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Abstract Objective To study the results of only posterior decompression and instrumentation in dorsal and dorsolumbar spine tuberculosis. Methods The patients (n = 30) who were included in this study had dorsal or dorsolumbar spine tuberculosis, with or without neurological deficit, and with or without deformity. All 30 patients were managed by only posterior approach decompression and instrumentation. We studied cases for correction and maintenance of deformity at dorsal and dorsolumbar spine, functional outcome by the Oswestry disability index (ODI) and visual analogue scale (VAS) scores, as well as neurological outcome by the Frankel grade. Results In the current series, 30 patients were operated with single stage posterior decompression and instrumentation, and showed significant improvement in neurological status and functional outcomes, which were accessed by the ODI score, VAS score, and Frankel grade. Conclusion The posterior (extracavitary) approach provides optimum access to the lateral and anterior aspects of the spinal cord for good decompression. It facilitates early mobilization and avoids problems of prolonged recumbency, provides better functional outcome, and significantly better sagittal plane kyphosis correction.
Resumo Objetivo Estudar os desfechos da descompressão posterior isolada e instrumentação na tuberculose da coluna dorsal e dorsolombar. Métodos Os pacientes (n = 30) incluídos neste estudo apresentavam tuberculose na coluna dorsal ou dorsolombar, acompanhada ou não por déficit neurológico e/ou deformidade. Todos os 30 pacientes foram tratados apenas por descompressão posterior e instrumentação. Estudamos a correção e manutenção da deformidade na coluna dorsal e dorsolombar, o desfecho funcional segundo o índice de deficiência de Oswestry (ODI) e a escala visual analógica (EVA); o desfecho neurológico foi estudado de acordo com a classificação de Frankel. Resultados Na atual série, 30 pacientes foram submetidos à descompressão posterior e instrumentação em estágio único e apresentaram melhora significativa no estado neurológico e desfecho funcional segundo os scores de ODI, EVA e classificação de Frankel. Conclusão A abordagem posterior (extracavitária) permite o acesso ideal aos aspectos laterais e anteriores da medula espinhal para uma boa descompressão. Facilita a mobilização precoce, evita problemas associados ao decúbito prolongado, proporciona melhor desfecho funcional e corrige a cifose no plano sagital de maneira significativamente melhor.
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Humanos , Discitis , Tuberculinum kochRESUMEN
Tuberculosis can involve almost any organ of the body. In the Central Nervous System (CNS) it can cause meningitis, tuberculoma, abscess,spondylitis, arachnoiditis, myeloradiculitis or other manifestations. Around 10% of all patients with tuberculosis have CNS involvement. Tuberculosis is rampant in the developing world and has reemerged as a major public health menace with the HIV pandemic. Compared with HIV-negative individuals, HIVpositive individuals with TB are 5 times more likely to have CNS involvement. Laboratory confirmation of CNS TB is difficult and hence empirical treatment has to be initiated as early as possible based on clinical and radiological features. In this article,we review the CNS manifestations of tuberculosis and their diagnosis and treatment
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BACKGROUND Spine tuberculosis is very common in the Indian people with high morbidity, although the Govt. of India has included treatment of the spine tuberculosis in pulmonary tuberculosis programme, the burden of the patients remained high. MATERIAL AND METHOD. Twenty patients with cervical and upper dorsal Pott’s spine were operated with anterior deidement, decompression, bone grafting, and instrumentation and were given ATT after wards and were followed for 6 months. OBSERVATION AND RESULTS. Seventeen ( 85.0%) of patients showed excellent–to–good results. The fusion rates for 1–level and 2–level anterior cervical corpectomy, and for anterior plate fixation were 100%. There were no postoperative deterioration neurologically and had minimum complication which resolved over weeks’ time. CONCLUSION. The improved fusion rate, low cost of the treatment with lower complication rates associated with anterior cervical plating may justify its use in the treatment of cervical and dorsal Pott’s associated myelopathies as the burden of tuberculosis in our country is large.
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Cataract is a major cause of decreased vision in elderly aged population. In rural areas till last decade small incision cataract surgery with IOL implantation is the only surgical option for treating cataracts. In recent past after introduction of the phacoemulsification with foldable IOL implantation is becoming popular surgical technique in urban areas. In our study conducted at rural eye center, phacoemulsification with IOL is gaining popularity over SICS with IOL. This shows increased awareness among the rural population towards minimal invasive surgery and latest surgical techniques regarding better recovery procedures.
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Introduction: Tuberculosis is increasing in the developing countries and re-emerging in the developed ones because of overcrowding and increase in of population. Spinal TB is the most clinically important form of extra-pulmonary tuberculosis, as it may produce serious neurological sequel due to compression of spinal cord by its excessive spread and involvement of spinal canal as a result of the disease itself, as well as the resultant deformity. Early recognition and prompt treatment are therefore necessary to minimize residual spinal deformity and or permanent neurological deficit. This retrospective study lightens and correlates the image morphology of spinal TB on MRI. Materials and methods: The study was done from January 2015 to June 2015 on 70 patients diagnosed with Tuberculosis of spine. MRI of spine was carried out in all the patients. MRI was done using a 1.5 tesla Philips system. MRI features were observed on T1W, T2W, Short tau inversion recovery (STIR) and post contrast (gadolinium) T1W sequences with sections in sagittal, coronal and axial planes. Results: This study showed that the most common clinical feature was back pain followed by deformity with most patients being afebrile. Most common vertebrae involved were dorsal followed by lumbar and the cervical with sacral being the least involved. Central type of vertebral lesion was common than paradiscal and rarely it involves posterior elements and inter vertebral disc. As compared to the other modalities soft tissue involvement, extent of lesion, type of lesion and Inter vertebral disc involvement are better visualised on MRI. Conclusion: MRI offers excellent visualization of the bone and soft tissue components of spinal tuberculosis and helps to identify disease at distant asymptomatic sites (skip lesions) before and accurately as compare to other modalities. MR imaging clearly demonstrated the extent of soft tissue Rathva A, Zala S. MRI is the gold standard investigation for early detection, extent of involvement and management of patient in Pott’s spine. IAIM, 2017; 4(1): 7-15. Page 8 involvement and its effect on the thecal sac/cord and neural foramen. It helps in early diagnosis and therefore management.
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Tubercular prevertebral abscess is rare presentation of pott’s spine in infancy. It can lead to life threatening airway obstruction and dysphagia requiring early diagnosis and proper management to prevent consequences. We present a case of 5 month child with tubercular prevertebral and epidural abscess who presented with dysphagia and stridor. Child responded dramatically to anti-tubercular therapy and surgical drainage of abscess. The child is doing well on follow up.
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Extra-pulmonary tuberculosis has shown an increasing trend in developing countries and accounts for 15-20% of total tuberculosis cases in India. Extra-pulmonary cases are usually diagnosed late due to vague and subtle signs & symptoms at a stage when major irreversible tissue damage had occurred. Tuberculosis is a chronic disease with infection remaining dormant for years in body to get activated whenever the immunity decreases. Spinal and cranial TB has the gravest manifestations, while the abdominal, female genital or pelvic TB poses a challenge because of lack of specific diagnostic tests. Here we are reporting a case of endometrial tuberculosis which was diagnosed very late, followed by treatment default and finally got complicated with Pott’s spine with paraplegia due to haematogenous spread. Timely intervention and anti-tubercular treatment improved the symptoms. It stresses on keeping the high suspicion of tuberculosis in unresponsive and persistent general symptoms.