Mal de pott en la provincia del Chaco / Pott’s disease in the province of Chaco

Introducción: la tuberculosis es la séptima causa de muerte mundial. Menos del 1% de los pacientes tiene compromiso raquídeo. El objetivo del estudio fue investigar la frecuencia del mal de Pott en la provincia e identificar pautas para regiones similares. Materiales y Métodos: Rastreo de pacientes internados por tuberculosis entre 1996 y 2014, en Hospitales provinciales de cabecera. Revisión de historias de casos raquídeos. Clasificaciones de Frankel y del GATA. Datos de censos nacionales. Revisión bibliográfica. Resultados: Catorce casos: 8 varones/6 mujeres. Edad promedio: 35.4 años (rango 3.8-63). Seguimiento: 2.8 años (1 mes-15 años); un óbito posoperatorio inmediato. Siete pacientes provenían de Departamentos con baja carga de morbilidad de tuberculosis. Síntomas iniciales: déficit neurológico (9 casos), dolor axial o radicular puro (4 casos) y deformidad vertebral pura (1 caso). Frankel al ingreso: E (5 casos), D (2), C (2) y A (5). Localizaciones: torácica, 5; toracolumbar, 6; lumbar, 1; múltiple 2 pacientes. Distribución étnica: 5 caucásicos, 5 aborígenes, 3 criollos, 1 mestizo. Según la Clasificación del GATA: 1 lesión de tipo IB; 4 de tipo II; 8 de tipo III; 1 caso inclasificable. Los pacientes de etnia originaria tuvieron cuadros neurológicos y lesiones GATA más graves. Doce fueron operados; 5 presentaron deformidad secuelar, sin diferencias entre doble instrumentación, instrumentación posterior aislada o sin instrumentación. Al seguimiento: 8 pacientes asintomáticos, 4 fallecidos y 2 con síntomas moderados; no hubo deterioros neurológicos y solo 5 mejorías. Conclusiones: En pacientes de etnia originaria son más frecuentes las formas graves, las presentaciones avanzadas y de tratamiento quirúrgico habitual. La mortalidad es alta.

Introduction: tuberculosis is the seventh leading cause of death. Spinal involvement represents <1% of cases. The objective was to investigate the frequency of Pott´s disease in our province, to typify its profile and to identify guidelines for similar regions. Methods: Identification of all tuberculosis admissions from 1996 to 2014 in the main referral hospitals of our province. Medical records review of all cases with spinal involvement. Frankel and GATA classifications. Data from last national census. Literature review. Results: Fourteen cases: 8 males/6 females. Average age: 35.4 years (range 3.8-63). Follow-up: 2.8 years (range 1 month-15 years); one immediate postoperative death. Seven patients came from low tuberculosis burden Departments. Initial symptoms: neurological impairment (9 cases), pure axial and/or radicular pain (4 cases) and pure spine deformity (1 patient). Initial Frankel: E, 5 cases; D, 2; C, 2; and A, 5 patients. Localization: thoracic, 5; thoraco-lumbar, 6; lumbar, 1; multiple 2 patients. Ethnic distribution: 5 caucasians, 5 natives, 3 creoles, 1 mestizo. According to GATA classification: 1 type IB lesion; 4 type II; 8 type III; one unclassifiable case. Native patients had more severe neurological and GATA lesions. Twelve patients were operated on; 5 had residual deformities without differences among double instrumentation, isolated posterior instrumentation and no instrumentation. At follow-up: 8 asymptomatic cases, 4 deceased and 2 patients with moderate symptoms. No neurological worsening was observed; only 5 patients improved. Conclusions: Severe forms, and advanced and common surgical presentations are more frequent in native patients. Mortality is high.

