Cases reported "Tuberculosis, Spinal"

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1/72. Pott's disease with unstable cervical spine, retropharyngeal cold abscess and progressive airway obstruction.

    PURPOSE: retropharyngeal abscess formation has the potential for acute respiratory compromise from obstruction or secondarily from rupture. The initial attempt to secure the airway is of paramount importance. We describe a patient with an unstable cervical spine secondary to Pott's disease who developed progressively obstructing retropharyngeal cold abscess. CLINICAL FEATURES: A 33-yr-old man with an unstable C-spine in halo traction presented with progressive airway obstruction secondary to retropharyngeal abscess extending from the cervical to the mid-thoracic vertebrae. After review of computerized tomography (CT) and magnetic resonance (MR) studies, preparations were made to secure the airway through fibreoptic assisted intubation. A conservative approach was chosen to secure the airway before surgical airway control as a first line approach. Following local and topical anesthesia, awake endoscopy was performed to assess the extent of obstruction and possibility of intubation without abscess rupture. A narrow tract along the lateral pharynx was identified to continue inferiorly to the epiglottis, from which point the cords were visualized. Extensive edema and abscess formation otherwise distorted the normal anatomy and prevented visualization from other directions. The airway was successfully secured without trauma with a well-lubricated 7.0 mm ID endotracheal tube. CONCLUSION: This report suggests that selected cases of tense obstructing retropharyngeal abscesses can be effectively managed with fibreoptic endoscopy for assessment and subsequent intubation before requiring surgical airway control as a first line strategy.
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2/72. 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.
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3/72. retroperitoneal fibrosis and membranous nephropathy.

    We report on a patient with a past history of Pott's abscess who suffered both from a retroperitoneal fibrosis and a membranous glomerulonephritis. Five cases of retroperitoneal fibrosis and immune complex glomerulonephritis are already reported in the literature. These associations might result from a particular systemic immune response to an unknown antigen. Consequently, we consider the role of tuberculosis in our case.
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4/72. Tubercular retropharyngeal abscess in early childhood.

    We present two cases of Pott's lower cervical spine with retro-pharyngeal abscess presenting at an unusually young age. These children presented with a life threatening respiratory distress; one of them had neurological deficit in the form of paraparesis. External drainage of abscess without anterior cervical fusion was adequate as a surgical measure for their prompt recovery while these cases were on conventional anti-tubercular therapy.
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5/72. Multidrug-resistant tuberculosis spondylitis.

    We report a case of multidrug-resistant spinal tuberculosis complicated by epiduritis and paraspinal abscess in a 68-year-old black woman. Multidrug-resistant tuberculous spondylitis is still rare in belgium. Two others cases were reported from 1992 to 1997. The optimal therapy is not standardized and the mandatory duration of treatment is not known. Clinical presentation, radiological findings, and treatment are presented. The need for prompt diagnosis and optimal therapy is emphasized.
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6/72. Intramedullary tuberculosis manifested as brown-sequard syndrome in a patient with systemic lupus erythematosus.

    A 25-year-old girl presented with progressive deterioration of right side weakness with decreased sensation on the left trunk. She had been treated with high dose steroid due to autoimmune thrombocytopenia for 2 months. Clinical, laboratory and immunologic studies revealed that she had systemic lupus erythematosus (SLE), MRI of spinal cord showed marginal contrast enhancing and fluid containing mass in the cord of the C5-6 level, suggesting intramedullary abscess. She underwent surgery of mass removal with biopsy. The pathologic findings from cord tissues revealed numerous acid fast bacilli (AFB) in necrotic tissues. After surgery and anti-tuberculous treatment, her neurologic symptoms were markedly improved with restoration of right side motor weakness. To our knowledge, this is the first case report of intramedullary tuberculosis in a patient with SLE. Since intramedullary tuberculosis may sometimes mimic neurologic complication of SLE itself, it may pose diagnostic and therapeutic confusion for clinicians. We report a case of spinal cord tuberculosis affecting C5, 6 level which was manifested as brown-sequard syndrome in a patient with SLE.
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7/72. Pott's disease of the lower cervical spine in a diabetic patient.

