Comprehensive Spinal Tuberculosis Score: A Clinical Guide for the Management of Thoracolumbar Spinal Tuberculosis.

STUDY DESIGN: A newly proposed scoring tool was designed to assist in the clinical management of adult thoracolumbar spinal tuberculosis (TB). PURPOSE: To formulate a comprehensive yet simple scoring tool to guide decision-making in the management of adult thoracolumbar spinal TB. OVERVIEW OF LITERATURE: Spine surgeons have differing consensus in defining the threshold grade for clinico-radiological parameters when deciding between operative or conservative treatment for adult thoracolumbar spinal TB. Currently, the void in decision-making from the lack of well-defined guidelines is compensated by the surgeon's experience in treating these patients. To the best of our knowledge, no scoring system holistically integrates multiple facets of spinal TB to guide clinical decision-making. METHODS: The RAND/University of California, Los Angeles appropriateness method was employed among an expert panel of 10 spine surgeons from four apex tertiary care centers. Vital characteristics that independently influenced treatment decisions in spinal TB were identified, and a scoring tool was formulated. Points were assigned for each component based on their severity. The cutoff scores to guide clinical management were determined from the receiver operating characteristic curve based on the retrospective records of 151 patients treated operatively or non-operatively with improved functional outcomes at the 1-year follow-up. RESULTS: The components of the comprehensive spinal TB score (CSTS) are pain, kyphosis angle, vertebral destruction, and neurological status. A score classification of <5.5, 5.5-6.5, and >6.5 was established to guide the patient toward conservative, conservative/ operative, and operative management, respectively. CONCLUSIONS: The CSTS was designed to reflect the essential indicators of mechanical stability, neurological stability, and disease process stabilization in spinal TB. The scoring tool is devised to be practical and serve as a common language in the spine community to facilitate discussions and decision-making in thoracolumbar spinal TB. The validity, reliability, and reproducibility of this tool must be assessed through multicenter long-term studies.

Extend of Skipped Multifocal Noncontiguous Spinal Tuberculosis Beyond Imagination: A Rare Case Report and Literature Review.

Skipped multifocal extensive spinal tuberculosis involving the whole spine is very rare, which presents with atypical presentations and imaging features. So far, only five cases have been reported. Most of these patients have only two noncontiguous lesions. We are reporting a case of an 18-year-old boy with noncontiguous multifocal spinal tuberculosis involving cervical, thoracic, thoracolumbar, and lumbar segments. The patient was treated with antituberculous drug therapy and was operated for thoracolumbar spinal lesion. He made an excellent recovery. The possibility of tuberculosis is considered for any skip lesions involving the spine cautiously. Careful physical examination, trials of antitubercular therapy, and using the whole spine magnetic resonance imaging routinely also play an important role in the diagnosis and treatment of this disease. In patients with noncontiguous spinal involvement, there is a high percentage of requirement of surgical treatment due to fulminant behavior of the disease in these patients.

Management of fracture dorso-lumbar spine in a pregnant female by surgery in prone position.

Surgical management of thoraco-lumbar spine fracture in pregnancy has specific concerns during surgery like positioning, approach, and radiation exposure to fetus. We report a case of burst fracture of 12th thoracic vertebrae with paraplegia in a young female with 26 weeks of gestation. Surgery was performed in prone position on a Toronto frame. This report also discusses the management of thoraco-lumbar spine fracture in pregnancy with review of literature.

Intramedullary Tuberculoma of Dorsal Spinal Cord: A Case Report with Review of Literature.

INTRODUCTION: Intramedullary tuberculoma (IMT)are extremely rare lesions should be distinguished from other space occupying lesions like neoplasms. Although it is a treatable condition delaying diagnosis leads to significant morbidity. CASE REPORT: We report a case of intramedullary thoracic tuberculoma with paraparesis showing deterioration of neurological status during medical treatment. Surgical resection had shown the excellent result. CONCLUSION: The possibility of IMT should be seriously considered when an intraspinal mass is found with evidence of tuberculosis. Anti-tuberculous therapy (ATT) is the mainstay of treatment and had shown good results. Surgical removal is to be considered in cases of worsening neurological status while the patient is on ATT.

Intradural extramedullary capillary hemangioma of lower thoracic spinal cord.

Capillary hemangiomas are benign tumors and tumor like conditions commonly involving skin and mucus membrane of head and neck region. They are extremely rare in the spinal cord. We report a 35-year-old male presenting with gradual progressive paraparesis over a period of 4 months. Magnetic resonance imaging showed a hypo- to isointense intradural mass at the level of D12 vertebral body on T1-weighted images and homogenous enhancement on gadolinium contrast. Complete surgical resection revealed intradural extramedullary tumor, which on histopathologic examination showed characteristics of capillary hemangioma. At 1.5 years followup patient was asymptomatic.