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

J Korean Soc Spine Surg. 2015 Jun;22(2):60-64. Korean.
Published online June 30, 2015.  https://doi.org/10.4184/jkss.2015.22.2.60
© Copyright 2015 Korean Society of Spine Surgery
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. and 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, Email: cnkang65@hanyang.ac.kr
Received May 12, 2014; Revised July 14, 2014; Accepted May 06, 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 90 m 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

Figures


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.
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Fig. 2
Sagittal T1-weighted image wth gadolinium enhancement of tuberculous spondylitis involving L1 and L2.
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Fig. 3
Intraoperative photography. After incision of dura, the severe adhesion between dura mater and arachnoid mater was observed.
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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.
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Fig. 5
Postoperative radiograph of anterior interbody fusion with an autogenous rib strut bone graft.
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Tables


Table 1
Previously Reported Cases Of TUberculous Meningitis with Spinal Tuberculous Arachnoiditis
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References
1. Almeida A. Tuberculosis of the spine and spinal cord. Eur J Radiol 2005;55:193–201.
2. Solanki GA. Spinal arachnoiditis. In: Palmer manual of neurosurgery. London: Churchill & Livingstone; 1996. pp. 769-774.
3. Zuger A, Lowy FD. Tuberculosis of the brain, meninges, and spinal cord. In: Tuberculosis. Boston: Little & Brown; 1996. pp. 541-556.
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;12:425–429.
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. Neurosurg Rev 1983;6:111–117.
9. Chotmongkol V, Kitkuandee A, Limpawattana P. Tuberculous radiculomyelitis (arachnoiditis) associated with tuberculous meningitis. Southeast Asian J Trop Med Public Health 2005;36:722–724.
10. Rand C, Smith MA. Anterior spinal tuberculosis: paraplegia following laminectomy. Ann R Coll Surg Engl 1989;71:105–109.