Correlation between clinical, radiological and operative findings in management of tuberculous and pyogenic spondylitis

Spinal infection is a major category of spinal diseases that is difficult to differentiate clinically from degenerative diseases or spinal neoplasm. Evaluation of the vertebral osteomyelitis and tuberculous spondylitis need an accurate and specific imaging modality to guide the invasive procedures for a definitive microbiological diagnosis and to spare patients with other disorders that might mimic these entities as aggressive neoplastic lesions of the spine. The aim of this study was to determine the accuracy of MRI for discrimination between different types of spinal infections mainly between tuberculous spondylitis and pyogenic spondylitis. We did a retrospective study of MRI images of 30 patients who had confirmed spondylitis either tuberculous or pyogenic in their MRI of the spine. Then we correlate the clinical and operative findings with the preoperative radiology of the patients. Statistical analysis was performed with the Fisher exact test and Monte Carlo test. The incidence of the following MRI findings was significantly higher in patients with tuberculous spondylitis than in those with pyogenic spondylitis a well-defined paraspinal abnormal signal was present in 14 patients 88% in tuberculous spondylitis vs 4 patients 28% in pyogenic spondylitis, a thin and smooth abscess wall was present in 14 patients 88% in TB vs 2 patients 14% in pyogenic spondylitis, presence of paraspinal or intraosseous abscess [15 patients 93% in TB vs 6 patients 42% in pyogenic infection, subligamentous spread or more than two vertebral levels was detected in 12 patients 75% in TB vs 5 patients 35% in pyogenic spondylitis. thick and irregular abscess wall was present in 5 patients 35% in pyogenic spondylitis vs 0% in TB, a horizontal bandlike sparing of the body was present in 4 patients 28% in pyogenic spondylitis vs 0% in TB. Hyperintense signal on T2-weighted images was more commonly observed in tuberculous spondylitis 15 patients 93% in tuberculous vs 8 patients 57% in pyogenic. The accuracy and specificity of preoperative MRI diagnosis correlated to the postoperative pathological findings was 100% of both types of spondylitisMRI is an accurate and sensitive modality in diagnosis of spinal infection. It also has a high specificity in differentiation of tuberculous spondylitis and pyogenic spondylitis

Percutaneous vertebroplasty for osteoporotic fracture of dorsolumbar and lumbar vertebra: surgical technique and early outcome

Vertebroplasty is an image-guided, minimally invasive, nonsurgical procedure used to strengthen fractured spinal vertebrae that has been weakened by osteoporosis. A hollow needle [trocar] is passed into the fractured vertebral body and a cement mixture including polymethylmethacrylate [PMMA], barium powder and a solvent is injected. The cement mixture resembles toothpaste or epoxy. We monitor the entire procedure on a fluoroscopy imaging screen and make sure that the cement mixture does not enter into the spinal canal. Vertebroplasty is highly effective because the cement fills the spaces and strengthens the bone; it is less likely to fracture again. After vertebroplasty, the cement stabilizes the fracture, and also provides pain relief. Patients regain mobility within 24 hours and are usually able to reduce, or even eliminate, their pain medications within a short time. Vertebroplasty can increase the patient's functional abilities, allow a return to the previous level of activity, and prevent further vertebral collapse. The aim of the present work is to study the procedure of percutaneous vertebroplasty in regard to the surgical technique and the early outcome. If it is effective in relieving the pain caused by osteoporotic vertebral compression fracture of dorsolumbar and lumbar veterbra and also evaluate any complications that may occur during the procedure. The study was conducted on patients admitted to the main Alexandria University Hospital from January 2006 to 2008. We did plain x-ray lumbosacral spine AP and lateral view preoperative and postoperative for all the patients, MRI or CT LSS preoperative and CT LSS postoperative

Transforaminal lumbar interbody fusion: surgical technique and early outcome

Objectives: This study was done to evaluate the functional outcome of transforaminal lumbar interbody fusion [TLIF] as a new technique for treatment of spondylolisthesis and degenerated lumbar disc disease, and the early outcome of the patients

Methods: This prospective study was carried out on 10 adult patients suffering from of spondylolysis and degenerated lumbar disc disease. The patients were admitted to the Alexandria university hospital over a period of 15 months starting from January 2005 to March 2006. The female to male ratio was 3 to 2, their ages ranged from 32 till 55 years with mean age of 42,5. All patients suffered from low back pain, while 9 patients showed signs of root affection and radiculopathy. All patients were subjected to preoperative, dynamic plain X-ray study and MRI of the lumbosacral spine. Eight patients [80%] had spondylolysis and the rest two 2 patients [20%] had degenerated lumbar disc disease. The level L4-L5 was affected in 6 patients [60%] while the level L5-SI was affected in 4 patients [40%]

Results: There was no operative mortality, and surgery did not provoke any permanent neurological aggravation. CSF leak was the mostfrequent postoperative complication [10%].After surgery 8 patients [ 80%] improved, and one patient [10%] stabilized, and one case [ 10%] suffered from exaggeration of back pain postoperatively, also all the patients were independent. Preoperative Prolo score was 14.4 and after surgery was 15.9

Conclusion: TLIF is a less invasive, reliable and safe technique for interbody fusion that can be performed with a posterior approach. It allows good decompression with minimal nerve root retraction. It restore the disc space height with preservation of the lumbar lordosis and augmentation of the posterior tension band via a screw-rod construct