    Over the last few years, tuberculosis has steadily been returning to the worlds attention as a major health threat. The spinal localization of tuberculosis (Pott's disease) represents around 1% of the case histories, in 3-5% of which there is cervical involvement. diabetes mellitus increases the risk of infectious disease and predisposes to tuberculosis. Here, a rare case is presented of Pott's disease in the lower cervical spine, associated with retropharyngeal abscess in a diabetic patient. The aim of this study is to emphasize the importance of early diagnosis in such patients, so that adequate pharmacological and/or surgical treatment can be initiated to avoid serious complications.
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8/72. Video-assisted thoracoscopic surgery in managing tuberculous spondylitis.

    The literature includes no studies on the use of video-assisted thoracoscopic surgery in the management of tuberculous spondylitis, and its role in the management of tuberculosis involving the thoracic spine remains unclear. The authors experience with 10 consecutive patients (six women, four men) who underwent video-assisted thoracoscopic surgery for the treatment of spinal tuberculosis involving levels from T5 to T11, from January 1996 to December 1997, was analyzed. Using the extended manipulating channel method (2.5-3.5 cm portal incisions), video-assisted thoracoscopic surgery was performed with a three-portal technique (seven patients) or a modified two-portal minithoracotomy technique that required a small incision for the thoracoscope and a larger incision, measuring 5 to 6 cm, for the procedures in three patients. All the patients were studied prospectively. The followup ranged from 17 to 42 months (mean, 24 months). postoperative complications included one lung atelectasis. Pleural adhesions, owing to local inflammation or paravertebral abscess, were seen in four patients and one patient with severe pleurodesis needed an open technique for treatment. Postoperative air leaks were seen in four (40%) of 10 patients but all were transient. The average neurologic recovery was 1.1 grades on the Frankel's scale. The data from this series of patients with tuberculous spondylitis show that video-assisted thoracoscopic surgery has diagnostic and therapeutic roles in the management of tuberculous spondylitis. Technically, a combination of thoracoscopy and conventional spinal instruments to perform video-assisted thoracoscopic surgery through the extended manipulating channels, which were placed slightly more posterior than usual, was effective and safe.
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9/72. 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.
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10/72. The results of anterior radical debridement and anterior instrumentation in Pott's disease and comparison with other surgical techniques.

    Classic procedure in the treatment of vertebral tuberculosis is drainage of the abscess, curettage of the devitalized vertebra and application of antituberculous chemotherapy regimen. Posterior instrumentation results are encouraging in the prevention or treatment of late kyphosis; however, a second stage operation is needed. Recently, posterolateral or transpedicular drainage without anterior drainage or posterior instrumentation following anterior drainage in the same session is preferred to avoid kyphotic deformity. Seventy-six patients with spinal tuberculosis were operated in the 1st Department of Orthopaedics and traumatology, Ankara social security Hospital, between January 1987 and January 1997. There were four children in our series. Average follow-up period was 36.1 /- 14.5 months and the average age at the time of operation was 40.8 /- 15.2 years. This study reports the surgical results of 45 patients with Pott's disease who had anterior radical debridement with anterior fusion and anterior instrumentation [14 patients with Z-plate and 31 patients with Cotrel-Dubousset-Hopf (CDH system)]. The results are compared with those of 8 patients who had posterolateral drainage and posterior fusion, 12 patients who had only anterior drainage and anterior strut grafting and, 11 patients who had posterior instrumentation following anterior radical debridement in the same session in terms of fusion rates, correction of kyphotic deformity, recurrence rate and clinical results. All patients had one year consecutive triple drug therapy. Preoperative 23.2 degrees /- 12.5 degrees local kyphosis angle was lowered to 6.1 degrees /- 6.9 degrees with a correction rate of 77.4 /- 22.3%. When the other three groups which had been instrumented were compared, the correction rates in the local kyphosis angle values were not statistically different and the variation in loss of correction at the last follow-up was also statistically insignificant. The sagittal contour of the involved vertebra's region did not change in the uninstrumented group, while it did so in instrumented groups which had normal range values postoperatively. overall, 27 patients had neurologic deficits preoperatively. Twenty of these (74.1%) had complete, and 5 (18.5%) had partial recovery with a combined 92.6% neurologic improvement. All the patients had a solid fusion mass at the last controls. Reactivation was not seen. Additionally, contrary to the common belief, anterior instrumentation which anterior autologous strut grafting following anterior radical debridement can be a good treatment option with low complication rate, high correction rate in acute local kyphosis, and high fusion rate.
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