A preliminary study on the surgical timing of spinal tuberculosis / 中国骨伤

OBJECTIVE@#To observe the changes of erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) and nerve function in patients with spinal tuberculosis before and after surgery, explore the timing of surgical intervention, and evaluate its influence on surgical safety.@*METHODS@#A retrospective analysis was conducted on 387 patients with spinal tuberculosis who received surgical treatment from March 2012 to March 2017, including 278 males and 109 females, aged 12 to 86 years old with an average of (49.9±19.1) years. There were 64 cases of cervical tuberculosis, 86 cases of thoracic tuberculosis, 76 cases of thoracolumbar tuberculosis and 161 cases of lumbar tuberculosis. There were 297 patients with single segmental involvementand 90 patients with multiple segmental involvement. Among them, 62 cases presented neurological damage, and preoperative spinal cord neurological function depended on ASIA grade, 5 cases of grade A, 8 cases of grade B, 39 cases of grade C, and 10 cases of grade D. According to the duration of preoperative antituberculosis treatment, the patients were divided into group A (256 cases, receiving conventional quadruple antituberculosis treatment for 2-4 weeks before surgery) and group B (131 cases, receiving conventional quadruple antituberculosis treatment for more than 4 weeks before surgery). The two groups were compared in terms of gender, age, preoperative complicated pulmonary tuberculosis, lesion site, lesion scope, surgical approach, drug resistance and other general clinical characteristics. ESR, CRP, visual analogue scale(VAS), Oswestry Disability Index (ODI), Frankel grade and postoperative complications were observed.@*RESULTS@#All 387 patients were followed up for 12 to 36 (18.3±4.5) months. There were no significant differences in gender, age, preoperative pulmonary tuberculosis, lesion site, lesion range, surgical approach, preoperative drug resistance and other characteristics between two groups. A total of 32 patients in two groups did not heal after surgery, with an incidence rate of 8.27%. The VAS and spinal cord dysfunction index of the two groups were significantly improved after surgery (@*CONCLUSION@#After 2-4 weeks of anti tuberculosis treatment before operation, patients with spinal tuberculosis could be operated upon with ESR and CRP in a descending or stable period. In principle, patients with spinal tuberculosis and paraplegia should be treated as soon as possible after active preoperative management of the complication without emergency surgery.

Minimally invasive direct lateral approach debridement, interbody bone grafting, and interbody fusion combined with posterior percutaneous pedicle screw fixation for lumbar spinal tuberculosis / 中国骨伤

OBJECTIVE@#To investigate the clinical efficacy and superiority of direct lateral interbody fusion combined with posterior percutaneous screw fixation in the treatment of lumbar tuberculosis.@*METHODS@#From June 2013 to August 2016, the clinical data of 83 patients with lumbar tuberculosis were retrospectively analyzed, including 55 males and 28 females, aged from 27 to 72 (49.5±13.5) years. These 83 patients were divided into two groups according to different operation methods, 35 cases in group A were treated with direct lateral interbody fusion combined with posterior percutaneous screw fixation;48 cases in group B were treated with anterior traditional extraperitoneal debridement combined with posterior internal fixation. After operation, regular quadruple antituberculosis drugs were continued for 18 months. The operation time, intraoperative blood loss, hospital stay, bone graft fusion time and complications were compared between the two groups. Visual analogue score (VAS) of lumbar pain, Oswestry Disability Index (ODI), sagittal Cobb angle, erythrocyte sedimentation rate (ESR) and C-reactive protein(CRP) values before and after operation were analyzed.@*RESULTS@#The operation was successfully completed in both groups, and the operation mode was not changed during operation. The operation time, intraoperative blood loss and hospital stay were (149.4±13.3) min, (354.3±69.0) ml, (9.4±1.6) d in group A and(116.8±10.0) min, (721.9±172.3) ml, (11.8±1.7) d in group B, respectively, with significant difference between the two groups (@*CONCLUSION@#The two kinds of operation can obtain satisfactory clinical effect. Direct lateral interbody fusion combined with posterior percutaneous screw fixation can reduce intraoperative blood loss and hospital stay, which is conducive to early rehabilitation of patients.

