Surgical treatment of noncontiguous spinal tuberculosis with gibbus deformity: A case report

Yu-Hung Chen^a, Chih-Bin Lin^b, Sheng-Wen Wu^c, Cheng-Hui Chiu^d, Tomor Harnod^c, Yu-Cheng Chou^c

^a Department of Nuclear Medicine, Buddhist Tzu Chi General Hospital and Tzu Chi University, Hualien, Taiwan
^b Department of Internal Medicine, Buddhist Tzu Chi General Hospital and Tzu Chi University, Hualien, Taiwan
^c Department of Neurosurgery, Buddhist Tzu Chi General Hospital and Tzu Chi University, Hualien, Taiwan
^d Department of Radiology, Mennonite Christian Hospital, Hualien, Taiwan

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Abstract
Noncontiguous tuberculous spondylitis, especially with involvement of the cervicothoracic junction, is uncommon. The disease is usually accompanied by severe neurologic deficits. The surgical approach to this junction is quite difficult. We present here a 21-year-old woman who had had paraplegia and ascending numbness for over 1 month. Magnetic resonance imaging revealed noncontiguous spinal tuberculosis at the cervical, thoracic, and lumbar levels complicated by cervicothoracic gibbus deformity. She underwent staged operations including anterior decompression, halo ring traction, posterior decompression, and posterolateral fusion with internal fixation. After surgery, the muscle power in her lower limbs improved gradually, she could walk without aids after 8 months, and she was disease-free 2 years and 4 months after surgery. For a patient with noncontiguous tuberculous spondylitis with cervicothoracic junction involvement, staged surgeries at the critical levels combined with adequate medication can result in a good neurologic recovery.

Keywords
Cervicothoracic; Gibbus; Noncontiguous; Spinal; Tuberculosis