The role of sensory and motor evoked potentials in the prognosis of Pott's paraplegia

Bladder dysfunction in spinal tuberculosis: clinical, urodynamic and MRI study

STUDY DESIGN

An observational study.

OBJECTIVE

We report clinical, MRI and urodynamic findings in spinal tuberculosis.

SETTING

Tertiary care teaching hospital.

METHOD

Patients with spinal tuberculosis having micturition disturbances or high postvoidal residual (PVR) urine were subjected to clinical evaluation, urodynamic and spinal MRI. Urinary symptoms were scored as per the American Urological Association Symptom (AUAS) Index. The outcome was defined at 12 months into complete, partial and poor.

RESULTS

Of 30 spinal tuberculosis patients, 15 had micturition disturbance and included urinary retention in 4, stress incontinence in 2, hesitancy in 6, urgency in 11 and urge incontinence in 9 patients. Thirteen patients had paraparesis and one had quadriparesis. Spinal MRI revealed granuloma in 2, dorsal vertebral involvement in 12 and cervical and lumbar vertebral involvement in 1 patient each. On urodynamic study, detrusor hyperreflexia (DH) with high-pressure voiding was present in six, detrusor areflexia (DA) in four, normal study in one and increased PVR urine in the remaining patients. AUAS score improved on follow-up. DA changed to DH with high-pressure voiding in one patient. The 15 patients without micturition disturbance had no horizontal sensory level, milder or no weakness and only 2 had spinal cord signal changes. Patients with micturition disturbances had poorer functional recovery at 1 year compared to those without micturition disturbances.

CONCLUSION

Bladder symptoms were present in 50% of the admitted patients with spinal tuberculosis and related to severity of paraplegia, horizontal sensory level, cord signal abnormality and poorer outcome compared to those without spinal tuberculosis. Urodynamic study helped in categorization and management.

ACUTE CENTRAL CORD SYNDROME ARISING FROM A CERVICAL EPIDURAL ABSCESS

OBJECTIVE

Acute central cord syndrome (ACCS) is a well-known sequela to spinal trauma but has rarely been associated with nontraumatic etiologies. Spinal epidural abscess (SEA) and spinal osteomyelitis/discitis are also well characterized clinical entities. Neither SEA nor osteomyelitis leading to ACCS has been previously reported.

CLINICAL PRESENTATION

In this report, a patient presented with refractory neck pain after minor trauma followed by development of left hand weakness and paresthesia, which progressed to a classic central cord injury clinical pattern over a period of 4 weeks.

INTERVENTION

Imaging and laboratory studies were consistent with SEA and osteomyelitis. Motor evoked potentials obtained during surgery definitively corroborated the clinical diagnosis of ACCS and supported a long tract pathophysiology.

CONCLUSION

ACCS may be caused by SEA.