Long Cervicothoracolumbal Rigid Bracing Stabilization on Incomplete Spinal Cord Injury of Post-Operated Multi-Focal Upper Cervical-Thoracic Spinal Tuberculosis: A Unique Case Report
DOI:
https://doi.org/10.51200/bjms.v16i.3744Keywords:
spinal cord injury, tuberculous spondylitis, rehabilitationAbstract
Background and aim: Spinal tuberculosis (STB) is a hazardous type of bone tuberculosis that could affect the entire spine, with predilection towards the lower thoracic level. Upper cervical spondylitis occurred only at 0.3 – 1% of all STB cases, but this rare type leads to severe consequences, including tetraplegia, autonomic dysfunction, and respiratory impairment. This case reported long CTLSO rigid external stabilisation reasoning to boost protection whilst recovering tuberculosis despite stable internal stabilisation. Methods: A 34-year-old male came with one year of worsening low-back pain, unintentional weight loss, and gradual loss of power and sensation of both feet within a month. Physical examination showed kyphotic deformity, tenderness, key-muscle-strength 3, and sensory impairment for lower extremities, with no autonomic disturbances. Laboratory works showed chronic ongoing infection. Whole-spine MRI showed multiple spondylodiscitis with multi-focal paravertebral abscesses at C3 – C5, C7 – T3, T9 – T12, L1, severe canal stenosis and anterior segment destruction of T12. Results: The patient was diagnosed with SCI AIS D with a neurological level of L3 secondary to T12 vertebra destruction from STB. He underwent abscess evacuation, debridement, and posterior stabilisation at T10 – L3 and debridement of abscess at C3 – C5 without the need for stabilisation. After procedures, the spine was further stabilised by a CTSLO brace with flexion, extension, lateral flexion, rotation stop. Inward rehabilitation includes incremental mobilisation, upper-limb-extensor-group-strengthening-programme, balance-exercise with ambulation training. Patient discharged with status: ambulate independently with a walker. To date, the patient has returned to work with independent ambulation. Conclusion: Type-III STB was indicated for surgical procedures. Instability of upper cervical prevented patient to performed loadbearing activity thus lowering patient functional outcomes. CTLSO supplementation was given to compensate for 3 lesion sites, the upper cervical, mid-thoracic, and lower-thoracic. For the C3 – C5 lesion, there was no internal stabilisation, so a proper external mode of stabilisation should be given. However, for the thoracic level, CTLSO was given due to (1) incomplete SCI lesion in the absence of deteriorating neurological deficit,c(2) porous nature of STB, and (3) good prognostic recovery of STB with anti-TB medication leading to the reversible neurological deficit.
Downloads
Published
How to Cite
Issue
Section
License
Borneo Journal of Medical Sciences
Copyright transfer and contributions agreement to publish in Borneo Journal of Medical Sciences (BJMS)
Transfer our author right to Borneo Journal of Medical Sciences (BJMS Publishers) along with title, interest in article without any limitations. The Journal shall own the work, including 1) copyright; 2) the right to grant permission to republish the article in whole or in part, with or without fee; 3) the right to produce preprints or reprints and translate into languages other than English for sale or free distribution; and 4) the right for electronic/visual reproduction, electronic storage and to republish the work in a collection of articles in any other mechanical or electronic format or printed publications.
We, the authors certify to participate sufficiently in the intellectual content, conception and design of this work or the analysis and interpretation of the data (when applicable), as well as the writing of the manuscript, to take public responsibility for it and have agreed to have our name listed as a contributor. We believe the manuscript represents valid work. Neither this manuscript nor one with substantially similar content under our authorship has been published or is being considered for publication elsewhere, except as described in the covering letter. Any such involvement, publishers of BJMS are not responsible and the authors are held for any untoward practices if any. Any other reproduction of the said article requires the permission from the publisher.
Authors also state that, the work is original and is not infringing with the rights of others and copyrights. Author also further declares that, each co-author have contributed significantly and have accepted to be co-authors for their significant contribution for the work.
We certify that all the data collected during the study is presented in this manuscript and no data from the study has been or will be published separately. We attest that, if requested by the editors, we will provide the data/information or will cooperate fully in obtaining and providing the data/information on which the manuscript is based, for examination by the editors or their assignees.
We give the rights to the corresponding author to make necessary changes as per the request of the journal, do the rest of the correspondence on our behalf and he/she will act as the guarantor for the manuscript on our behalf. All persons who have made substantial contributions to the work reported in the manuscript, but who are not contributors, are named in the Acknowledgment and have given us their written permission to be named. If we do not include an Acknowledgment that means we have not received substantial contributions from non-contributors and no contributor has been omitted.
Total Views: 213
| 
Total Downloads: 156
1.png){kind=logo}
