Clinical Presentations and Surgical Outcomes in Patients with Spondylitis Tuberculosis: A Case Series
I Made Yedi Wisnawan *
Department of Orthopaedic and Traumatology, Prof. Dr. I.G.N.G. Ngoerah General Hospital, Udayana University, Bali, Indonesia.
I Gusti Lanang Ngurah Agung Artha Wiguna
Department of Orthopaedic and Traumatology, Prof. Dr. I.G.N.G. Ngoerah General Hospital, Udayana University, Bali, Indonesia.
*Author to whom correspondence should be addressed.
Abstract
Aims: To describe the clinical presentations, diagnostic findings, surgical indications, and available postoperative outcomes of patients with spinal tuberculosis who underwent surgical management with debridement or decompression, stabilisation, and fusion.
Study Design: Retrospective case series.
Place and Duration of Study: Department of Orthopaedic and Traumatology, Prof. Dr. I.G.N.G. Ngoerah General Hospital, Udayana University, Bali, Indonesia. The study period was based on the treatment and follow-up data available in the medical records.
Methodology: Three patients aged 17, 24, and 34 years with clinically and radiologically suspected spinal tuberculosis were included. Demographic data, symptoms, neurological findings, radiological features, microbiological and histopathological results, surgical management, perioperative complications, and available postoperative information were reviewed. Diagnosis was interpreted using clinical presentation, magnetic resonance imaging, polymerase chain reaction testing for tuberculosis, culture results, and histopathological findings.
Results: All three patients presented with back pain and pathological vertebral fracture. Two patients had neurological involvement described clinically as sensory symptoms or lower-limb weakness; standardised ASIA or Frankel grades were not recorded. Magnetic resonance imaging showed vertebral destruction, deformity, canal compromise, and abscess formation in selected cases. All patients underwent decompression or debridement with stabilisation and fusion, together with biopsy and culture. No perioperative complications were documented. Cultures showed no growth in all cases, polymerase chain reaction testing for tuberculosis was positive in all cases, and histopathology showed chronic granulomatous inflammation in one patient and non-specific chronic inflammation in two patients. Follow-up duration and objective postoperative radiological fusion findings were not consistently documented.
Conclusion: In this small case series, surgery was used as an adjunct to antituberculosis therapy in selected patients with spinal tuberculosis complicated by pathological fracture, instability, deformity, abscess formation, or neurological involvement. The findings should be interpreted cautiously because only three patients were included and objective long-term radiological outcomes were limited. Larger studies with standardised neurological grading, defined follow-up, and postoperative radiological assessment are needed.
Keywords: Spinal tuberculosis, tuberculous spondylitis, Pott disease, pathological vertebral fracture, spinal decompression, debridement, stabilisation, spinal fusion, polymerase chain reaction, neurological involvement, case series