Paraplegia due to non-osseous spinal tuberculosis: report of three cases and review of the literature

Abstract

In developing countries, a recognized etiology of paraplegia can be tuberculous radiculomyelitis or tuberculomas, especially in patients with evidence of either active or latent tuberculosis. These entities should also be considered in high-risk patients or in patients who have emigrated from regions with a high prevalence of tuberculosis (TB). Both arachnoiditis and intradural tuberculomas are uncommon forms of spinal TB. We report three cases of TB of the spinal cord in young males with paraplegia or paraparesis who were hospitalized over a one-year period. The clinical presentation and clinical course differed among the three patients: radiculomyelitis complicating tuberculous meningitis for the first patient and spinal tuberculomas in the other two. Neuroimaging with magnetic resonance imaging (MRI) was critical for diagnosis. The therapy for spinal TB should be conservative since the neurologic deficits are mainly secondary to the inflammatory process. Usually these lesions respond to medical therapy alone, and with early diagnosis one can avoid unnecessary surgical intervention. In our limited clinical experience, corticosteroids (IV, intrathecal, or both) appear to have a beneficial effect.