Case Report | Published:

Tetraplegia associated with post-operative syringomyelia in spinal tuberculosis: a result of an epidural compartment syndrome?

Spinal Cord Series and Casesvolume 5, Article number: 18 (2019) | Download Citation

Abstract

Introduction

The commonly recognized causes of post-operative neurological deterioration in spinal tuberculosis are inadequate decompression, damage to vascular supply of the spinal cord, and multi-drug resistant organisms. There are no known cases of syringomyelia developing after surgical decompression of spinal tuberculosis.

Case presentation

A teenage girl presented with rapid onset quadriparesis secondary to a tubercular epidural abscess extending from C4-T8. The neurological status deteriorated to quadriplegia immediately following decompression by hemilaminectomy at C7 and T7 levels. Investigations into the cause of neurological deterioration revealed syrinx formation at T5–9 levels. The patient had partial motor and sensory recovery in the first 3 weeks post-operatively. Tubercular infection was treated with a 1-year course of multi-drug anti-tubercular therapy. However, there was no further neurological improvement at 2 years follow-up.

Discussion

Syringomyelia in tuberculosis has been associated with tubercular meningitis, intradural tuberculomas, and post-surgical vascular insult. None of these were implicated as the cause of syrinx formation in this case. We hypothesize that the rapid evolution of epidural abscess in an intact vertebral column led to an acute “epidural compartment syndrome”, which caused ischemic damage to the spinal cord. Compression caused by the epidural abscess was relieved by surgical decompression, allowing the central canal to dilate and expand into the softened spinal parenchyma, hence leading to syrinx formation.

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Author contribution

Author YK was the chief resident of the ward where the patient concerned was admitted. The chief operating surgeon was author NB, while authors PL and AK were his surgical assistants. They were responsible for preparation of the manuscript. Final proof reading and editing of the manuscript was done by NB and YK. The manuscript has been read and approved by all the authors and requirement for authorship of this document has been met. Each author believes that the manuscript represents honest work.

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Affiliations

  1. Department of Orthopaedics, Lilavati Hospital and Research Center, Mumbai, Maharashtra, India

    • Nishit Bhatnagar
  2. Department of Orthopaedics, Maulana Azad Medical College and Lok Nayak Hospital, New Delhi, India

    • Ankit Kataria
  3. Department of Orthopaedics, Sparsh Hospital, Bengaluru, Karnataka, India

    • Purushotham Lingaiah
  4. Department of Orthopaedics, Max Smart Super Specialty Hospital, New Delhi, India

    • Yugal Karkhur

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Conflict of interest

The authors declare that they have no conflict of interest.

Informed consent

A written informed consent was obtained from the patients’ legal guardians authorizing radiological examination, photographic documentation, and treatment. They were also informed that the data concerning the case would be submitted for publication and they consented.

Corresponding author

Correspondence to Nishit Bhatnagar.

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DOI

https://doi.org/10.1038/s41394-019-0159-y