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Reconstruction of complicated spinal tuberculosis with long-segment fibula transplantation: a case report – Lumbar Spinal Stenosis

This article presents a case report of a 60-year-old woman with complex spinal tuberculosis (STB) involving multiple vertebral bodies. The patient experienced paralysis in both lower extremities and underwent a series of surgical procedures to alleviate spinal cord compression and correct kyphotic deformity. The treatment included emergency abscess clearance, laminectomy, spinal decompression, long-segment fixation, and two-stage transabdominal anterior abscess removal. After five years, the patient’s neurological status improved, and her quality of life significantly improved. The study highlights the importance of early intervention and the effectiveness of unconventional reconstruction methods such as fibula grafts

Summarised by Mr Mo Akmal – Lead Spinal Surgeon
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Published article

CONCLUSION: For patients with spinal tuberculosis and acute paralysis, it is essential to relieve spinal cord compression as soon as possible to recover spinal cord function. For lesions that cannot be debrided entirely, although limited debridement combined with anti-tuberculosis drug therapy has the risk of sinus formation and tuberculosis recurrence, it is much safer than the risk of thorough debridement surgery. In this case, an unconventional long-segment fibula graft, pelvis-vertebral…

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BMC Musculoskelet Disord. 2023 Oct 17;24(1):821. doi: 10.1186/s12891-023-06935-4.ABSTRACTBACKGROUND: Treating complex cases of spinal tuberculosis (STB) that involve multiple vertebral bodies and cause destruction of the spinal structure, kyphotic deformity, and acute nerve injury can be challenging. This report describes the course of treatment and 5-year follow-up of a complex case of multisegmental STB.CASE PRESENTATION: This,

BMC Musculoskelet Disord. 2023 Oct 17;24(1):821. doi: 10.1186/s12891-023-06935-4.

ABSTRACT

BACKGROUND: Treating complex cases of spinal tuberculosis (STB) that involve multiple vertebral bodies and cause destruction of the spinal structure, kyphotic deformity, and acute nerve injury can be challenging. This report describes the course of treatment and 5-year follow-up of a complex case of multisegmental STB.

CASE PRESENTATION: This report describes a case of tuberculosis affecting the vertebrae extending from thoracic 12 to lumbar 5 in a 60-year-old woman who suffered sudden paralysis in both lower extremities. The patient underwent emergency posterior paraspinal abscess clearance, laminectomy with spinal decompression. Partial correction of the kyphotic deformity via long-segment fixation from the T9 vertebral body to the ilium in a one-stage posterior procedure. The patient’s neurological status was diagnosed as grade E on the American Spinal Injury Association (ASIA) scale after the one-stage operation. Following standardized 4-combination anti-tuberculosis drug therapy for three months in postoperative patients, the patient underwent two-stage transabdominal anterior abscess removal, partial debridement of the lesion and bilateral fibula graft support. One year after the two-stage operation, the patient’s visual analog scale (VAS) score of back pain was 1 point, and the patient’s erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) levels returned to normal. Five years after the second-stage operation, the Oswestry disability index (ODI) of patient quality of life was 14 points. There was a 4-degree change in the Cobb angle over five years. During the five-year follow-up period, the grafted fibula did not experience any subsidence.

CONCLUSION: For patients with spinal tuberculosis and acute paralysis, it is essential to relieve spinal cord compression as soon as possible to recover spinal cord function. For lesions that cannot be debrided entirely, although limited debridement combined with anti-tuberculosis drug therapy has the risk of sinus formation and tuberculosis recurrence, it is much safer than the risk of thorough debridement surgery. In this case, an unconventional long-segment fibula graft, pelvis-vertebral support, was an effective reconstruction method.

PMID:37848853 | DOI:10.1186/s12891-023-06935-4

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Reconstruction of complicated spinal tuberculosis with long-segment fibula transplantation: a case report

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BMC Musculoskelet Disord. 2023 Oct 17;24(1):821. doi: 10.1186/s12891-023-06935-4.ABSTRACTBACKGROUND: Treating complex cases of spinal tuberculosis (STB) that involve multiple vertebral bodies and cause destruction of the spinal structure, kyphotic deformity, and acute nerve injury can be challenging. This report describes the course of treatment and 5-year follow-up of a complex case of multisegmental STB.CASE PRESENTATION: This

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