Tuberculous spondylolisthesis: a re-appraisal on clinico-radiologic spectrum and surgical treatment paradigm.

Tuberculous spondylolisthesis: a re-appraisal on clinico-radiologic spectrum and surgical treatment paradigm.

World Neurosurg. 2018 Mar 08;:

Authors: Narayan V, Mohammed N, Savardekar AR, Patra DP, Nanda A

Abstract
INTRODUCTION: Spinal tuberculosis [TB] is a common infectious disease prevalent in developing countries and a rising disaster in developed countries. The association of tuberculosis with spondylolisthesis is rarely reported in literature. The aim of our review is to analyse the clinical features and radiologic characteristics of TB spondylolisthesis along with providing a concise update on its surgical management, based on current literature.
METHODS: A systematic review is performed after conducting a thorough search in the PubMed database. The articles are selected systematically, reviewed completely and relevant data is summarized and discussed.
RESULTS: and Observations: A total of 19 articles are selected for the review. The most common clinical manifestation observed is focal back pain followed by motor deficit. Majority of the patients have Grade 2 listhesis and associated tubercular abscess. The anterior as well as posterior surgical approaches have its own advantages and the choice of approach depends on the location of pathology, ease of access, achievement of spinal stability and avoidance of contiguous infection spread. Though posterior approach and fixation using pedicular screws and rods along with debridement of pus or granulation tissue is the favored approach in dorsolumbar TB, anterior approach, corpectomy and fusion is preferred in cervical TB.
CONCLUSIONS: Treatment of TB spondylolisthesis encompasses a wide spectrum of surgical options. However the main stay of treatment is chemotherapy. The indications where surgical management may have an upper hand over medical management are spinal cord compression, significant instability, large tubercular abscess, painful vertebral lesions, kyphosis and infection by MDRTB or XDRTB, where medical management alone does not help. The surgery is benefitted in these situations by achieving radical debridement, permanent stability, prevention of further neurologic deterioration, and early recovery. Even though conservative management may help in certain cases, posterior approach, decompression and fusion is preferred in unstable dorso-lumbar pathology while anterior approach is preferred in cervical pathology. Combined approaches can be considered in pediatric spine TB for the correction of kyphotic deformity and its consequent maintanence.

PMID: 29526779 [PubMed - as supplied by publisher]

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