[Early anterolateral surgery for tuberculosis of the lower cervical spine with neurological complications in adult. Our experience in Gabon].
OBJECTIVE
To report our therapeutic experience with tuberculosis of the lower cervical spine with neurological complications in 9 adults in Gabon.


METHODS
A retrospective study of these 9 adults treated for progressive Pott's tetraplegia or paraplegia from 1982 to 1998 was conducted. The medical treatment consisted of the early administration in the first 3 patients of rifampin, isoniazid and ethambutol for 18 months; and, in the remaining 6 patients, of rifampin, isoniazid, ethambutol and pyrazinamide for 6 months. This medical treatment was systematically started 3 weeks before surgery in 7 patients, once the disease had been diagnosed radiologically. Two patients with an acute onset of paraplegia underwent surgery on an emergency basis. The standard anterior approach was used: debridement was done in 3 cases, to establish the diagnosis; 6 patients underwent radical surgery for severe neurological deficit and spinal instability. Average follow-up time was 40.6 months.


RESULTS
Three patients were found to be functionally and neurologically normal at follow-up examinations. Eight of the nine patients recovered sufficiently to walk unaided. One patient was able to get about on crutches. After 3-4 months, a satisfactory consolidation was already observed, with reduction of kyphosis in 4 cases. All patients were considered medically cured by the Antituberculous Center.


CONCLUSIONS
Early radical surgery, as primary procedure, in conjunction with a six-month chemotherapeutic regimen (four drugs) seems to be adequate for the management of tuberculosis of the lower cervical spine with neurological complications and spinal instability, in our setting.
Loembe
P M
PM
Service de Neurochirurgie, Fondation Jeanne-Ebori, Université Omar-Bongo, BP 212, Libreville, Gabon.
Mwanyombet-Ompounga
L
L
Assengone-Zeh
Y
Y
Kengue-Lechiombeka
P R
PR
D000328:Adult; D000995:Antitubercular Agents / Q000627:therapeutic use; D002574:Cervical Vertebrae / Q000601:surgery*; D003131:Combined Modality Therapy; D003646:Debridement; D004630:Emergencies; D004977:Ethambutol / Q000627:therapeutic use; D005500:Follow-Up Studies; D005681:Gabon; D006801:Humans; D007538:Isoniazid / Q000627:therapeutic use; D007738:Kyphosis / Q000209:etiology; D010264:Paraplegia / Q000209:etiology; D026741:Physical Therapy Modalities; D011718:Pyrazinamide / Q000627:therapeutic use; D011782:Quadriplegia / Q000209:etiology; D012189:Retrospective Studies; D012293:Rifampin / Q000627:therapeutic use; D016896:Treatment Outcome; D014399:Tuberculosis, Spinal / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy / Q000601:surgery*
D000995:Antitubercular Agents; D011718:Pyrazinamide; D004977:Ethambutol; D007538:Isoniazid; D012293:Rifampin