Innovative multi-cage long segment lumbar spine reconstruction for multilevel lumbar tuberculosis

• Main Authors: Aftab Younus, Adrian Kelly
• Format: Article
• Language: English
• Published: Elsevier 2019-12-01
• Series: Interdisciplinary Neurosurgery
• Online Access: http://www.sciencedirect.com/science/article/pii/S2214751919302221

Tuberculosis (TB) is a disease of poverty with a global concentration in sub Saharan Africa. While 10% of extra-pulmonary tuberculosis is skeletal, 50% of this occurs in the spinal column. Multi-level lumbar spinal TB is however a rarity, especially in the HIV negative population. Besides the medical management of this condition which decades ago revolutionized the treatment of these patients, spinal surgeons must today still decide on the best way to manage the challenges of progressive neurology, instability, deformity and the often large cold abscesses that accompany this condition.We present a young immunocompetent male patient whom presented to our unit complaining of moderate lumbar backache of six months duration with associated progressive lower limb weakness of one week duration. Neurological examination utilizing manual muscle testing revealed a flaccid paraparesis with power 3/5. Our radiological investigations revealed extensive tuberculous destruction of multiple vertebrae of his lumbar spine and a large pre-vertebral lumbar tubercular abscess. The extensive tubercular involvement of his lumbar spine included unstable pathological burst fractures of L1; L2 and L4. Due to his progressive neurology secondary to bony compression he was taken to surgery and an open thoraco-abdominal approach to the lumbar spine was utilized to perform L1; L2 and L4 corpectomies followed by an innovative multi-cage reconstruction and fusion from T12 - L5. Post-operatively the patient had improvement in his symptoms and was discharged two weeks later in a brace, ambulant with a walker, on TB treatment, for out-patient follow-up. At his one year review he was independently ambulant with no progression of his deformity.In conclusion patients with spinal TB often have profound radiological findings however in our patient multi-level corpectomies and an innovative multi-cage lumbar reconstruction enabled a resolution of his neurological deficit and a restoration of lumbar lordosis.