ABSTRACT
total of 39 HIV-infected adults with spinal tuberculosis underwent anterior spinal decompression for neurological deficit. Fresh-frozen allografts were used in 38 patients. Antituberculous drugs were prescribed for 18 months, but antiretroviral therapy was not used. Six patients died within two years of surgery. Neurological recovery and allograft incorporation were observed at follow-up at a mean of 38 months, although the CD4/CD8 ratios were reversed in all patients. Adequate preoperative nutritional support and compliance with antituberculous treatment are essential in ensuring a satisfactory outcome.
Subject(s)
Decompression, Surgical , HIV Infections/complications , Tuberculosis, Spinal/complications , Tuberculosis, Spinal/surgery , Adolescent , Adult , Antitubercular Agents/therapeutic use , Bone Transplantation , Female , Humans , Lymphocyte Subsets , Male , Prospective Studies , Transplantation, HomologousABSTRACT
Forty-seven patients with cervical spine trauma were evaluated prospectively with magnetic resonance imaging (MRI) and angiography (MRA) to determine the incidence of vertebral artery injury. Twelve patients (25%) had vertebral artery injuries (one bilateral), and occlusion was identified in nine patients and dissection in four. The vertebral artery injury did not result in neurological dysfunction. No specific treatment was instituted for the vascular injury, and in four patients, MRA showed no evidence of recanalization at follow-up.
Subject(s)
Cervical Vertebrae/injuries , Joint Dislocations/complications , Spinal Fractures/complications , Vertebral Artery Dissection/etiology , Vertebrobasilar Insufficiency/etiology , Adolescent , Adult , Aged , Child , Female , Humans , Magnetic Resonance Angiography/methods , Magnetic Resonance Imaging/methods , Male , Middle Aged , Prospective Studies , Vertebral Artery Dissection/diagnosis , Vertebrobasilar Insufficiency/diagnosisABSTRACT
Sixteen patients had paraplegia due to tuberculosis of the cervicodorsal junction. Spinal decompression was performed through an extended lower cervical approach, and a humeral allograft was used to reconstruct the anterior column. All patients improved neurologically with satisfactory correction of the deformity and successful incorporation of the allograft.
Subject(s)
Cervical Vertebrae/surgery , Decompression, Surgical/methods , Humerus/transplantation , Paraplegia/surgery , Thoracic Vertebrae/surgery , Tuberculosis, Spinal/complications , Child , Child, Preschool , Female , Follow-Up Studies , Humans , Male , Paraplegia/etiology , Retrospective Studies , Spinal Cord Compression/etiology , Spinal Cord Compression/surgery , Spinal Fusion/methods , Treatment Outcome , Tuberculosis, Spinal/surgeryABSTRACT
Twenty-nine patients with pyogenic vertebral osteomyelitis were reviewed retrospectively after an average follow-up of 3.7 years. We identified 17 patients with predisposing factors (10 diabetes, 4 urinary tract infection, 2 HIV-positive, 1 rheumatoid arthritis). No patient presented with a febrile illness. The lumbar spine was involved in 15 patients. Eighteen patients had neurological impairment at presentation. Eleven patients who were neurologically intact had needle biopsies and the remaining 18 patients who were neurologically compromised had an open decompression. Staphylococcus aureus was cultured in 14 patients. Although spinal tuberculosis is relatively common in our environment it is important to obtain a tissue diagnosis in order to exclude pyogenic vertebral osteitis.
Subject(s)
Cervical Vertebrae , Lumbar Vertebrae , Spondylitis , Thoracic Vertebrae , Adult , Cervical Vertebrae/diagnostic imaging , Cervical Vertebrae/surgery , Chemotherapy, Adjuvant , Female , Humans , Lumbar Vertebrae/diagnostic imaging , Male , Middle Aged , Retrospective Studies , Spondylitis/diagnostic imaging , Spondylitis/drug therapy , Spondylitis/surgery , Thoracic Vertebrae/diagnostic imaging , Thoracic Vertebrae/surgery , Tomography, X-RayABSTRACT
We report on five patients with Salmonella typhi spondylitis who were immunologically normal and had no prodromal gastrointestinal illness. The diagnosis was confirmed on blood cultures, Widal test, and needle biopsy of the spine. Appropriate antibiotic treatment resulted in a favorable outcome.
Subject(s)
Ampicillin/administration & dosage , Lumbar Vertebrae , Salmonella typhi/isolation & purification , Spondylitis/diagnosis , Spondylitis/drug therapy , Adolescent , Biopsy, Needle , Child , Female , Follow-Up Studies , Humans , Male , Retrospective Studies , Spondylitis/immunology , Tomography, X-Ray ComputedABSTRACT
We report two cases of vertebral osteochondroma. In one patient a solitary cervical lesion presented as entrapment neuropathy of the ulnar nerve and in the other as a thoracic tumour associated with hereditary multiple exostoses producing paraplegia. We highlight the importance of an adequate preoperative evaluation in such patients.
Subject(s)
Osteochondroma/complications , Spinal Cord Compression/etiology , Spinal Neoplasms/complications , Adolescent , Adult , Female , Humans , Male , Osteochondroma/diagnostic imaging , Spinal Cord Compression/diagnostic imaging , Spinal Neoplasms/diagnostic imaging , Tomography, X-Ray ComputedABSTRACT
Fresh-frozen allografts from the humerus were used to help to stabilise the spine after anterior decompression for tuberculosis in 47 children with a mean age of 4.2 years (2 to 9). The average angle of the gibbus, before operation, was 53 degrees; at follow-up, two years later, it was 15 degrees. Rejection of the graft or deep sepsis was not seen. Cross trabeculation between the allograft and the vertebral body was observed at six months, with remodelling occurring at approximately 30 months.
Subject(s)
Bone Transplantation , Humerus/transplantation , Tuberculosis, Spinal/surgery , Child , Child, Preschool , Decompression, Surgical , Female , Humans , Infant , Magnetic Resonance Imaging , Male , Prospective Studies , Spinal Fusion , Transplantation, Homologous , Tuberculosis, Spinal/diagnosisABSTRACT
We have treated seven patients with cryptococcal spondylitis. Five presented with a neurological deficit and one was HIV-positive. Amphotericin-B and 5-flucytosine were used in five patients and ketoconazole was given orally in the remaining two. Three patients made a complete neurological recovery. Since these lesions mimic spinal tuberculosis, which is commonly seen in our environment, we draw attention to the importance of obtaining a tissue diagnosis.
