Isolated involvement of the posterior elements in spinal tuberculosis: a review of twenty-four cases.

[pyomyositis]

The literature on tuberculosis of the posterior spinal elements without involvement of the vertebral body is scarce . In this study we report our experience with twenty-four cases of neural arch tuberculosis that were treated at our center .We performed a retrospective review of the clinical and radiographic data of twenty-four consecutive patients who had tuberculosis of the posterior spinal elements with total sparing of the vertebral bodies and intervertebral disc space . We categorized the patients into two groups on the basis of the clinical and radiographic evaluation . The patients who had rapid onset weakness of the lower limbs or pyramidal signs or who showed evidence of epidural abscess underwent emergency decompressive laminectomy (Group A ). Patients who had pyomyositis of the posterior spinal muscles without any neurological deficit , pyramidal signs , or epidural abscess were managed with antitubercular therapy alone (Group B ).The common presenting features were spastic limb weakness and back pain . The majority of the patients had involvement of the thoracic spine . Epidural abscess , erosion of lamina , and pyomyositis of posterior spinal muscles were common imaging findings . Group A consisted of nineteen patients and Group B consisted of five patients . The mean period of follow-up was 16 .9 months (range , nine to sixty months ). Patients in Group A had a poorer outcome than those in Group B . Thirteen of the nineteen patients in Group A improved to become independent in the activities of daily living , with complete neurological recovery in eight patients and partial recovery in five patients . Six of the nineteen patients continued to have spastic paraplegia and were wheelchair-dependent . All of the patients in Group B remained neurologically intact during the follow-up period . None of the patients had recurrence of the disease or developed anterior element involvement or kyphotic deformity during the follow-up period .Neural arch tuberculosis is often missed at the time of initial presentation . In association with epidural abscess , it leads to rapid neurological deterioration . This atypical picture of spinal tuberculosis showed a high rate of neurological deficit at the time of initial presentation for medical care .

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pyomyositis

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