Management of spinal tuberculosis with extensive bony destruction of C1 vertebrae

2^nd World Congress on Surgery, Surgeons and Anesthesia

June 23-24, 2022 | Webinar

Praveen Subbiah, Lakshya Sharma, Najma Ahmed, Geoffrey Tipper

University Hospital Sussex NHS Foundation Trust, UK
King's College London, UK
Kingâ??s College London, UK
University Hospital Sussex NHS Foundation Trust, UK

Scientific Tracks Abstracts: Surgery

Abstract :

Global cases of Tuberculosis have increased. Data suggests that 25% of the world’s population carries latent disease. 10% progress to active disease, of which only 1% includes infectious spread to the spine. Tuberculosis of the spine is therefore an uncommon variant of spinal infection, and debate continues regarding its optimal management. This leads to challenges regarding surgical intervention: a relative paucity of direct experience combined with conflicting reviews in the literature can lead to equipoise. AIM/OBJECTIVES: This report focuses on spinal tuberculosis and aims to highlight that despite the long history of Tuberculosis, Controversy still exists regarding its best treatment practice. PATIENT/METHODS: We present a case report of an individual with extensive destruction by tuberculosis of the C1 vertebra, a clinical episode that generated several multidisciplinary reviews and debates regarding best management which included consideration of fixation. However, treatment was tailored to cervical immobilisation and medical management. RESULTS: Serial CT imaging was performed and At three months there were signs of bony regrowth and clinically no ongoing neck pain. Then Halo was converted back to hard collar immobilisation and a scan at eight months demonstrated remarkable regrowth of the C1 arch and the associated occipital condyle with a full, pain-free range of motion at the occipital cervical junction. CONCLUSION: Early prospective case series points to the successful management of spinal tuberculosis even in the case of epidural abscesses and signs of myelopathy on examination. Conversely, Evidence that TB does not adhere to surgical metalwork (Rajasekaran et al, 2018) is one of several arguments in favour of the surgical approach. It is the interpretation of these criteria that leads to management challenges. Tuli’s “middle path” approach of primarily medical management in the first instance with surgical intervention held in reserve is supported by this case report and even complex anatomy such as the occipital cervical junction can recover significantly References: Bhandari A, Garg RK, Malhotra HS, Verma R, Singh MK, Jain A, Sharma PK (2014) Outcome assessment in conservatively managed patients with cervical spine tuberculosis. Spinal Cord. 2014 Jun;52(6):489-93. doi: 10.1038/sc.2014.49. Epub 2014 Apr 22. PMID: 24752293 Lan, Z., Ahmad, N., Baghaei, P., Barkane, L., Benedetti, A., & Brode, S. (2020). Collaborative Group for the Meta-Analysis of Individual Patient Data in MDR-TB treatment 2017. Drugassociated adverse events in the treatment of multidrug-resistant tuberculosis: an individual patient data meta-analysis. Lancet Respir Med, 8(4), 383-394. DOI: 10.1016/S2213-2600(20)30047- 3 Patil SS, Mohite S, Varma R, Bhojraj SY, Nene AM (2014) Nonsurgical management of cord compression in tuberculosis: a series of surprises. Asian Spine J. 2014;8(3):315-321. doi:10.4184/ asj.2014.8.3.315 Pradipta, I. S., Forsman, L. D., Bruchfeld, J., Hak, E., & Alffenaar, J.-W. (2018). Risk factors of multidrug-resistant tuberculosis: A global systematic review and meta-analysis. Journal of Infection, 77(6), 469-478. PMID: 30339803 DOI: 10.1016/j.jinf.2018.10.004 Rajasekaran S, Soundararajan DCR, Shetty AP, Kanna RM (2018) Spinal Tuberculosis: Current Concepts. Global Spine J. 2018 Dec;8(4 Suppl):96S-108S. doi: 10.1177/2192568218769053. Epub 2018 Dec 13. PMID: 30574444; PMCID: PMC6295815. Srinivasa R, Furtado SV, Kunikullaya KU, Biradar S, Jayakumar D, Basu E (2021) Surgical Management of Spinal Tuberculosis - A Retrospective Observational Study from a Tertiary Care Center in Karnataka. Asian J Neurosurg. 2021 Sep 24;16(4):695-700. doi: 10.4103/

Biography :

Dr Praveen Subbiah is working in Department of Neurosurgery at University Hospital Sussex NHS Foundation Trust in UK.