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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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