1/54. Atypical forms of spinal tuberculosis: case report and review of the literature.OBJECTIVE: The object of this report is to highlight some of the less known atypical features of spinal tuberculosis (TB) in the hope of facilitating early diagnosis. Pure neural arch and sacral TB is rare and the co-existence of these two as widely separated skip lesions in the same patient is even rarer. CLINICAL PRESENTATION: An unusual case of tuberculous process affecting the sacrum as well as the neural arches of upper cervical vertebrae is presented. Neither the clinical features nor the imaging techniques, including radiography, bone scintigraphy, computed tomography, and magnetic resonance imaging, were helpful in establishing the diagnosis. The destructive lesion of the sacrum with a rectally palpable presacral mass was thought to be a chordoma or chondrosarcoma until the patient developed upper cervical cord compression with an extradural myelographic block. Development of this second destructive lesion involving the posterior spinal elements (the neural arch) led to a diagnosis of malignant spinal metastasis. The true diagnosis was only revealed by the histology of the solid tumor-like extradural mass in the upper cervical region and demonstration of acid-fast bacilli (AFB) in the lesion. Anti-TB chemotherapy resulted in complete resolution of sacral and cervical lesions as well as the neurologic deficits. CONCLUSION: Differential diagnosis of the obscure spinal lesion should include tuberculosis, specifically the atypical forms; especially because complete cure is possible with early treatment and neurologic morbidity is high in neglected cases.- - - - - - - - - - ranking = 1keywords = compression (Clic here for more details about this article) |
2/54. Spinal lesions, paraplegia and the surgeon.Thirty-six patients with spinal cord lesions and varying degrees of paraplegia were seen by the surgical team at the Angau Memorial Hospital, Lae, over a thirty month period. Because the continued presence of a spinal lesion may lead to progressive cord destruction and ischaemic myelopathy, prompt treatment is advocated. The depressing results that have followed treatment of fracture dislocations of the cervical spine and secondary neoplasm with paraplegia is recorded and some suggestions are made that may improve the outlook in future cases. Early and major surgery is advocated in the treatment of spinal abscesses, tumours, Pott's paraplegia and unstable fracture dislocations of the lumbar spine.- - - - - - - - - - ranking = 0.16023451184039keywords = fracture (Clic here for more details about this article) |
3/54. mycobacterium xenopi infection of the spine: a case report and literature review.STUDY DESIGN: A case report of mycobacterium xenopi. OBJECTIVES: To present a case report of a vertebral osteomyelitis caused by M. xenopi and to review the world literature on the subject. SUMMARY OF BACKGROUND DATA: M. xenopi is most commonly a pulmonary pathogen in immunosuppressed patients or those with underlying lung disease. infection of the spine is very rare, with only four cases reported. Three of these cases occurred in immunosuppressed patients, and the fourth in a patient with previous tuberculosis osteomyelitis of the spine. methods: The information was obtained from a review of the patient's clinical notes and follow-up appointments. RESULTS: The patient was a 73-year-old woman with an M. xenopi osteomyelitis of T6-T7, confirmed by magnetic resonance imaging and a computed tomography-guided biopsy. She was treated with surgical decompression and stabilization before a 2-year antibiotic regimen was begun. At follow-up assessment 1 year after the antibiotics were finished, she still had some ongoing back pain, but no evidence of relapse. CONCLUSIONS: This is the first reported case of an M. xenopi infection of the spine in a patient with no predisposing factors. This type of infection can be difficult to treat, with a high relapse rate reported despite prolonged courses of antibiotics.- - - - - - - - - - ranking = 1keywords = compression (Clic here for more details about this article) |
4/54. Management of tuberculomas of the craniovertebral junction.tuberculosis of the craniovertebral junction is extremely rare. However, recent evidence suggests that the incidence of this condition may be increasing in the United Kingdom. The diagnosis is often difficult despite advances in imaging using MRI. CT guided biopsy of lesions often yields inconclusive results. The transoral approach to the anterior craniovertebral junction provides excellent access to this region with a low operative morbidity and mortality, enabling biopsy of lesions and decompression of the neuraxis. Management of secondary atlantoaxial instability, regarding both timing and method of stabilization, is controversial. We report two cases of tuberculomas of the craniovertebral junction, that illustrate the role of transoral surgery in both diagnosis and treatment of this condition. Previous management strategies are reviewed and future recommendations are presented.- - - - - - - - - - ranking = 1keywords = compression (Clic here for more details about this article) |
