Seung-Pyo Suh; Dong-Hyuck Park; Chul-Woong Kim; Chang-Nam Kang

doi:10.4184/jkss.2015.22.2.60

Journal List > J Korean Soc Spine Surg > v.22(2) > 1076078

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Suh, Park, Kim, and Kang: Surgical Outcome of Tuberculous Myelitis, Arachnoiditis and Spondylitis after Brain Meningitis - A Case Report –

Case Report

Journal of Korean Spine Surg 2015;22(2):60-64.

Published online: 21 June 2015

DOI: https://doi.org/10.4184/jkss.2015.22.2.60

Surgical Outcome of Tuberculous Myelitis, Arachnoiditis and Spondylitis after Brain Meningitis - A Case Report –

Seung-Pyo Suh, M.D.^∗, Dong-Hyuck Park, M.D., Chul-Woong Kim, M.D., Chang-Nam Kang, M.D.

Department of Orthopaedic Surgery, Hanyang University College of Medicine, Seoul, Korea

^∗Department of Orthopaedic Surgery, Sung-Ae Hospital, Seoul, Korea

Corresponding author: Chang-Nam Kang, M.D. Department of Orthopaedic Surgery, Hanyang University College of Medicine 222 Wangsimni-ro, Seongdong-gu, Seoul 133-792, Korea TEL: +82-2-2290-8485, FAX: +82-2-2299-3774 E-mail: cnkang65@hanyang.ac.kr

Received 12 May 2014 Revised 14 July 2014 Accepted 6 May 2015

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Study Design

A case report.

Objectives

To report a rare case of a surgically treated tuberculous myelitis and arachnoiditis patient with incomplete paraplegia.

Summary of Literature Review

Tuberculous myelitis and arachnoiditis is a rare disease with a high rate of neurologic deficit. This condition is treated using antituberculous medication and high-dose steroid therapy, but surgical treatment has rarely been reported and the outcomes vary.

Material and Methods

A 29-year-old female had tuberculous myelitis and arachnoiditis. The patient was treated with antituberculous medication and high-dose steroid therapy, but the treatment failed and the patient could not walk because of incomplete paraplegia. The surgical treatment was performed twice; we decompressed by total laminectomy and debrided the infected arachnoid membrane. Four months after surgery, we performed anterior interbody fusion due to the development of spondylitis with kyphosis.

Results

Three years after the first operation, the patient's neurologic state improved and she could walk 90m without assistance.

Conclusions

Here, we report a very rare case of surgically treated tuberculous myelitis and arachnoiditis and provide a treatment option for this condition to spine surgeons.

Keywords: Tuberculous myelitis, Tuberculous arachnoiditis, Tuberculous spondylitis, Surgical treatment

REFERENCES

1. Almeida A. Tuberculosis of the spine and spinal cord. Eur J Radiol. 2005; 55:193–201.

2. Solanki GA. Spinal arachnoiditis. Palmer manual of neurosurgery. London: Churchill & Livingstone;1996. p. 769–74.

3. Zuger A, Lowy FD. Tuberculosis of the brain, me-ninges, and spinal cord. Tuberculosis. Boston: Little & Brown;1996. p. 541–56.

4. Jain AK. Treatment of tuberculosis of the spine with neurologic complications. Clin Orthop Relat Res. 2002; 398:75–84.

5. Jain AK, Dhammi IK. Tuberculosis of the spine: a review. Clin Orthop Relat Res. 2007; 460:39–49.

6. Hristea A, Constantinescu RV, Exergian F, et al. Paraplegia due to non-osseous spinal tuberculosis: report of three cases and review of the literature. Int J Infect Dis. 2008; 12:425–9.

7. Poon TL, Ho WS, Pang KY, et al. Tuberculous meningitis with spinal tuberculous arachnoiditis. Hong Kong Med J. 2003; 9:59–61.

8. Dastur H. Diagnosis and neurosurgical treatment of tuberculous disease of the CNS. Neurosurgical review. 1983; 6:111–7.

9. Chotmongkol V, Kitkuandee A, Limpawattana P. Tuberculous radiculomyelitis (arachnoiditis) associated with tuberculous meningitis. Southeast Asian J Trop Med Public Health. 2005; 36:722–4.

10. Rand C, Smith MA. Anterior spinal tuberculosis: paraplegia following laminectomy. Ann R Coll Surg Engl. 1989; 71:105–9.

Figures and Tables%

Fig. 1.

Preoperative magnetic resonance images. (A) Sagittal T2-weighted image of T6-T11 demonstrates tuberculous myelitis and arachnoiditis. (B) Axial T2-weighted images show the cord swelling and thickening of the dural sac.

Fig. 2.

Sagittal T1-weighted image wth gadolinium enhancement of tuberculous spondylitis involving L1 and L2.

Fig. 3.

Intraoperative photography. After incision of dura, the severe ad-hesion between dura mater and arachnoid mater was observed.

Fig. 4.

Preoperative lateral radiograph shows severe progression of kyphosis (Cobb's angle:30°) and sagittal T2-weighted image of tuberculous spondylitis involving L1 and L2.

Fig. 5.

Postoperative radiograph of anterior interbody fusion with an autogenous rib strut bone graft.

Table 1.

Previously Reported Cases Of TUberculous Meningitis with Spinal Tuberculous ArachnoiditiS

Reference	Case	Age/Sex	Affected vertebra (level)	Treatment	Outcome
Hristea et al.⁶⁾				Antituberculous therapy
	1	20/Male	T2-T9	IV dexamethasone	Paraplegia → Walk with aid
				Oral prednisone
				Antituberculous therapy
	2	44/Male	L5-S1	IV dexamethasone	Walking difficulty → Walk well
	2	44/Male		Intra-thecal methylprednisolone
	3	29/Male	T8-T9	Antituberculous therapy	Walking difficulty → Walk well
	3	29/Male	T8-T9	IV dexamethasone
Poon et al.⁷⁾				Decompressive thoracic laminectomy
	1	36/Female	T4-T5	Antituberculous therapy	Paraplegia → Walk with support
				IV dexamethasone
Chotmongkol et al.⁹⁾				Hemilarminectomy
				Removal of the arachnoid cyst	Quadriparesis → No improvement
	1	17/Male	C1-T1	Antituberculous therapy
				IV dexamethasone
Our case				Decompressive thoracic laminectomy
				Removal of the arachnoid cyst
	1	29/Female	T6-L1	Antituberculous therapy	Paraparesis → Walk with aid
				IV dexamethasone
				Intra-thecal methylprednisolone

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