Comparative analysis of binding multi-fold rib graft, iliac bone graft and titanium mesh graft during surgery of tuberculosis of thoracic vertebra / 中国骨伤

OBJECTIVE@#To compare the clinical effects of three different methods of binding multi-fold rib graft, iliac bone graft and titanium mesh graft in tuberculosis of thoracic vertebra by approach of transverse rib process.@*METHODS@#A hundred and seven patients with tuberculosis of thoracic vertebra received surgical treatment from January 2010 to December 2016 were retrospectively analyzed. The patients were divided into three groups according different methods of bone graft. The surgical approach of the transverse rib process was used in all 107 patients, after thoroughly remove the necrotic tissue of tuberculosis, three different bone grafts were used respectively including iliac bone graft (36 cases, group A), binding multi-fold rib graft (35 cases, group B), titanium mesh bone graft (36 cases, group C). Perioperative indexes, the time required for bone graft during operation, intraoperation blood loss, the loss rate of the anterior edge of the lesion, Cobb angle, postoperative bone graft fusion time, spinal nerve recovery and Oswestry Disability Index were compared among three groups.@*RESULTS@#All the patients were followed up for 13 to 24 months, and the operation time required for bone graft was (23.2±4.1) min in group A, (23.8± 4.4)min in group B, and (25.5±4.2) min in group C, with no statistically significant difference among three groups (@*CONCLUSION@#The approach of transverse rib process for debridement of lesions can effectively treat tuberculosis of thoracic vertebra by binding multi-fold rib graft, iliac bone graft and titanium mesh graft, but binding multi-fold rib graft can effectively avoid iliac bone donor complications, and is an effective alternative to iliac bone graft, which is worth popularizing.

Percutaneous endoscopic debridement and irrigation for thoracic infections

SUMMARY OBJECTIVE: To investigate the safety and efficacy of percutaneous endoscopic debridement and irrigation for thoracic infections and to make an appropriate choice according to the patient's condition. METHODS. Thirty patients with thoracic infections who received surgical treatment from August 2014 to December2016 were retrospectively analyzed. There were 16 males and 14 females, aged from 41 to 90 years, with an average of 64.4 years. A total of 9 cases were treated with percutaneous endoscopic debridement and irrigation (minimal group), and 21 cases were treated with open debridement in combination with pedicle screw fixation (conventional group). Patients underwent follow-up for 1 month. General condition, operative index, laboratory results, and imaging features were recorded. RESULTS. Compared with the conventional group, there were more comorbidities in patients in the minimal group (8 cases in the minimal group, 10 cases in the conventional group, P=0.049), shorter hospital stay (10.1 + 2.26 days in the minimal group, 16.1 + 6.81 days in the conventional group, P=0.016), less bleeding volume (383.3 + 229.86ml in the minimal group, 90 + 11.18ml in the conventional group, P=0.000), lower VAS score at discharge (2.9 + 0.93 in the minimal group, 3.9 + 0.91 in the conventional group, P=0.013). There was no spinal instability case in the minimal group, 10 cases in the conventional group, P=0.013. There were significant differences. The C reaction protein prior to operation in the minimal group was 28.4±7.50mg/L. Compared with 45.1 + 15.78mg/L in the conventional group, P=0.005, it was lower. CONCLUSIONS. Percutaneous endoscopic debridement and irrigation are an effective surgery for treatment of thoracic infections, especially suitable for patients with comorbidities and poor general condition. However, for severe infection and spinal instability, we tend to choose open surgery in combination with fixation.

