Surgical treatment of spinal tuberculous granuloma

Abstract

Objective To study the clinical, imaging characteristics, surgical treatments and results of spinal tuberculous granuloma. Methods A total of 15 cases of spinal tuberculous granuloma were retrospectively studied. Laminectomy with partial excision of tuberculous granuloma, open spinal dura mater with communication inside and outside the blood supply, and postoperative continued application of anti-TB drugs≥1 year were performed. Results The surgery area covered 1-7 segment, up to the neck pillow, and down to the lumbar segments. The granuloma length was 3-16 cm. The lesions located mainly in extramedullary of subarachnoid cavity, most commonly seen in the lower point of the physiological curvature of the thoracic subarachnoid cavity. The granuloma could be entirely separated from the dura. From the appearance of neurological damage to the surgery, the shortest time was 3 days, the longest time was 1 month. The prognosis of patients with short duration was better than that of those with a long time. Two weeks after surgery, the muscle strength of 2 cases was increased from grade Ⅰ to grade Ⅳ and the Frankel classification changed from C to D-E. The muscle strength of 13 cases was increased from grade Ⅱ to grade Ⅳ, and the Frankel classification changed from C to D. The follow-up duration was from 1 month to 3 years. Varying degrees of neurological recovery were observed in all the patients. After two months, the MRI of 11 cases showed disappearance of granulomas around the surgical area. After six months, the MRI of 9 cases showed that the granulomas of surgical and non-surgical areas were completely disappeared. Conclusion Surgical decompression could improve the prognosis of spinal tuberculous granuloma. After neurological damage occurred, the sooner the surgery performed, the better the prognosis. Key words: Tuberculosis, central nervous system; Granuloma; Spinal canal