Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Case Reports
. 2021 Sep 8;2021(9):rjab406.
doi: 10.1093/jscr/rjab406. eCollection 2021 Sep.

Surgical management of spinal tuberculosis with a two-stage posterior instrumentation with bridging: a case report

Faisal Mohammedsaleh Konbaz  1 , Suhail Saad Alassiri  1 , Sami Ibrahim Al Eissa  1 , Majed Salah Abaalkhail  1 , Hassan Nezar Khdary  2 , Abdulrahman Khalid Albuijan  3
Affiliations
Case Reports

Surgical management of spinal tuberculosis with a two-stage posterior instrumentation with bridging: a case report

Faisal Mohammedsaleh Konbaz et al. J Surg Case Rep. .

Abstract

Tuberculosis (TB) affects millions of people every year. Spinal TB is a common extrapulmonary manifestation of the disease. Spinal TB can be devastating and carries an unfortunate outcome. Herein, we present an atypical spinal TB that was treated initially based on intraoperative cultures with posterior decompression and instrumentation of T11-L3 with directed antibiotic therapy. Recurrence of the lesion and failure of instrumentation necessitated further investigation and intervention 1 year later. Using a two-stage surgical procedure leaving the infected spine to heal first with directed anti-TB medications. The patient was managed using posterior instrumentation with bridging from T5 to the pelvis, spanning the destructed area and utilizing a bridging technique with multiple rod constructs across the infected spine. Here, we present the benefit of using the bridging technique to promote bone healing and achieve a solid fixation.

PubMed Disclaimer

Figures

Figure 1
Figure 1
(A) T2-weighted sagittal lumbar spine MRI demonstrating a pathological fracture of L1 with spinal canal and neural foramina stenosis and cord edema and epidural and prevertebral soft tissue components. (B) T2-weighted axial lumbar spine MRI of the corresponding level of L1 vertebral body.
Figure 2
Figure 2
(A) T2-weighted sagittal spine MRI demonstrating changes at the thoracolumbar spine with previous decompression for pathological fracture of L1 vertebra. There is interval progression of the disease with a soft tissue mass at the previous site extending to the prevertebral and epidural spaces, compressing the neural element. (B) T2-weighted axial spine MRI of the corresponding level of L1 vertebral body.
Figure 3
Figure 3
(A) Sagittal spine CT demonstrating a burst fracture involving L1 vertebral body with retropulsion of fragments and epidural soft tissue mass indenting the conus medullaris at the level of T12–L1. (B) Axial spine CT of the corresponding level of L2 vertebral body. (C) Axial spine CT of the corresponding level of L3 vertebral body. (D) Axial spine CT of the corresponding level of T11 vertebral body.
Figure 4
Figure 4
(A) AP lumbar spine X-ray demonstrating the bridging technique. (B) Lateral spine X-ray showing the bridging technique sparing the infected area.
Figure 5
Figure 5
(A) Sagittal spine CT demonstrating healed bone and re-ossification of T11-L3. (B) Axial spine CT of the corresponding level of T11 vertebral body.
Figure 6
Figure 6
(A) T2-weighted sagittal spine MRI demonstrating changes at the thoracolumbar spine with complete resolution of infection and no cord compression. (B) T2-weighted axial spine MRI of the corresponding level of L1 vertebral body.
Figure 7
Figure 7
(A) AP lumbar spine X-ray demonstrating final fixation from T5-S2-alar-iliac screws. (B) Lateral spine X-ray.
See this image and copyright information in PMC

References

    1. Zaman K. Tuberculosis: a global health problem. J Health Popul Nutr 2010;28:111–3. - PMC - PubMed
    1. Global Tuberculosis Report 2020. Geneva: World Health Organization, 2020, Licence: CC BY-NC-SA 3.0 IGO
    1. Glaziou P, Floyd K, Raviglione MC. Global epidemiology of tuberculosis. Semin Respir Crit Care Med 2018;39:271–85. - PubMed
    1. Alateah SM, Othman MW, Ahmed M, Al Amro MS, Al Sherbini N, Ajlan HH. A retrospective study of tuberculosis prevalence amongst patients attending a tertiary hospital in Riyadh, Saudi Arabia. J Clin Tuberc Other Mycobact Dis 2020;21:100185.Published 2020 Sep 22. 10.1016/j.jctube.2020.1001855. - DOI - PMC - PubMed
    1. Izudi J, Semakula D, Sennono R, Tamwesigire IK, Bajunirwe F. Treatment success rate among adult pulmonary tuberculosis patients in sub-Saharan Africa: A systematic review and meta-analysis. BMJ Open 2019;9:e029400. - PMC - PubMed

Publication types