RESUMO OBJETIVOS: Investigar a eficácia e segurança de desbridamento endoscópico percutâneo e irrigação torácica para infecções e fazer uma escolha adequada de acordo com a condição do paciente. MÉTODOS: Trinta pacientes com infecção torácica que receberam tratamento cirúrgico de agosto de 2014 a dezembro de 2016 foram analisadosretrospectivamente. Havia 16 homens e 14 mulheres, de 41 a 90 anos, com uma média de 64,4 anos. Nove casos foram tratados com desbridamento endoscópico percutâneo e irrigação (grupo mínimo) e 21 casos foram tratados com desbridamento aberto em combinação com fixação do parafuso pedicular(grupo convencional). Os pacientes foram submetidos a acompanhamento durante um mês. Estado geral, índice operacional, resultados de laboratório e imagem e funcionalidades foram gravados. RESULTADOS: Em comparação com o grupo convencional, há mais comorbidades em pacientes do grupo mínimo (8 casos no grupo mínimo, 10 casos no grupo convencional, P = 0,049), menos tempo no hospital (10,1 + 2,26 dias no grupo mínimo, 16,1 + 6,81 dias no grupo convencional, P = 0,016), menos volume de sangramento (383,3 + 229,86 ml no grupo mínimo, 90 + 11,18 ml no grupo convencional, P = 0,000), menor pontuação no VAS a quitação (2,9 + 0,93 no grupo mínimo, 3,9 + 0,91 no grupo convencional, P = 0,013). Não houve nenhum caso de instabilidade espinhal no grupo mínimo, e 10 casos no grupo convencional, P = 0,013. Houve diferenças significativas. O nível de proteína C-reativa antes da operação no grupo mínimo era de 28,4±7,50mg/L. Em comparação com 45,1 + 15,78 mg/L no grupo convencional, P = 0,005, era mais baixa. CONCLUSÃO: O método de desbridamento endoscópico percutâneo e irrigação é eficaz para o tratamento de infecções em cirurgia torácica, especialmente adequado para pacientes com comorbidades e mau estado geral. Mas, para a infecção grave e instabilidade vertebral, tendemos a escolher a cirurgia aberta em combinação com a fixação.

Evaluation of Outcome of Posterior Decompression and Instrumented Fusion in Lumbar and Lumbosacral Tuberculosis

BACKGROUND: For surgical treatment of lumbar and lumbosacral tuberculosis, the anterior approach has been the most popular approach because it allows direct access to the infected tissue, thereby providing good decompression. However, anterior fixation is not strong, and graft failure and loss of correction are frequent complications. The posterior approach allows circumferential decompression of neural elements along with three-column fixation attained via pedicle screws by the same approach. The purpose of this study was to evaluate the outcome (functional, neurological, and radiological) in patients with lumbar and lumbosacral tuberculosis operated through the posterior approach. METHODS: Twenty-eight patients were diagnosed with tuberculosis of the lumbar and lumbosacral region from August 2012 to August 2013. Of these, 13 patients had progressive neurological deterioration or increasing back pain despite conservative measures and underwent posterior decompression and pedicle screw fixation with posterolateral fusion. Antitubercular therapy was given till signs of radiological healing were evident (9 to 16 months). Functional outcome (visual analogue scale [VAS] score for back pain), neurological recovery (Frankel grading), and radiological improvement were evaluated preoperatively, immediately postoperatively and 3 months, 6 months, and 1 year postoperatively. RESULTS: The mean VAS score for back pain improved from 7.89 (range, 9 to 7) preoperatively to 2.2 (range, 3 to 1) at 1-year follow-up. Frankel grading was grade B in 3, grade C in 7, and grade D in 3 patients preoperatively, which improved to grade D in 7 and grade E in 6 patients at the last follow-up. Radiological healing was evident in the form of reappearance of trabeculae formation, resolution of pus, fatty marrow replacement, and bony fusion in all patients. The mean correction of segmental kyphosis was 9.85° postoperatively. The mean loss of correction at final follow-up was 3.15°. CONCLUSIONS: Posterior decompression with instrumented fusion is a safe and effective approach for management of patients with lumbar and lumbosacral tuberculosis.

