Skip to main content Skip to main navigation menu Skip to site footer

Spinal Cord Injury in Tuberculous Spinal Epidural Abscess Patient with Deficiency of Vitamin D : A Case Report with Literature Review

Abstract

Background: Spinal cord injury is not only caused by trauma but also by non-trauma, such as spinal epidural abscess (SEA). Tuberculous SEA is a rare infectious disorder, a delayed diagnosis associated with morbidity and mortality. The problems of tuberculous SEA is not only infection but also neurological deficit, axial back pain, pathological fracture, deformity, and socioeconomic and psychogenic problem. There are a few cases of SEA caused by Mycobacterium tuberculosis, mostly caused by Staphylococcus aureus with decreasing body’s defense mechanism caused by a deficiency of vitamin D. This study aimed to evaluate the neurological recovery of non-traumatic spinal cord injury caused by spinal tuberculosis with spinal epidural abscess and vitamin D deficiency that treated with vitamin D as an adjuvant.

Case Report: A 31-year-old female came to the orthopedic clinic with paraparesis ASIA grade C, axial back pain, and spinal deformity for three months, with vitamin D levels of 15.5 ng/ml. MRI showed epidural abscess at the level of the 10th-11th thoracic vertebrae, spondylodiscitis of the 10th-11th thoracic vertebrae accompanied by paraspinal abscess of the 8th thoracic vertebrae to the 1st lumbar vertebra. The diagnosis was confirmed by cultured and histopathological examination. The treatment was surgery, followed by anti-TB drugs and daily vitamin D 5000 IU for one year. After one year of follow-up, the patient returned to work without a neurological deficit and axial back pain.

Conclusion: This report describes the importance of early diagnosis and proper treatment of spinal cord injury in tuberculous SEA with a deficiency of vitamin D.

References

  1. Tetsuka S, Suzuki T, Ogawa T, Hashimoto R, Kato H. Spinal Epidural Abscess: A Review Highlighting Early Diagnosis and Management. JMA J. 2019/10/24. 2020;3(1):29–40. Available from: https://pubmed.ncbi.nlm.nih.gov/33324773
  2. Vakili M, Crum-Cianflone NF. Spinal Epidural Abscess: A Series of 101 Cases. Am J Med. 2017;130(12):1458–63. Available from: http://dx.doi.org/10.1016/j.amjmed.2017.07.017
  3. Bond A, Manian FA. Spinal Epidural Abscess: A Review with Special Emphasis on Earlier Diagnosis. Biomed Res Int. 2016/12/01. 2016;2016:1614328. Available from: https://pubmed.ncbi.nlm.nih.gov/28044125
  4. Stratton A, Gustafson K, Thomas K, James MT. Incidence and risk factors for failed medical management of spinal epidural abscess: a systematic review and meta-analysis. J Neurosurg Spine. 2017;26(1):81–9. Available from: http://dx.doi.org/10.3171/2016.6.spine151249
  5. Garg D, Goyal V. Spinal Tuberculosis Treatment: An Enduring Bone of Contention. Ann Indian Acad Neurol. 2020/07/16. 2020;23(4):441–8. Available from: https://pubmed.ncbi.nlm.nih.gov/33223659
  6. Huang S-J, Wang X-H, Liu Z-D, Cao W-L, Han Y, Ma A-G, et al. Vitamin D deficiency and the risk of tuberculosis: a meta-analysis. Drug Des Devel Ther. 2016;11:91–102. Available from: https://pubmed.ncbi.nlm.nih.gov/28096657
  7. Groves NJ, Burne THJ. The impact of vitamin D deficiency on neurogenesis in the adult brain. Neural Regen Res. 2017;12(3):393–4. Available from: https://pubmed.ncbi.nlm.nih.gov/28469647
  8. Madhuripan N, Hicks RJ, Feldmann E, Rathlev NK, Salvador D, Artenstein AW. A Protocol-Based Approach to Spinal Epidural Abscess Imaging Improves Performance and Facilitates Early Diagnosis. J Am Coll Radiol. 2018;15(4):648–51. Available from: http://dx.doi.org/10.1016/j.jacr.2017.09.041
  9. Eltorai AEM, Naqvi SS, Seetharam A, Brea BA, Simon C. Recent Developments in the Treatment of Spinal Epidural Abscesses. Orthop Rev (Pavia). 2017;9(2):7010. Available from: https://pubmed.ncbi.nlm.nih.gov/28713526
  10. Chima-Melton C, Pearl M, Scheiner M. Diagnosis of spinal epidural abscess: a case report and literature review. Spinal cord Ser cases. 2017;3:17013. Available from: https://pubmed.ncbi.nlm.nih.gov/28435744
  11. Alerhand S, Wood S, Long B, Koyfman A. The time-sensitive challenge of diagnosing spinal epidural abscess in the emergency department. Intern Emerg Med. 2017;12(8):1179–83. Available from: http://dx.doi.org/10.1007/s11739-017-1718-5
  12. Toppo AJ, Rogerson A, Oh DHW, Tybor DJ, Wurcel AG, Salzler MJ. Injection Drug Use in Patients With Spinal Epidural Abscess. Spine (Phila Pa 1976). 2020;45(12):843–50. Available from: http://dx.doi.org/10.1097/brs.0000000000003401
  13. Babic M, Simpfendorfer CS. Infections of the Spine. Infect Dis Clin North Am. 2017;31(2):279–97. Available from: http://dx.doi.org/10.1016/j.idc.2017.01.003
  14. Hewson DW, Bedford NM, Hardman JG. Spinal cord injury arising in anaesthesia practice. Anaesthesia. 2018;73:43–50. Available from: http://dx.doi.org/10.1111/anae.14139
  15. Moatz B, Michael K, Rhee JM. Spinal epidural abscesses: Diagnosis and current treatment options. Semin Spine Surg. 2016;28(3):143–9. Available from: http://dx.doi.org/10.1053/j.semss.2015.07.004
  16. Epstein NE. Timing and prognosis of surgery for spinal epidural abscess: A review. Surg Neurol Int. 2015;6(Suppl 19):S475–86. Available from: https://pubmed.ncbi.nlm.nih.gov/26605109
  17. Patel AR, Alton TB, Bransford RJ, Lee MJ, Bellabarba CB, Chapman JR. Spinal epidural abscesses: risk factors, medical versus surgical management, a retrospective review of 128 cases. Spine J. 2014;14(2):326–30. Available from: http://dx.doi.org/10.1016/j.spinee.2013.10.046
  18. Berbari EF, Kanj SS, Kowalski TJ, Darouiche RO, Widmer AF, Schmitt SK, et al. 2015 Infectious Diseases Society of America (IDSA) Clinical Practice Guidelines for the Diagnosis and Treatment of Native Vertebral Osteomyelitis in Adultsa. Clin Infect Dis. 2015;61(6):e26–46. Available from: http://dx.doi.org/10.1093/cid/civ482
  19. Artenstein AW, Friderici J, Visintainer P. A Predictive Model Facilitates Early Recognition of Spinal Epidural Abscess in Adults. West J Emerg Med. 2018/02/12. 2018;19(2):276–81. Available from: https://pubmed.ncbi.nlm.nih.gov/29560054

How to Cite

I Nyoman Semita, Ni Njoman Juliasih, Azham Purwandhono, Setyawardani, A., & Muhammad Yuda Nugraha. (2022). Spinal Cord Injury in Tuberculous Spinal Epidural Abscess Patient with Deficiency of Vitamin D : A Case Report with Literature Review. Bali Medical Journal, 11(3), 1478–1482. https://doi.org/10.15562/bmj.v11i3.3008

HTML
32

Total
44

Share

Search Panel

I Nyoman Semita
Google Scholar
Pubmed
BMJ Journal


Ni Njoman Juliasih
Google Scholar
Pubmed
BMJ Journal


Azham Purwandhono
Google Scholar
Pubmed
BMJ Journal


Astuti Setyawardani
Google Scholar
Pubmed
BMJ Journal


Muhammad Yuda Nugraha
Google Scholar
Pubmed
BMJ Journal