Tuberculous myelopathy: current aspects of neurologic sequels in the southeast of Iran.

OBJECTIVE

The spinal cord may be affected in different ways in the course of tuberculous infection. The objective of this study was to determine the epidemiologic features, clinical manifestations, pathophysiologic mechanisms, neurologic sequels, and treatment outcomes of tuberculous myelopathy in the southeast of Iran in which the disease is endemic.

METHODS

A retrospective study was scheduled. All cases of tuberculous myelopathy treated in our hospital over the last 7 years were reviewed. Only those with histologic or microbiologic confirmation or those who responded to antituberculous therapy were included.

RESULTS

During a 7-year period, 43 cases of tuberculous myelopathy were found. The most frequent clinical manifestations were backache (86%) and fever (67%). Twenty patients were paraparetic or paraplegic and 40% had kyphosis. Imaging studies revealed thoracic and/or lumbar spine involvement in 92% of patients with tuberculous spondylitis. Fifteen, five and two patients had sensorimotor spinal cord syndrome, radiculomyelitis and intramedullary syringomyelic syndrome, respectively. Forty-seven percent required surgical intervention. There was improvement in 81% of the cases.

CONCLUSIONS

Different pathophysiologic mechanisms acted on the clinical manifestations of spinal neurotuberculosis. A good outcome is expected if the diagnosis is made in the early stages before the appearance of spinal deformity and neurologic deficits.