Mal de Pott en un indígena colombiano / Pott´s disease in a Colombian indigenous man

Cada año mueren alrededor de dos millones de personas a causa de la tuberculosis y se estima que un tercio de la población mundial está infectada con el bacilo que la causa, pero solo entre 5 y 10 % desarrolla la enfermedad. El riesgo de que la enfermedad progrese al estado activo depende de factores endógenos y exógenos. Las comunidades indígenas son un grupo con un alto riesgo de infectarse y enfermar de tuberculosis; además de factores como el aislamiento geográfico, el abandono social y cultural y la desnutrición, se han identificado en ellos polimorfismos genéticos que los hacen más propensos a la infección. La tuberculosis vertebral es la forma más destructiva de la enfermedad y representa cerca de la mitad de los casos de tuberculosis esquelética. Se presenta el caso de un paciente indígena colombiano con tuberculosis vertebral y resultado negativo para HIV. El diagnóstico se basó en los hallazgos clínicos y en los estudios de imaginología, y se confirmó mediante la prueba molecular rápida Genotype MTBDR plus ® y de la reacción en cadena de la polimerasa PCR IS6110; el cultivo fue negativo a las 16 semanas de incubación. Se discuten brevemente la patogénesis, el diagnóstico y el tratamiento, y se comentan algunos aspectos relacionados con la situación de la tuberculosis en las comunidades indígenas colombianas.

Approximately 2 million people die each year from tuberculosis. One third of the world´s population is estimated to be infected with the tuberculosis bacillus, although only 5-10% will develop the disease in their lifetime. The disease progression risk depends on endogenous and exogenous factors. Indigenous communities are a high-risk group for infection and development of tuberculosis. In addition to factors such as geographical isolation, social and cultural neglect and malnutrition, susceptibility to genetic polymorphisms has been identified in them. Spinal tuberculosis is the most destructive form of the disease, which represents approximately half of all cases of skeletal tuberculosis. The case of an HIV negative, indigenous Colombian man is presented. His diagnosis was done based on clinical and image findings, and it was confirmed with the rapid molecular assay Genotype MTBDRplus ® and IS6110 PCR.The culture in solid media was negative after 16 weeks. We briefly discuss the pathogenesis, diagnosis and treatment. Finally, we comment on some aspects of the situation of tuberculosis among indigenous Colombian communities.

Spinal tuberculosis in western mexico, 2008-2013 / Tuberculose da coluna vertebral no oeste do méxico, 2008-2013 / Tuberculosis espinal en el occidente de méxico, 2008-2013

Objective: To identify the prevalence, clinical features and postoperative outcome of patients with spinal tuberculosis at the Instituto Mexicano del Seguro Social, in Jalisco, Mexico from 2008 to 2013. Methods: Prevalence study of patients undergoing spine surgery due to tuberculosis. Clinical, surgical pre- and postoperative parameters were evaluated by analysis of 41 medical records. Results: Seventeen (41.4%) were women and 24 (58.6%) were men with a mean age of 47.7 years. The main diagnoses were tuberculous spondylitis in 14 (34.1%) patients; discitis in 13 (31.7%); infectious spondylitis in 9 (21.9%); chronic spondylitis in four (9.7%); abscess in one patient (2.4%). Only 22% of patients were positive for epidemiological study of tuberculosis contacts. The most affected region was the lumbar spine followed by the thoracic spine and the most affected vertebrae were L3-L4. The most used surgical instrumentation was by posterior approach with drainage on 29 occasions, anterior approach with drainage in nine, and the mixed approach in three. Twenty-nine patients were independent to perform daily activities after discharge. Conclusion: The discitis or infectious spondylodiscitis should be considered in any patient with localized pain at any level of the spine. Once solved the problem of infection and stability, patients respond favorably to the surgical procedure. .