5/54. Atlantoaxial tuberculosis: three cases.tuberculosis of the craniocervical junction (CCJ) is exceedingly rare but carries a risk of compression of the medulla oblongata and upper spinal cord. Three cases among 63 patients with spinal tuberculosis are reported. Mean age was 51 years (range, 20-69) and mean time to diagnosis was 4.6 months (range, 1-8). Although atlantoaxial dislocation was a consistent feature, none of the patients had neurological deficits. Computed tomography of the CCJ disclosed a suggestive pattern combining osteolysis and an abscess anterior to the spine. The diagnosis was confirmed by microbiological studies in two cases and histology in one. The outcome was favorable after antituberculous therapy, immobilization of the neck, and surgical fusion. Although tuberculosis remains common in developing countries, involvement of the CCJ is rare. tuberculosis of the CCJ carries a risk of instability and severe neuraxis compression. Consequently, early diagnosis and treatment are of the utmost importance.- - - - - - - - - - ranking = 2keywords = compression (Clic here for more details about this article) |
6/54. tuberculosis of the cervicodorsal junction.Sixteen patients had paraplegia due to tuberculosis of the cervicodorsal junction. Spinal decompression was performed through an extended lower cervical approach, and a humeral allograft was used to reconstruct the anterior column. All patients improved neurologically with satisfactory correction of the deformity and successful incorporation of the allograft.- - - - - - - - - - ranking = 1keywords = compression (Clic here for more details about this article) |
7/54. spinal cord compression, infection, and unknown primary cancers.The management of a patient with spinal cord compression can be complicated and challenging; however, this challenge becomes even more pronounced if the patient presents without a known cancer diagnosis in the context of progressive neurologic symptoms. Unless potential causes such as infection/tuberculosis are included in the differential diagnosis of an apparent unknown primary, then the correct diagnosis may be incorrectly determined.- - - - - - - - - - ranking = 5keywords = compression (Clic here for more details about this article) |
8/54. Surgery for expansion of spinal tuberculoma during antituberculous chemotherapy: a case report.We report a case of intramedullary spinal tuberculoma in a girl aged 2 years and 6 months. At the age of 18 months, the patient was hospitalized for 2 months with tuberculous meningitis. Tuberculomas then appeared in the thoracic spinal cord, and the patient developed paraparesis despite continuation of chemotherapy. Spinal magnetic resonance imaging demonstrated multiple ring-enhanced lesions in the cord on the T1-weighted image; on the T2-weighted image, the lesions had a bright core surrounded by a hypointense rim. laminectomy and partial excision were performed, and the paraparesis improved. In addition to antituberculous chemotherapy and dexamethasone, surgical decompression was needed to treat the expansion of the spinal tuberculoma.- - - - - - - - - - ranking = 1keywords = compression (Clic here for more details about this article) |
9/54. Tuberculous epidural granuloma simulating a herniated lumbar disc.A case of tuberculous epidural granuloma producing L5 root compression in a 37-year-old Negro male is presented. Excision of the granuloma and the administration of anti-tuberculous therapy was followed by complete recovery. Tuberculous epidural granuloma simulating a radicular syndrome is rarely seen. A search of the literature revealed only five previously reported cases.- - - - - - - - - - ranking = 1keywords = compression (Clic here for more details about this article) |
10/54. Cervico thoracic junction spinal tuberculosis presenting as radiculopathy.A case of cervico thoracic junctional area spinal tuberculosis presenting as painful radiculitis of the upper extremity is reported. The predominant symptom of radicular pain and muscle weakness in the hand, along with a claw deformity, led to considerable delay in diagnosis. The presence of advanced bone destruction with severe instability was demonstrated on the MRI scan done later. Surgical management by radical anterior debridement and fusion, along with chemotherapy, led to resolution of the upper extremity symptoms. The brachial plexus radiculopathy secondary to tuberculosis has not been reported. The absence of myelopathic signs even in the presence of advanced bone destruction, thecal compression and instability is uncommon in adults.- - - - - - - - - - ranking = 1keywords = compression (Clic here for more details about this article) |
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