The reasons and clinical treatments of postoperative relapse of Pott's disease

Subjacent Disease in an Operated Case of Spinal Tuberculosis: A Case Report and Literature Review

Introduction

Spinal tuberculosis (TB) recurrence in subjacent vertebral segments in a post-operative case is one of the atypical presentations of this common disease.

Case Report

A 63-year-old gentleman presented with fever and bilateral lower limb weakness for 10 days. The patient was on anti-tubercular therapy for the past 18 months and had a history of surgical decompression and posterior instrumentation for D12 and L1 vertebrae spinal TB. Radiological investigations showed new-onset TB in D9 and D10 vertebral levels. Management with revision surgery was done.

Conclusion

Recurrence of spinal TB in segments of vertebrae subjacent to previously operated segments in a patient on long-term anti-tubercular treatment is a rare and undescribed presentation of the common disease. High index of suspicion is required for early diagnosis and prompt management to prevent long-term morbidities.

Surgical management of consecutive multisegment thoracic and lumbar tuberculosis: anterior-only approach vs. posterior-only approach

Purpose

To compare the efficacy, safety, and technical characteristics of anterior-only and posterior-only approach surgeries for the treatment of consecutive multisegment thoracic and lumbar tuberculosis.

Methods

Thirty-five patients who developed consecutive multisegment thoracic and lumbar tuberculosis from September 2012 to May 2016 were retrospectively analyzed. Group A was the posterior-only surgery group, and group B was the anterior-only surgery group. The data on the surgery, deformity correction, functional scores, and complications were compared between the two groups.

Results

There was no significant difference in the operation time or blood loss between groups A and B (P > 0.05). The preoperative average Cobb angle of kyphosis in groups A and B were 36.2 ± 15.2° and 27.9 ± 7.7°, respectively, which significantly decreased to 4.9 ± 11.8° and 10.4 ± 5.6° after the operation, respectively (P < 0.05). At the final follow-up, the angles were 7.1 ± 10.5° and 14.6 ± 8.0°. The correction angle and correction rate in group A (31.3 ± 16.6°, 88.6 ± 43.6%) were greater than those in group B (17.5 ± 4.4°, 64.9 ± 14.0%) (P < 0.05). There was no significant difference in the loss angle between groups A and B (P > 0.05), but the loss rate in group B (24.0 ± 27.8%) was higher than that in group A (9.6 ± 10.2%) (P < 0.05). There was no significant difference in the incidence of complications between the two groups (P > 0.05).

Conclusion

The posterior-only and anterior-only approaches can lead to satisfactory clinical results in the treatment of patients with consecutive multisegment thoracic and lumbar tuberculosis. With posterior-only surgery, kyphosis can be better corrected, and the correction can be better maintained than with anterior-only surgery.