Objetivo: Identificar a prevalência, as características clínicas e a evolução pós-cirúrgica de pacientes com tuberculose vertebral do Instituto Mexicano del Seguro Social, em Jalisco, México, no período de 2008 a 2013. Métodos: Estudo de prevalência de pacientes submetidos a cirurgia de coluna vertebral devido à tuberculose. Foram avaliados os parâmetros clínicos, cirúrgicos, pré e pós-operatórios pela análise de 41 prontuários médicos. Resultados: Dezessete (41,4%) eram mulheres e 24 (58,6%) homens, com média de idade de 47,7 anos. Os principais diagnósticos foram: espondilite tuberculosa em 14 (34,1%) pacientes; discite em 13 (31,7%); espondilite infecciosa em 9 (21,9%); espondilite crônica em 4 (9,7%); abcesso em 1 paciente (2,4%). Somente 22% dos pacientes eram positivos para estudo epidemiológico de contatos tuberculosos. A região vertebral mais afetada foi a lombar, seguida pela torácica e as vértebras mais acometidas foram L3-L4. A instrumentação cirúrgica mais utilizada foi por via posterior com drenagem em 29 ocasiões, pela via anterior com drenagem em nove e pela via mista em três ocasiões. Vinte e nove pacientes apresentaram independência nas atividades diárias depois da alta hospitalar. C...

Objetivo: Identificar la prevalencia, las características clínicas y la evolución post quirúrgica de los pacientes con tuberculosis espinal del Instituto Mexicano del Seguro Social en Jalisco, México de 2008 a 2013. Métodos: Estudio de prevalencia con pacientes sometidos a cirugía de columna por tuberculosis. Se evaluaron aspectos clínicos, quirúrgicos, pre y post operatorios, mediante la revisión de 41 registros médicos. Resultados: Diecisiete pacientes (41,4%) fueron mujeres y 24 (58,6%) hombres, con una edad promedio de 47,7 años. Los diagnósticos principales fueron: espondilitis tuberculosa en 14 (34,1%) pacientes; discitis en 13 (31,7%); espondilitis infecciosa en 9 (21,9%); espondilitis crónica en 4 (9,7%) y absceso en 1 paciente (2,4%). Únicamente el 22% de los pacientes fueron positivos para la prueba epidemiólogica de Combe. La región vertebral más afectada fue la lumbar seguida por la torácica y las vértebras más frecuentemente afectadas fueron L3-L4. La instrumentación quirúrgica más utilizada fue la vía posterior con drenaje en 29 ocasiones, la vía anterior más drenaje en nueve y vía mixta en tres. Veintinueve pacientes presentaron independencia en sus actividades diarias después de su alta. Conclusión: ...

Result of surgical decompression and internal fixation with titanium cage in patients with carries spine

The objective of the study is to assess, the postoperative outcome of the intervertebral titanium cage, in patients operated for Caries spine with unstable spine with/without neurological deficits. This is a retrospective study, carried out in department of Neurosurgery Sheikh Zayed Hospital, Rahim Yar Khan, during 2 years, from January 2006 to December 2007. All patients underwent a neurological and radiological assessment. Those patients who had collapse of vertebral body/s, with/without gibbus formation having some neurological deficit were included. Patients fit for surgery, were operated upon, with placement of intervertebral adjustable titanium cage. These patients were followed up for eighteen months. The study comprised of 11 patients, with their age ranging from 20 to 53 years having 7 males and 4 females. The patients were admitted through OPD or the emergency department in neurosurgical ward of Sheikh Zayed hospital, Rahim Yar Khan. The majority of the patients had D10-11 lesion [36.3%] followed by L2 in 18.1%. The neurological status of the patients received showed paraplegia in 27.27% while paraparesis in 72.72% of patients. The neurological outcome of 11 patients, after eighteen months of follow up, showed marked improvement in 72.72% patients of incomplete spinal cord compression [paraparesis]. While some improvement in 27.27% patients of complete spinal cord damage [paraplegia]. All patients with kyphotic lesions had near normalization of the anatomical curve of the spine. All patients were kept on antituberculous chemotherapy for one year. Our experience with usage of the titanium cage for internal fixation in Caries spine showed very promising results, especially in patients of paraperesis with/without gibbus formation. This technique may become a main stay of surgical management in Caries spine for thoracolumber region in our setup

Anterior spinal decompression and bone grafting in densely paraplegics due to tuberculosis

Spinal tuberculosis is a common problem in neurosurgery practice and is endemic in the third world countries like Pakistan. Present study was therefore designed to assess the results of anterior spinal decompression and bone grafting in densely paraplegic patients due to tuberculosis. This prospective observational study was conducted in Department of Neurosurgery, Government Lady Reading Hospital, Peshawar from April 2003 - May 2007. Thirty-six paraplegic patients with spinal tuberculosis were admitted and operated. Clinical and demographic characteristics of patients like name, age, sex and duration were documented. All necessary investigations like x-ray, CT scan, MRI and histopathology along with biochemical and haematological studies for diagnostic purpose were documented. Clinical criteria, operative findings, procedures and postoperative outcome of these patients were also assessed. Thirty-six cases with paraplegia due to spinal tuberculosis were operated. Excellent results [where patients were well without neurologic deficit] were achieved within 2 months in 27[75%] patients, while good [where neurologic deficits were still impaired] results were seen in 9[25%] cases within a 6 months duration. Anterior spinal decompression and fusion with bone graft has excellent results in paraplegic patients due to tuberculosis

Tuberculosis ósea en columna vertebral evolución clínica y tratamiento realizado en el Hospital Escuela Oscar Danilo Rosales Arguello enero del 2000-diciembre 2008 / Tuberculosis spine bone in clinical course and treatment at the Hospital Escuela Oscar Danilo Rosales Arguello January 2000-December 2008

Se realizo estudio tipo descriptivo serie de casos y tienen como objetivo describir el comportamiento clínico y pautas de tratamiento en pacientescon tuberculosis ósea en columna vertebral ingresados en el departamento de Ortopedia y Traumatoloiga del Hospital Escuela Oscar Danilo Rosales en el período comprendido de enero del 2000 hasta diciembre del 2008 identificando las caracateristicas socio demográficas, clinicas, determinando estudios radiologicos, microbiologicos y de laboratorio y pautas terapeúticas. Se identificaron trece casos diagnósticados como tuberculosis extrapulmonar de los cuales siete eran de Mal de Pott teniendo cmo resultados que la mayoria de los pacientes afectados en el presente estdio fueron del sexo femenino, de procedencia urbana y entre los 20 y 64 años. El estudio Surrel II fue el mas frecuentemente encontrado. El segmento lumbar fue el nivel más afectado. Todos los pacientes del estudio recibieron tratamiento antitifico. A la mayor partre de los casos se les practico ciruga espinal mediante abordaje anterior, mas injerto óseo. En los dos casos sometidos a procedimientos quirúrgicos, se realizaron con una duraciòn promedio de mas de 2 horas. Al momento del ingreso, la mayor parte de los pacientes encontraron con un estado neurologico Frankel D2. Al Año del procedimiento quirurgico la mayoria de los casos obtuvo mejoria clinica presentando un estado neurologico Frankel E. Los pacientes no sometidos a cirugia se les procedieron a colocar corsé...

Anterior instrumentation for cervical spine tuberculosis: an analysis of surgical experience with 61 cases.

OBJECTIVE: To evaluate the efficacy of anterior instrumentation in patients with subaxial and cervicodorsal spinal tuberculosis in reconstruction of the spine, providing pain relief, neurological recovery and prevention of deformity. MATERIALS AND METHODS: The records of 61 consecutive patients, of surgically treated spinal tuberculosis affecting C3 to D2 region, in our neuro and spinal surgery unit over a five-year period were retrospectively reviewed. Patients with involvement of the C3-C6 vertebrae underwent excision of the involved vertebrae and intervertebral discs followed by reconstruction with titanium implants by anterior approach. A transclavicular approach was used for patients with involvement of the C7-D2 vertebrae. A five-drug antituberculous regimen was administered for a period of one year. The follow-up ranged from 24 to 84 months (mean 38 months). Clinical and radiological assessment using flexion and extension radiographs was performed at 24 months for all cases. RESULTS: The neck pain score based on a visual analog scale (1-10) changed from a pre-operative average of 7 to 2 at follow-up after 4 months. Fifty-two patients (85%) had complete relief of pain while 16 patients who had Grade III to IV muscle strength regained complete power. The asymmetric wasting in patients with involvement of the cervicodorsal region did not recover completely. Flexion-extension radiographs at 24 months did not show any evidence of instability or nonunion. CONCLUSIONS: Anterior reconstruction using titanium plates and locking screws for stabilization of the subaxial and cervicodorsal region tuberculosis is a useful adjunct in preventing kyphotic deformity. A satisfactory segmental stability and fusion is achieved by this technique.

Treatment of tuberculous spondylitis at the cervicothoracic junction. Clinical impact of surgery by means of sternotomy

The operative treatment of tuberculous spondylitis remains a challenge with regard to the surgical approach to the cervicothoracic junction. In addition, it is difficult to restore the resected vertebral bodies. Two cases of tuberculous spondylitis in this area are presented. The first case concerns a 25-year-old African patient suffering from the effects of tuberculous spondylitis: Destruction of vertebral bodies dorsal [D]1, D2, and D3, kyphosis coupled with compression of the spinal cord, as well as incomplete motor and sensory paraplegia [Frankel grade C]. The operative treatment of tuberculous spondylitis that is described, approached the cervicothoracic junction by means of a sternotomia. Corpectomy of vertebral bodies D1 through D3 were followed by their restoration with the help of a titanium cage. As a result, the paraplegia disappeared. Ventral decompression was followed by dorsal instrumentation. The results of the operation are decompression of the spinal cord, correction of the kyphosis, and stable fusion followed by restitution of the paraplegia. Primary stability was provided by the use of a titanium cage and dorsal instrumentation. There was no need for an external brace. There was no loss of correction 3 years after the operation. The 2nd case concerns a 49-year-old European patient suffering from thoracic pain radiating around the chest. A partial destruction of D2 and D3 with kyphosis and compression of the spinal cord because of a tuberculous spondylitis were detected, neurological deficits were not found. The corpectomy of D2 and D3 were proceeded by means of a sternotomy, the defect was restored with the help of a titanium cage. Due to the use of a ventral Morscher plate an additional dorsal instrumentation was not necessary. The patient was fixed in a minerva plaster for 3 months. There was no loss of correction 2 years after the operation. Both patients are manual workers and postoperatively adapted to their former work

Tratamiento quirúrgico de los procesos de columna dorsal por vía transtorácica / Surgical treatment of the dorsal column processes by transthoracic approach

La vía transtorácica para el abordaje de procesos vertebrales torácicos con paraplejia es de gran utilidad en el tratamiento del mal de Pott, principalmente en países con tasas elevadas de tuberculosis extrapulmonar, y de tumores bronquiogénicos o metastásicos que comprometen a la columna vertebral. Con esta técnica se puede alcanzar el sitio de origen del proceso y permitir resecar los tejidos anormales que comprometen la integridad de la médula espinal, pudiendo restablecer en algunos casos con paraplejía la movilidad musculas y las funciones de la neurona motora inferior. Diversos procesos pueden ser abordados con esta técnica. En los casos presentados no hubo complicaciones postoperatorias. El tratamiento quimioterápico antituberculoso influye favorablemente en los casos de mal de Pott.

Espondilitis tuberculosa de ubicación no habitual: a propósito de un caso / Atypical form of spinal tuberculosis

Se presenta una paciente de 41 años con dolor lumbar de 20 meses de evolución, al que se agregó impotencia funcional y parestesia de miembros inferiores. La Tomografía Axial Computada de columna lumbosacra sin y con contraste evidenció compromiso óseo y de partes blandas. El examen directo del material obtenido por punción aspirativa bajo guía Tomografía Computada fue positivo para BAAR. Se reporta un caso de espondilodiscitis tuberculosa de ubicación no habitual, revisión bibliográfica y diagnósticos diferenciales

