J Korean Soc Spine Surg.  2015 Jun;22(2):60-64. 10.4184/jkss.2015.22.2.60.

Surgical Outcome of Tuberculous Myelitis, Arachnoiditis and Spondylitis after Brain Meningitis: A Case Report

• Suh SP
• Park DH
• Kim CW
• Kang CN

• KMID: 2322954
• DOI: http://doi.org/10.4184/jkss.2015.22.2.60

Abstract

STUDY DESIGN: A case report.
OBJECTIVES
To report a rare case of a surgically treated tuberculous myelitis and arachnoiditis patient with incomplete paraplegia. SUMMARY OF LITERATURE REVIEW: Tuberculous myelitis and arachnoiditis is a rare disease with a high rate of neurologic deficit. This condition is treated using antituberculous medication and high-dose steroid therapy, but surgical treatment has rarely been reported and the outcomes vary. MATERIAL AND METHODS: A 29-year-old female had tuberculous myelitis and arachnoiditis. The patient was treated with antituberculous medication and high-dose steroid therapy, but the treatment failed and the patient could not walk because of incomplete paraplegia. The surgical treatment was performed twice; we decompressed by total laminectomy and debrided the infected arachnoid membrane. Four months after surgery, we performed anterior interbody fusion due to the development of spondylitis with kyphosis.
RESULTS
Three years after the first operation, the patient's neurologic state improved and she could walk 90 m without assistance.
CONCLUSIONS
Here, we report a very rare case of surgically treated tuberculous myelitis and arachnoiditis and provide a treatment option for this condition to spine surgeons.

Keyword

Tuberculous myelitis; Tuberculous arachnoiditis; Tuberculous spondylitis; Surgical treatment

MeSH Terms

Adult
Arachnoid*
Arachnoiditis*
Brain*
Female
Humans
Kyphosis
Laminectomy
Membranes
Meningitis*
Myelitis*
Neurologic Manifestations
Paraplegia
Rare Diseases
Spine
Spondylitis*

Figure

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  Fig. 1. Preoperative magnetic resonance images. (A) Sagittal T2-weighted image of T6-T11 demonstrates tuberculous myelitis and arachnoiditis. (B) Axial T2-weighted images show the cord swelling and thickening of the dural sac.

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  Fig. 2. Sagittal T1-weighted image wth gadolinium enhancement of tuberculous spondylitis involving L1 and L2.

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  Fig. 3. Intraoperative photography. After incision of dura, the severe ad-hesion between dura mater and arachnoid mater was observed.

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  Fig. 4. Preoperative lateral radiograph shows severe progression of kyphosis (Cobb's angle:30°) and sagittal T2-weighted image of tuberculous spondylitis involving L1 and L2.

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  Fig. 5. Postoperative radiograph of anterior interbody fusion with an autogenous rib strut bone graft.

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