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Epidural anesthesia in a patient with history of Pott’s Disease
Abstract Number: T-66
Abstract Type: Case Report/Case Series
Abstract: Tuberculosis remains a global health concern. Despite this, little is known about the safety of neuraxial anesthesia in patients with a history of spinal tuberculosis (TB). We describe the management of a 33 year old in labor with known history of treated spinal TB with uncomplicated labor epidural anesthesia.
Introduction: According to WHO, tuberculosis was one of the top 10 causes of death worldwide. Though less common in the United States, it is highly prevalent in other countries.1 Spinal TB, also known as Pott’s disease, is an infection of the vertebrae from TB.4 Despite its prevalence, there is scarce literature on the safety of neuraxial anesthesia in patients with a history of treated spinal TB.
Case Description: A 33 year old G1P0 at 37 weeks presented to Labor and Delivery with severe preeclampsia based on blood pressure. The patient reported a history of spinal TB in 2009, for which she had received successful medical treatment in Cape Verde. She denied any current neurological symptoms and had an unremarkable physical exam. She was subsequently induced and had a lumbar epidural catheter placed for labor analgesia that was removed shortly after successful vaginal delivery. Her postpartum course was uneventful and the patient was discharged 3 days later.
Discussion: Our patient never required surgery for her disease and had been symptom-free since receiving adequate medical treatment. Once on appropriate antimicrobial treatment, the response to therapy is monitored clinically based on improvement in pain, constitutional or neurological symptoms.3 Serial radiographs are not useful as findings may appear to worsen while on appropriate treatment.5 The majority of patients respond to medical treatment and recurrence rate of skeletal TB is only about 2%.2 Given that our patient had been symptom-free and had a benign physical exam, we felt confident to safely place an epidural catheter. To our knowledge, there are no prior case reports of uncomplicated neuraxial anesthesia performed on a patient with successfully treated spinal TB. Prior case reports written were in patients with untreated Pott’s disease resulting in tragic consequences (i.e. paraplegia). The patient population in the United States now is more international and our case report supports the safe use of regional in patients with history of treated Pott’s disease.
2. Asian Spine J. 2012; 6: 294-308
4. Clin Infect Dis. 2016; 63: e147-e195
5. Br J Radiol. 1992; 65: 476-479