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

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


Study Design

A case report.


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.


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


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.


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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
Intra-thecal methylprednisolone
3 29/Male T8-T9 Antituberculous therapy Walking difficulty → Walk well
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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