Spinal Tuberculosis Treated Surgically in the Department of Neurosurgery, Almenara Hospital, Lima, Peru
Authors: Laos Plasier Eduardo , Polo De la Piedra César 
Published: May 2015

Introduction

Peru is the second country in South America with the highest rate of tuberculosis, approximately 0.5% were tuberculosis spondylitis, being a variant of high morbidity because of the bone destruction, deformity, and neurological deficit potential. Tuberculosis is a difficult disease to treat and control because of poor access to health services and the delay in diagnosis. The treatment has undergone changes over time, from purely medical treatment or laminectomy to aggressive surgical treatment combined with specific chemotherapy; this marks a trend that is reflected in the way of acting in our service.

Material and Methods

We performed a retrospective case series and describe 14 cases collected between 2008 and 2013 hospitalized in the “Neurotrauma and Column,” database of operative reports is reviewed and files medical records. The data obtained are presented in tables and bar frequency and percentage.

Results

Of the 14 patients, 12 (86%) are women and 2 (14%) were men, the average age was 45 years. Overall, 13 (93%) underwent some form of surgery. The mean disease duration before surgery was 10.3 months the average time motor deficit before surgery was 5.1 months. The region of the spine was most frequently committed to the dorsal region (79%), 93% had vertebral collapse, and all compatible images with paraspinal abscesses and/or intraspinal. Overall, 12 (86%) to motor deficit and 13 (93%) had pain in affected region. With regard to diagnosis, it had microbiological confirmation in five cases (36%), histopathological diagnosis of specific granuloma in seven (50%), and only epidemiological–clinical–radiographical suspicion in two (14%) cases, in response to specific treatment. Using the classification GATA obtain IA (zero), IB (one), II (seven), and III (five). With regard to treatment, only 1 patient received specific chemotherapy (GATA IB), 13 were treated in combination with surgery: 6 (46%) debridement with or without drainage of abscess, interbody graft more transpedicular fixation by posterolateral approach, 4 (31%) laminectomy more biopsy with or without debridement, and 2 (15%) transpedicular fixation more laminectomy 1 (8%) interbody fusion noninstrumented. Of the 13 patients treated surgically, 11 cases showed motor deficit before surgery, 4 (31%) showed no change in the postoperative relative the motor deficit. Overall, nine (69%) improved at follow-up, two of which currently have no motor deficits.

Conclusion

Spinal tuberculosis is a major cause of disability; the main symptoms are pain and motor engine. Sometimes, confirmatory microbiological diagnosis cannot be established pathologically, but the response to specific treatment directed diagnosis. The surgical approach and technique used must be compatible with the theoretical basis of neurological decompression, fusion and spinal stability, and surgeon experience. In relation to the motor deficit, most improvement and disability significantly reduced, taking into consideration the duration of the motor deficit before surgery.