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

ABSTRACT

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: