doiSerbia

Ligamentum flavum hypertrophy in a patient with Pott’s disease

Aleksić Vuk (University of Belgrade, Faculty of Medicine, Clinical Center of Serbia, Clinic of Neurosurgery, Belgrade, Serbia + Clinical Hospital Center Zemun, Department of Neurosurgery, Belgrade, Serbia), aleksicvuk@hotmail.com
Ilić Rosanda (University of Belgrade, Faculty of Medicine, Clinical Center of Serbia, Clinic of Neurosurgery, Belgrade, Serbia)
Milićević Mihailo (University of Belgrade, Faculty of Medicine, Clinical Center of Serbia, Clinic of Neurosurgery, Belgrade, Serbia)
Milisavljević Filip (University of Belgrade, Faculty of Medicine, Clinical Center of Serbia, Clinic of Neurosurgery, Belgrade, Serbia)
Joković Miloš (University of Belgrade, Faculty of Medicine, Clinical Center of Serbia, Clinic of Neurosurgery, Belgrade, Serbia)

Introduction. The spine is involved in less than 1% of all tuberculosis (TB) cases, and it is a very dangerous type of skeletal TB as it can be associated with neurologic deficit and even paraplegia due to compression of adjacent neural structures and significant spinal deformity. The spine TB is one of the most common causes for an angular kyphotic deformity of spine. Patients with kyphosis angle ≥ 60° at dorsolumbar spine are at great risk to develop late onset neurological deficit and paraplegia due to chronic compression and stretching of the spinal cord over bonny ridges. In a small number of cases, other conditions may lead to neurological deficit in patients with long standing angular kyphosis which also alters the treatment strategy that otherwise involves prolonged and mutilant surgery. Case outline. We present a case of a 61-year-old male patient with concomitant 90° dorsolumbar spine kyphosis due to spinal TB and ligamentum flavum hypertrophy which led to spinal canal stenosis with myelopathy, and consequent paraplegia. The patient underwent dorsal decompression with hypertrophic yellow ligament removal after which he recovered to the level of walking. Conclusion. Many authors propose guidelines for treatment of spinal TB, taking into account the stage of the disease, the age of the patient, the angle of kyphosis, and other factors. We find that personalized medical approach is the best approach for each patient.

Keywords: kyphotic deformity, late onset paraplegia, TB spine, spinal canals stenosis, flavum hypertrophy