Operative treatment of progressive deformity in spinal tuberculosis.

We report on 14 patients with tuberculosis of the spine treated by operation. All had disease of three or more vertebrae with involvement of both the anterior and posterior columns and a progressive kyphotic deformity in spite of conservative treatment. We consider such spines to be 'unstable' and have found that anterior as well as posterior fusion with instrumentation is necessary.

Epidemiological survey of spinal cord injury: A study of 377 patients.

The total number of patients admitted to the Spinal Cord Injury Unit, Riyadh Central Hospital, Riyadh, Saudi Arabia from June 1979 to March 1984 approached 450 patients. Of those, 377 (369 males and 8 females) patients with complete records and sustaining traumatic injury were studied. The patients were divided into four groups: cervical, dorsal, dorsolumbar and lumbar. In each group, the following parameters were studied: age, sex, nationality, length of period prior to admission, and source of admission. The cause of injury was divided into four groups, including road traffic accident, industrial injuries, domiciliary injuries and gunshot wounds. The study included the type of bony injury and associated injuries, complications both on admission and during hospital course and neurological deficit and progress. The results of treatment are displayed in a variety of tables with explanations in the text. It is hoped that this work would be a pointer to the size of the problem in Saudi Arabia, and would highlight the difficulties encountered and tentatively put forth suggestions for correction.

Evaluation of radiological investigations in spinal tuberculosis.

Thirty-four cases of spinal tuberculosis were investigated by plain radiography, computerised tomography and myelography followed by computerised tomography. All the patients were operated on and the findings compared with the results of the investigations.

Bifacetal dislocation following tuberculosis of the cervical spine.

We present a case of bifacetal dislocation following tuberculosis of the cervical spine with a minimal neurological deficit and a huge retropharyngeal abscess in a 14-year-old Saudi child. Treatment was by anterior debridement, decompression and bone grafting followed 2 weeks later by posterior wiring and fusion from C2 to C5. We also review the literature relating to this subject.

Atypical forms of spinal tuberculosis.

Twenty-three patients with atypical forms of spinal tuberculosis treated between 1975 and 1985, are described. All presented with signs and symptoms of compression of the spinal cord or cauda equina, ranging from paraesthesiae and increasing weakness of extremities to paraplegia and loss of sphincter control. None of them showed visible or palpable spinal deformity nor the typical radiographic appearance of destruction of the intervertebral disc and the two adjoining vertebral bodies. These atypical forms constituted about 12 percent of all the cases of spinal tuberculosis seen (a total of 190 cases); and fell into three well-defined groups: those with the involvement of neural arch only; those with the involvement of a single vertebral body; and, those without bony involvement. The correct surgical approach in these groups was found to be different: spinal cord compression caused by the tuberculous disease of the neural arch was best treated by laminectomy; whereas single vertebral body disease required an anterior or anterolateral approach. Spinal computerized tomography was helpful in defining the extent of disease and planning the surgical approach. Histological confirmation of tuberculosis was obtained in all the cases and acid fast bacilli (A.F.B.) were found in, and cultured from, the biopsy specimens of 18 cases.

Desmoplastic fibroma--a rare tumour in a rare site.

We report the occurence of a desmoplastic fibroma in the terminal phalanx of the big toe in a 42-year-old male. The tumour is rare, only 66 cases have been reported in the English language journals. The case history together with review of the literature is presented.

Osteitis of the humerus following BCG vaccination.

A 22-month-old Saudi child developed a granulomatous lesion of the left humerus following BCG vaccination in the overlying deltoid area 15 days after birth. The clinical picture, investigations and the histopathology reports are presented. The literature regarding BCG vaccine complications and their frequency is reviewed.

Severe mincer injuries of the hand in children in Saudi Arabia.

A review of twenty-two children with a mean age of 1.9 +/- 0.3 years who sustained injuries to the fingers and hand by domestic mincer machine. In each case the child inserted his hand in the machine while in motion. The pattern of injury is discussed and recommendations to avoid these mutilating injuries are made.

Is avoidance of sunlight a cause of fractures of the femoral neck in elderly Saudis?

A study of the frequency of admitted cases of femoral neck fractures to Riyadh Central Hospital, Riyadh, Saudi Arabia, showed admission of 95 patients over 40 years of age in a period of one year. The male to female ratio was 64% males to 36% females. Vitamin D nutritional status of patients with fractures of the neck of the femur expressed as 25-(OH)D3 was significantly lower (5.9 +/- 2.9 ng/ml) than of controls (9.7 +/- 4.7 ng/ml). Comparison of the housing types of both patients and controls showed that those living in traditional mud houses have significantly lower levels of 25-(OH)D3 than those occupying villas or flats. A third group of patients with low stores of vitamin D were exposed to natural ultraviolet light for a short period. This resulted in a significant increase in the levels of serum 25-(OH)D3 and a decrease in alkaline phosphatase activity. It is concluded that low levels of serum 25-(OH)D3 may play a role in the pathogenesis of femoral neck fractures in elderly Saudis and this may be due to minimal exposure to natural ultraviolet irradiation.

The wrinkly skin syndrome: a report of two siblings from Saudi Arabia.

A brother and sister born to a Saudi couple showed aging appearance, wrinkled skin over the hands and feet, inelastic skin, prominent veins over the hands, and other musculoskeletal and connective tissue manifestations. Both children were small for their age and had congenital dislocation of the hips. The paper describes the main manifestations and compares them with the previously described two families.