRefPubMedGoogle Scholar
  4. 4.
    Bick KM (1976) Classics of orthopaedics. JB Lippincott Co., PhiladelphiaGoogle Scholar
  5. 5.
    Pande KC, Babhulkar SS (2002) Atypical spinal tuberculosis. Clin Orthop Relat Res 398:67–74CrossRefPubMedGoogle Scholar
  6. 6.
    Newman PH (1963) The etiology of spondylolisthesis. J Bone Joint Surg (Br) 45:39–59Google Scholar
  7. 7.
    Ratliff AHC (1956) Tuberculosis at the site of spondylolisthesis. Br J Surg 43:502–504CrossRefPubMedGoogle Scholar
  8. 8.
    Tuli SM (1997) Tuberculosis of the skeletal system. Jaypee Brothers, New DelhiGoogle Scholar
  9. 9.
    Chadha M, Agarwal A, Kumar S (2006) Spinal tuberculosis with concomitant spondylolisthesis: coexisting entities or ‘cause and effect’? Spinal Cord 44(6):399–404CrossRefPubMedGoogle Scholar
  10. 10.
    Turunc T, Demiroglu YZ, Uncu H et al (2007) A comparative analysis of tuberculous, brucellar and pyogenic spontaneous spondylodiscitis patients. J Infect 55:158–163CrossRefPubMedGoogle Scholar
  11. 11.
    Jain AK, Dhammi IK (2007) Tuberculosis of the spine: a review. Clin Orthop Relat Res 460:39–49CrossRefPubMedGoogle Scholar
  12. 12.
    Christodoulou AG, Givissis P, Karataglis D, Symeonidis PD, Pournaras J (2006) Treatment of tuberculous spondylitis with anterior stabilization and titanium cage. Clin Orthop Relat Res 444:60–65CrossRefPubMedGoogle Scholar
  13. 13.
    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 30:2342–2349CrossRefPubMedGoogle Scholar
  14. 14.
    Konstam PG (1963) Spinal tuberculosis in Nigeria. Ann R Coll Surg Engl 32:99–114PubMedGoogle Scholar
  15. 15.
    Moon MS, Woo YK, Lee KS, Ha KY, Kim SS, Sun DH (1995) Posterior instrumentation and anterior interbody fusion for tuberculous kyphosis of dorsal and lumbar spines. Spine 20(17):1910–1916CrossRefPubMedGoogle Scholar
  16. 16.
    Bilsel N, Aydingoz O, Hanci M, Erdogan F (2000) Late onset Pott’s paraplegia. Spinal Cord 38:669–674CrossRefPubMedGoogle Scholar
  17. 17.
    Mushkin AY, Kovalenko KN (1999) Neurological complications of spinal tuberculosis in children. Int Orthop 23:210–212CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag 2010

Authors and Affiliations

  • Matthew Anthony Kirkman
    • 1
    • 2
    Email author
  • Krishnamurthy Sridhar
    • 1
  1. 1.Department of NeurosurgeryNational Neurosciences CenterKolkataIndia
  2. 2.The Medical SchoolNewcastle UniversityNewcastle upon TyneUK

Personalised recommendations