Spinal tuberculosis easy to diagnose; difficult to manage

The author reviewed 60 cases of spinal tuberculosis treated from Jan 1993 to Jan 1995 at Lahore General Hospital, Clinical findings included back pain in 47[79%] paraparesis in 40[66%] and Kyphosis in 31[52%] patients, less common features included fever, sensory disturbance and sphincter dysfunctions. Predominant vertebral body involvement was present in 26 [43%] and marked bone collapse in 11 [18%] patients. Intraspinal granulomatous tissue causing neurological dysfunction in the absence of bone destruction was seen in 33[55%] cases. All 60 patients received antituberculous medications. Laminectomy and debridement of extra granulomatous tissue or abscess drainage was done in 43 [71%] patients, laminectomy and bracing in 8.3%, biopsy followed by bracing in 11.6% and bracing only in 3.3%. We didn't perform internal stabilization in any of our patients. An average follow-up time of 6 months course of antituberculous therapy [ATT] shorter than six months were invariably associated with disease recurrence. It is suggested that any young female from poor social background with backache and positive family history of tuberculosis should be examined and investigated fully for tuberculous spine and managed with appropriately selected treatment modality and compliance of the patient. Satisfactory outcome can be obtained in majority of patients

Personal experience in posterior spinal fixation approach for patients with spinal tuberculosis

This study consisted of 20 consecutive patients of spinal tuberculosis treated in the period from January 1993 till October 1996. 12 patients were males and 8 were females. The age of presentation ranged from 34 to 72 years with mean age 46 years. The clinical presentation included persistent mid- or low back pain and tenderness in 20 patients, paraparesis in 9 and kyphosis in 12. All patients were treated by antituberculous chemotherapy together with posterior approach. The mean follow-up period was 24 months [range 12-36 months]. All patients showed clinical and radiological evidence of fusion. 7 patients had improvement in motor power and 12 in the angle of kyphosis. There was 91% initial correction and 79% final correction of kyphosis. With chemotherapy, posterior approach provide satisfactory results in selected patients of spinal tuberculosis to achieve treatment goals including correction and maintaining correction of spinal deformity

Mal de Pott torácico com abscesso mediastinal: relato de caso / Pott's disease with mediastinal abscess: report of case

Relatamos um caso de Mal de Pott, diagnosticado em um paciente de 9 anos, internado com quadro de paraparesia progressiva. A tomografia e a ressonância magnética mostraram lesäo expansiva no mediatino posterior, com extensäo intrarraquiana e destruiçäo óssea (T3 a t6). O paciente foi submetido a tratamento cirúrgico por via postero-lateral. O exame anatomopatológico revelou tratar-se de processo granulomatoso tuberculoso. A ressonância magnética, realizada no pós-operatório, mostrou diminuiçäo acentuada da lesäo, com regressäo da compressäo medular. O paciente recebeu alta hospitalar com melhora neurológica importante, medicado com esquema tríplice por 1 ano, e com colete cérvico torácico

Mal de Pott: tratamento clínico e cirúrgico / Pott's disease: clinical and surgical treatment

Foram analisados os prontuários de 22 pacientes atendidos no período de março de 1983 a março de 1993, diagnosticados como portadores de tuberculose vertebral. Destes, três foram excluídos, por näo terem retornado para controle ambulatorial. Todos os pacientes tratados fizeram uso de quimioterapia tríplice (rifampicina, isoniazida e pirazinamida) e colete gessado por período mínimo de seis meses. Apenas dois pacientes foram submetidos a tratamento cirúrgico associado à quimioterapia e imobilizaçao gessada. Os procedimentos cirúrgicos foram: a) drenagem cirúrgica do abscesso por via anterior (caso 15); b) drenagem do abscesso, descompressao medular e artrodese com enxerto ósseo de perônio e ilíaco em chips por via anterior (caso 11). Apesar da utilizaçäo de métodos conservadores na maioria dos casos (17 pacientes), o índice de bons resultados foi semelhante aos descritos na literatura, com a realizaçäo de procedimentos cirúrgicos. Essa constataçäo é de grande importância em nosso contexto, onde as condiçöes socioeconômicas dificultam os procedimentos invasivos.