caa a22 4500 445831286 CHVBK 20180317145315.0 cr unu---uuuuu 170323e20110101xx s 000 0 eng 10.1007/s00586-010-1524-5 doi (NATIONALLICENCE)springer-10.1007/s00586-010-1524-5 Posterior listhesis of a lumbar vertebra in spinal tuberculosis [Elektronische Daten] [Matthew Kirkman, Krishnamurthy Sridhar] The management of spinal tuberculosis, especially in children, is controversial. In children, vertebral destruction is more severe than adults because of the cartilaginous nature of their bone. Modern chemotherapy has significantly decreased mortality in spinal tuberculosis, but morbidity remains high. Without early surgery, patients can develop severe kyphosis leading to respiratory insufficiency, painful costopelvic impingement and paraplegia. Lumbar kyphosis results in early degenerative lumbar canal stenosis and is cosmetically unacceptable. We report a paediatric case of atypical spinal tuberculosis demonstrating the need for early surgical intervention to prevent significant spinal instability and neurologic deficit. A 12-year-old girl presented with increasing ambulatory difficulty and double incontinence 4months after initiating treatment for pulmonary tuberculosis. There was no history of traumatic injury. Examination revealed severe lower limb neurologic deficit, with hypotonia, areflexia, marked sensory loss, and grade 0/5 power in both lower limbs. Plain radiographs and magnetic resonance imaging (MRI) demonstrated grade IV posterior listhesis of the L2 vertebral body over L3, cauda equina compression and bilateral psoas abscesses. Erosion of both the body and pedicle of L2 was observed. Both serology and pus drained from the psoas abscesses were negative for microorganisms. The patient underwent an L2 vertebrectomy via a left retroperitoneal approach. A titanium cage packed with autologous bone graft was inserted, and the spine was stabilized by fixation with screw and rods. Histopathology confirmed a diagnosis of tuberculosis. Eighteen months following the procedure, the patient has regained some power in her right leg and has completed her course of anti-tuberculous chemotherapy, but remains wheelchair-bound. To our knowledge, this is the first reported case of posterior listhesis secondary to spinal tuberculosis. Here, we discuss the possible management options in such a case, and the indications for surgery. As the global HIV/AIDS epidemic causes a resurgence in tuberculosis, increased awareness among the medical community regarding the atypical presentations of spinal tuberculosis is necessitated; both in the developing world where advanced clinical presentations are common, and in the developed world where spinal tuberculosis is an often-neglected diagnosis. Springer-Verlag, 2010 Posterior listhesis nationallicence Spinal tuberculosis nationallicence Lumbar spine nationallicence Vertebrae nationallicence Pott's disease nationallicence Kirkman Matthew Department of Neurosurgery, National Neurosciences Center, Kolkata, West Bengal, India aut Sridhar Krishnamurthy Department of Neurosurgery, National Neurosciences Center, Kolkata, West Bengal, India aut European Spine Journal Springer-Verlag 20/1(2011-01-01), 1-5 0940-6719 20:1<1 2011 20 586 https://doi.org/10.1007/s00586-010-1524-5 text/html Onlinezugriff via DOI 1 research-article jats NATIONALLICENCE 856 40 https://doi.org/10.1007/s00586-010-1524-5 text/html Onlinezugriff via DOI NATIONALLICENCE 700 1- Kirkman Matthew Department of Neurosurgery, National Neurosciences Center, Kolkata, West Bengal, India aut NATIONALLICENCE 700 1- Sridhar Krishnamurthy Department of Neurosurgery, National Neurosciences Center, Kolkata, West Bengal, India aut NATIONALLICENCE 773 0- European Spine Journal Springer-Verlag 20/1(2011-01-01), 1-5 0940-6719 20:1<1 2011 20 586 Metadata rights reserved Springer special CC-BY-NC licence nationallicence BK010053 XK010053 XK010000 NATIONALLICENCE NATIONALLICENCE NL-springer