Mal de Pott chez l'enfant : aspects épidémiologiques, cliniques et thérapeutiques en chirurgie pédiatrique à Cotonou

Introduction : Le mal de Pott est une forme grave de tuberculose extra-pulmonaire à cause du risque de lésions neurologiques. Patients et méthodes : Il s'est agi d'une étude rétrospective menée sur 10 ans (janvier 2006 à décembre 2015) dans le service de chirurgie pédiatrique du Centre National Hospitalier et Universitaire Hubert Koutoukou Maga (CNHU-HKM). Nous avons étudié ses caractéristiques épidémiologiques, cliniques et thérapeutiques chez des sujets âgés de 0 à 15 ans. Résultats : Il a été colligé 20 cas, soit 2 cas/an. L'âge moyen des enfants était de 5,5 ans avec des extrêmes de 9 mois et 15 ans. Ceux de moins de 5 ans étaient les plus atteints (14 cas). Le sex-ratio était de 3. Les douleurs rachidiennes (10 cas) et les tuméfactions du dos (8 cas) étaient les principaux motifs de consultation. La fièvre et la douleur provoquée à la palpation des épineuses vertébrales étaient les signes cliniques les plus résents chacun dans 16 cas/20. Des signes neurologiques étaient notés dans 8 cas. Les signes radiographiques étaient dominés par l'ostéolyse vertébrale et le pincement de l'interligne articulaire. Il a été identifié 1 cas d'image en fuseau. Les lésions siégeaient essentiellement sur le rachis lombaire (8 cas). Le traitement était spécifique et orthopédique. L'évolution était favorable chez 16 patients après un recul moyen de 86 mois. Conclusion : Le mal de Pott est une affection qui doit être vite diagnostiquée et traitée afin d'en éviter les complications qui sont redoutables

Spinal tuberculosis; A study of the disease pattern, diagnosis and outcome of medical management in Sri Lanka.

Background: Sri Lanka has an intermediate burden of tuberculous disease. Most patients with spinal tuberculosis (STB) are managed with medical treatment alone as advanced surgical facilities are not freely available. Objective: To describe the clinico-demographic and imaging pattern of STB and to assess the outcome of medical treatment in the local setting. Design: Descriptive case series. Methods: All patients diagnosed with definite or probable STB, had their symptomatology and investigations recorded. They were followed up with anti-TB treatment (ATT) according to standard guidelines. An initial six-week tapering course of steroid was given when there was an evidence of neural involvement. Results: Of 32 patients with STB, backache was the commonest presenting feature (92%). Nine had lower limb neurological deficits. Uni-focal upper lumbar involvement was the commonest disease pattern noted in the series. High ESR (84%) and Mantoux positivity (53%) were frequent. 72% had end-plate changes on imaging. 53% had paraspinal soft tissue components. The triad of backache, high ESR and end-plate and/or paraspinal disease on CT/MRI showed a diagnostic sensitivity of 81.2%. Response to ATT was satisfactory in 87%. Poor neurological response was seen among some with large paraspinal collections or extensive vertebral damage at diagnosis. Conclusion: This study showed that backache over one month, high ESR and specific CT/MRI features helped diagnosis of STB, in the absence of definitive evidence. Medical management alone, comprising a prolonged course of ATT with an initial steroid cover when indicated, appeared to be safe and effective in the local setting for uncomplicated STB.

Espondilitis tuberculosa en adultos: revisión de una serie de casos en un hospital de tercer nivel, Lima-Perú / Tuberculous spondylitis in adults: a case series from a reference hospital in Lima, Peru

Describimos las características clínicas y demográficas en pacientes adultos con espondilitis tuberculosa así como un análisis exploratorio que buscó establecer características que contribuyeron al desarrollo de esta enfermedad, en un hospital de tercer nivel de Lima. Realizamos un estudio tipo serie de casos y describimos 33 casos recolectados entre 1999-2009. 18 pacientes (55 por ciento) fueron varones, la media de edad fue 31 años (IQ 23 a 51 años) y un tiempo de enfermedad de 3 meses (IQ 1 a 8 meses). El principal síntoma fue lumbalgia en 28 (85 por ciento). Los segmentos más comprometidos fueron el torácico en 28 (60 por ciento) casos y lumbar en 13 (28 por ciento). Tuberculosis pulmonar se encontró en 14 (42 por ciento) casos. Veinticuatro (73 por ciento) recibieron esquema I. La duración de tratamiento fue 10,5 ± 4,2 meses . Las características clínicas, diagnósticas fueron similares a series nacionales previas e internacionales.

We describe the demographic and clinical characteristics of adult patients with tuberculous spondylitis as well as an exploratory analysis that seeked to establish patient characteristics that contributed to the development of this disorder at a reference hospital in Lima. This is a case-series descriptive study where data collection from 33 medical records of patients from 1999 to 2009 was done. Eighteen (55 percent) were male. Median age was 31 years (IQR 23 to 51 years). Median time of symptoms was 3 months (IQR 1 to 8 months). The most frequent symptom was back pain in 28 (85 percent). The most frequently affected areas were the thoracic spine involved in 28 (60 percent) cases and lumbar spine in 13 (28 percent). Pulmonary tuberculosis was present in fourteen (42 percent) cases. Twenty four (73 percent) patients received first line treatment. Treatment duration was 10.5 ± 4.2 months. Clinical and diagnostic characteristics were similar to previous Peruvian case reports and current literature.

Espondilite tuberculosa: uma revisão de 31 pacientes do Hospital Santa Marcelina / Tuberculous spondylitis: a report of thirty one cases from Santa Marcelina Hospital / Espondilitis tuberculosa: una revisión de 31 pacientes del Hospital Santa Marcelina

INTRODUÇÃO: a infecção da coluna vertebral pelo bacilo de Koch costuma ser devastadora, sendo necessários seu diagnóstico e tratamento precoce. OBJETIVO: avaliar o tratamento e o seguimento em relação à dor, cifose residual, imagem por ressonância magnética (RM), e a importância da biópsia correlacionando-a com o tratamento clínico. Métodos: estudo retrospectivo de 31 pacientes com diagnóstico de espondilite tuberculosa, fazendo uma análise estatística dos dados descritivos: sexo, idade, status neurológico, segmento vertebral acometido, presença de abscesso e cifose residual, e suas correlações clínicas importantes comparando nossos casos com a literatura e correlacionando seus dados, tais como sexo e faixa etária mais comum, se a presença do abscesso influencia no déficit neurológico ou na cifose residual. RESULTADOS: a amostra identificou uma incidência em 23 homens e 8 mulheres. Foi identificado abscesso frio em 4 pacientes, sendo os que apresentaram uma grave deformidade final: a biopsia percutânea foi realizada em 19 pacientes com positividade em 5, não influenciando o tratamento do paciente. A dor pós-tratamento clínico apresentou melhora importante; foi utilizado esquema tríplice por um ano. CONCLUSÃO: o tratamento clínico da tuberculose deve ser iniciado assim que se suspeitar da doença e tiver imagens compatíveis com: corpo vertebral, diminuição da altura do espaço discal e elevação do ligamento longitudinal anterior. Na presença de cifose, o uso de um colete rígido deve ser ponderado, sendo ele o de Boston ou um colete gessado. A avaliação neurológica deve ser acompanhada com um intervalo curto, quinzenalmente nos primeiros três meses, pois se o tratamento clínico for ineficaz e o paciente apresentar déficit neurológico, o tratamento cirúrgico deve ser considerado. A biopsia é um exame de alta especificidade, mas de baixa sensibilidade. Quando positiva, reforça o tratamento medicamentoso.

INTRODUCTION: the infection of the spine by the mycobacterium tuberculosis is often devastating, requiring early diagnosis and treatment. Objective: to assess the treatment and follow-up regarding the pain, residual kyphosis, image of magnetic resonance imaging (MRI), and importance of biopsy relating to the clinical treatment. METHODS: retrospective study of 31 patients with diagnosis tuberculous spondylitis making a statistical analysis, studying the data descrition: gender, age, neurological status, spinal segment and kyphosis abscess, presence of residual kyphosis and their clinical correlations, comparing our major cases with literature and relashionship, and if the presence of abscess can influence in on neurological deficit or residual kyphosis. RESULTS: the sample identified an incidence in 23 men and 8 women; cold abscess was identified in 4 patients, and how those with a severe deformity final percutaneous biopsy was performed in 19 patients with positivity in 5, with no influence patient treatment. The pain after treatment showed significant improvement and we used triple drug regimen for one year. CONCLUSIONS: the clinical treatment of tuberculosis should start once the disease is suspected and have compatible images with: vertebral body, decreased disc space height, and elevation of the anterior longitudinal ligament. In the presence of kyphosis using a weighted vest to be hard, being the Boston vest or a plaster cast. The neurological evaluation should be accompanied, and with a short interval, fortnightly during the first three months, because if the clinical treatment is ineffective and the patient has neurological deficit surgical treatment should be considered. The biopsy is a test of high specificity but low sensitivity. When the test is positive it reinforces drug treatment.

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

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...

Mal de Pott: uma doença milenar em um novo século / Pott's disease: an ancient disease in a new century

A tuberculose espinhal, também conhecida como Mal de Pott ou Doença de Pott, caracteriza-se como a forma mais frequente de tuberculose extrapulmonar. Apresentamos aqui o caso de uma paciente encaminhada ao Serviço de Neurologia do Hospital de Clínicas de Porto Alegre com um quadro de dois meses de evolução, apresentando sintomas de compressão medular. O diagnóstico de tuberculose espinhal foi realizado por punção guiada por tomografia computadorizada e a paciente foi submetida à drenagem do abscesso. Concomitantemente, foi iniciado o tratamento com RHZ e a paciente evoluiu com melhora dos sintomas neurológicos. Esse caso ilustra que mesmo pacientes com alterações neurológicas importantes devido à tuberculose medular podem apresentar melhora significativa com tratamento.

Spinal tuberculosis, also known as Pott's disease, is the most common form of extra-pulmonary tuberculosis. We report on a patient referred to the Division of Neurology of Hospital de Clínicas de Porto Alegre presenting with spinal cord compression symptoms for two months. The diagnosis of spinal tuberculosis was rapidly done by a computerized tomography guided biopsy. The patient was submitted to abscess surgical draining and complementary RHZ treatment, with recovery of neurological symptoms. This case illustrates that even patients with severe neurological deficits due to spinal tuberculosis may have a good outcome with the appropriate treatment.

[Management of Pott's disease nowadays in Tunisia about a series of 45 cases]

To investigate the characteristics of patients managed for Pott's disease at the rheumatology department of CHARLES NICOLLE teaching hospital, Tunisia between 1994 and 2004. Retrospective chart review. The incidence, epidemiology, clinical features, imaging study findings, and diagnostic procedures were recorded. Diagnosis of spinal tuberculosis was based on: positive culture for Mycobacterium tuberculosis, percutaneous vertebral biopsy showing granulomas with caseating necrosis or on strong clinical suspicion. There were 45 patients, 21 women and 24 men with a mean age of 51 years [15-85y]. None of our patients had either AIDS or treatment by TNF alpha blockers. Mean time from symptom onset to diagnosis was 8.6 months [1.5-24]. Neurological impairement was present in 7 cases: a spinal cord compression in 5 cases, and an equina cord syndrome in 2 cases. The vertebral area involved was cervical in one case, thoracic in 21 and lumbar in 24 cases. The most common imaging findings were disk space nanowing [visible on plain radiographs in 44 of the 45 patients] and paraspinal abscesses [visible by CT in 28 of 45 patients]. Centro-somatic tuberculous osteitis of the vertebra have been diagnosed in only one case. Percutaneous vertebral biopsy was positive in 12 out of 36 cases. Anti-tuberculosis treatment has been administrated in all cases associated to vertebral immobilization when indicated. Surgery has been performed in only 3 cases in front of neurological manifestations. Pott's disease is still a public health problem in Tunisia because tuberculosis is endemic in our country. Atypical presentation and insidious evolution are responsible for long diagnosis delay. Treatment is now medical. Early diagnosis and treatment are mandatory for a good outcome

Tuberculose vertebral (doença de Pott) associada a abscesso de psoas: relato de dois casos e revisão da literatura / Spinal tuberculosis (Pott's disease) associated to psoas abscess: report of two cases and a literature review

A tuberculose é uma das principais doenças infecciosas de acometimento mundial com 3,9 milhões de casos notificados no mundo, em 2002. A forma esquelética pode corresponder a 3 por cento do número total de casos, sendo 50 por cento devido à tuberculose vertebral. O abscesso de psoas é uma entidade clínica rara com aproximadamente 12 casos relatados por ano na literatura médica e tem no Mycobacterium tuberculosis, um dos seus agentes etiológicos. O objetivo deste trabalho é relatar dois casos de tuberculose vertebral associada a abscesso de psoas atendidos em nosso serviço, bem como uma revisão da literatura.

Spinal epidural abscess due to Mycobacterium tuberculosis in a patient with AIDS: case report and review of the literature

Spinal epidural abscess (SEA) is a rare infectious disorder that often has delayed diagnosis and is associated with significant morbidity and mortality rates. We present a case of an AIDS patient with a SEA due to Mycobacterium tuberculosis. This type of SEA in AIDS patients is characterized by localized spinal pain and prolonged fever. Magnetic resonance imaging is the method of choice in the diagnostic process. Early diagnosis, followed by specific therapy (surgical decompression combined with antituberculous drugs), is necessary to improve the prognosis of these kinds of patients.

Mal de Pott com lesões cutâneas em paciente HIV-positivo / Pott’s disease with cutaneous lesions in HIV-positive patient

O Mal de Pott é definido como uma tríade de sinais clínicos, com presença de abscesso, deformidade óssea vertebral e paraplegia. Os autores relatam um caso de tuberculose ósteo-articular (Mal de Pott) com lesões cutâneas, em paciente HIV-positivo, e fazem revisão da literatura, abordando aspectos clínicos, diagnósticos e terapêuticos. Enfatizam a evolução exuberante e rara desse tipo de infecção pelo Mycobacterium tuberculosis, em paciente imunossuprimido, e sua dificuldade diagnóstica.

Espondilodiscite tuberculosa: o problema diagnóstico diante da necessidade de uma conduta terapêutica precoce / Tuberculous spondylitis: a diagnosis problems in front of therapeutical approaches early needs

Os autores fazem uma análise retrospectiva de 10 casos de espondilodiscite tuberculosa (EDT), atendidos no Hospital Universitário Lauro Wanderley da Universidade Federal da Paraíba (HULW/UFPB), no período de 1987 a 1997, todos com diagnóstico presuntivo de EDT, confirmados por exames de imagem. Enfatizam os aspectos clínicos, epidemiológicos, laboratoriais de diagnóstico, inclusive por imagem, comentando cada caso per se. Ressaltam os aspectos radiográficos mais sugestivos dessa enfermidade, visando à instituição de um protocolo terapêutico para posterior seguimento e evolução. Chamam ainda a atenção para a instituição do tratamento específico precoce, no intuito de evitar seqüelas irreparáveis, sobretudo a forma mais temível: a neurotuberculosa

Enfermedad de Pott: un reto diagnóstico y terapéutico para el médico actual / Pott's disease: a diagnostic and therapeutic analysis in thirty cases of subungueal exostosis

El resurgimiento de la tuberculosis se ha asociado al incremento concomitante en la incidencia de la enfermedad de Pott.Se estudiaron 32 pacientes con diagnóstico de enfermedad de Pott toracolumbar, en el periodo de junio de 1994 a junio de 1999. A todos los pacientes se les realizaron exámenes de laboratorio: biometría hemática con velocidad de sedimentación globular, exámenes microbiológicos: baciloscopias en orina y esputo, cultivo de la expectoración o de orina, pruebas inmunológicas: PPD (derivado de la proteína purificada).En 15 pacientes se efectuó ELISA para bacilo tuberculoso, inmunocromatografía en 13 de ellos por amplificación del DNA. Reacción en cadena de la polimerasa a cuatro pacientes (PCR). A todos los pacientes se les administró tratamiento médico antifímico, con duración mínima de 12 meses, y tratamiento quirúrgico por compromiso neurológico o por inestabilidad vertebral.Cuatro pacientes no recuperaron la función neurológica, debido al tiempo prolongado de paraplejía que tenían antes de ingresar al hospital. Hubo un fallecimiento por presentar tamponade cardiaco, como complicación de la enfermedad tuberculosa.Presentaron xifosis vertebral residual con la aparición de compromiso neurológico, tres pacientes a quienes se reintervienen quirúrgicamente.Se concluye que los estudios inmunológicos permiten un diagnóstico oportuno y apoyan la valoración de la efectividad del tratamiento médico, además de indicar cuándo el paciente ha sanado; cabe mencionar que tal resultado se presenta entre los nueve y doce meses de tratamiento médico. El tratamiento quirúrgico se realizó en todos los pacientes con compromiso neurológico, debido al granuloma intrarraquídeo, invasión del absceso pótico hacia el canal raquídeo o por colapso vertebral, que comprimió a la médula y/o raíces nerviosas y por inestabilidad vertebral, demostrado radiológicamente de acuerdo a las columnas de Francis Denis.

Tuberculose de coluna cervical baixa em crianca: relato de caso / Tuberculosis of the lower cervical spine in a child: a case report

Os autores apresentam um caso de crianca de oito anos com queixa de dor e deformidade em regiao cervical com duracao de tres meses, alem de sinais de compressao medular...

Mal de Pott: diagnóstico y tratamiento / Bad of Pott: I diagnose and treatment

Reportamos 2 casos de espondilitis tuberculosa en mujeres de 51 a 65 años de edad respectivamente quienes presentaron dolor en la columna vertebral acompañado de síntomas generales, una de ellas con compromiso neurológico. Ambas tuvieron lesiones osteolíticas, y espondilodiscitis en la resonancia magnética. En el segundo caso, además hubo evidencia de abscesos fríos en cuerpos vertebrales y músculos paravertebrales que requirió debridación y descomprensión medular más artrodesis de columna. Recibieron tratamiento con agentes antituberculosos con buena evolución.

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.

Spinal tuberculosis with neurological deficit

A prospective evaluation of various modalities of management of spinal tuberculosis with neurologic deficit is given in this article. Twenty patients suffering from this ailment were managed over a period of three years. All of these were given an initial trial of antituberculou chemotherapy. Ten patients who responded favourably were continued on conservative management. Rest of the ten patients underwent surgery in the form of modified Hong Kong operation [six patients], anterolateral decompression [three patients], and costotransversectomy [one patient], all followed by hyperextension brace. The selection of the type of operation was based on the age, state of health and the extent of the disease. Seven out of the ten patients of conservative management recovered completely while three were lost to follow up. Modified Hong Kong operation showed 67%, anterolateral decompression 33% and costotransversectomy 100% recovery. Three patients, one after modified Hong Kong operation and two after anterolateral decompression died showing 15% mortality. No single method of management suits every patient and a "tailor made" treatment is needed after individual assessment of each case