Patients with complicated Pott's disease: management in a rehabilitation department and functional prognosis.

OBJECTIVE: The objective is to study the rehabilitation management and to assess autonomy in daily life activities as well as walking recovery in patients with complicated Pott's disease. PATIENTS AND METHODS: Retrospective study in nine patients over a period of 8 years extending from 2000 to 2008, collated in the Department of Physical Medicine and Functional Rehabilitation, CHU Sahloul, Sousse, Tunisia. RESULTS: The mean age of our patients was 43.8 years; sex ratio was 5/4. The spine involvement of tuberculosis was dorsal in seven cases, dorso-lumbar in one patient, and multiple (cervical, dorsal and lumbar) in one case. All patients were paraplegic with a neurological involvement of the bladder. They had prior antituberculosis chemotherapy for at least 8 months. Decompression surgery was performed in six cases. Two female patients presented disorders of spinal posture during treatment requiring surgical revision with osteosynthesis. All patients received additional rehabilitation care. Following a mean duration of hospitalisation in the Rehabilitation department of 47 days with twice-daily sessions of tailored physiotherapy, three patients remained in complete paraplegia, autonomous in wheel-chair and with vesical and sphincter incontinence. The measure of functional independence (MFI) was at admission/discharge 71/92. CONCLUSION: Rehabilitation takes an important place in the medico-surgical management in Pott's disease, to limite or compensate the disabilities and handicap related to this pathology.

Case report: community rehabilitation for a patient with incomplete spinal cord lesion.

This is a case report of Mr S, a 43-year-old man with a spinal cord lesion caused by tuberculosis resulting in incomplete paraplegia. He was discharged from hospital with significant residual disability. He received a major part of his rehabilitation in the community from an interdisciplinary neuro rehabilitation team with good results. Because Mr S was overweight, over 20 stones, the therapists had to use considerable creativity and imagination to facilitate his rehabilitation. Mr S's high level of motivation and courage was essential to the success achieved. The purpose of the case report is to demonstrate that a positive outcome can be achieved despite the many difficulties faced in the rehabilitation of an overweight patient with an incomplete spinal cord lesion in a community setting.

A new halo-pelvic apparatus.

STUDY DESIGN: A technical report of a new, versatile halo-pelvic apparatus for use in spinal immobilization is presented. OBJECTIVES: To show how simple modifications of existing external fixation devices allow a halo-pelvic fixation apparatus to be constructed. SUMMARY OF BACKGROUND DATA: Halo-pelvic fixation has been used successfully in the past for immobilization and correction of severe spinal deformities such as tuberculous kyphosis. With the advent of new spinal instrumentation systems and techniques, external immobilization of the whole spine is rarely indicated. However, on rare occasions, spine surgeons may be presented with cases in which no internal fixation has been possible. METHODS: Halo-skull fixation and pelvis fixation were performed using standard techniques. A simple custom-made halo connection bar was used to connect the halo to uprights from the pelvis external fixator. Because the majority of the system makes use of standard external fixation equipment, it is easy to apply and adjust. RESULTS: Between 1997 and 2001, this frame was successfully applied to stabilize the spines of three patients with severe tuberculous kyphosis exceeding 100 degrees. CONCLUSIONS: One simple modification of existing external fixation equipment has allowed a new halo-pelvic device to be constructed and used effectively to immobilize the spine.

Role of posterior stabilisation in the management of tuberculosis of the dorsal and lumbar spine.

We present a prospective study of patients with tuberculosis of the dorsal, dorsolumbar and lumbar spine after combined anterior (radical debridement and anterior fusion) and posterior (instrumentation and fusion) surgery. The object was to study the progress of interbody union, the extent of correction of the kyphosis and its maintenance with early mobilisation, and the incidence of graft and implant-related problems. The American Spinal Injury Association (ASIA) score was used to assess the neurological status. The mean preoperative vertebral loss was highest (0.96) in the dorsal spine. The maximum correction of the kyphosis in the dorsolumbar spine was 17.8 degrees. Loss of correction was maximal in the lumbosacral spine at 13.7 degrees. All patients had firm anterior fusion at a mean of five months. The incidence of infection was 3.9% and of graft-related problems 6.5%. We conclude that adjuvant posterior stabilisation allows early mobilisation and rehabilitation. Graft-related problems were fewer and the progression and maintenance of correction of the kyphosis were better than with anterior surgery alone. There is no additional risk relating to the use of an implant either posteriorly or anteriorly even when large quantities of pus are present.

[Our experience with rehabilitation of patients with Pott's tuberculous paraplegia].

Spinal tuberculosis with paraplegia is rarely seen in Israel. All the 10 patients that were hospitalized in our rehabilitation departments had contracted the disease abroad prior to their immigration to Israel. The comprehensive rehabilitation process must include close cooperation between pulmonary physicians, orthopedic surgeons and rehabilitation medicine specialists. An updated review of the relevant literature is presented.

[Surgical treatment of tuberculous spondylitis using ceramic implants]. / Operativnoe lechenie tuberkuleznogo spondilita s primeneniem keramicheskikh implantantov.

The use of osseous grafts in the treatment of tuberculous spondylitis is associated with substantial shortcomings, requiring a long-term bedside regimen, followed by fixation of the spine with a rigid corset. The application of ceramic implants allowed one to attack several tasks: to provide primary stabilization of the vertebral segment, to exclude corset fixation, to reduce a postoperative period and surgical traumatism by refusing to take an autograft. Forty nine operations were performed in patients aged 23-65 years. In the early postoperative period neurological disorders completely disappeared in 7 patients, the remaining has significant positive changes. Complete osteoceramic adhesion occurred 2-4 months later. Following 2 patients, 26 patients were stricken off the disability register. The remaining patients continued to be disabled (7 and 16 patients had disability groups 2 and 3, respectively) due to significant contaminant diseases.

[Possibilities of reducing the duration of the treatment of patients with tuberculous spondylitis]. / O vozmozhnosti sokrashcheniia srokov lecheniia bol'nykh tuberkuleznym spondilitom.

In the article are described the results of operative treatment of 185 patients with tuberculous spondylitis. In order to restore stability there was carried out posterior spondylidesis after Genle with removal o ffoci by means of posterior access in 70 patients. 115 patients were subjected to anterolateral spondylidesis, 55 of them--by generally accepted method and 60--with creation of trapezoid lock between the body of a vertebra and transplants. In this group of patients was used removable jacket made of polivike before the patient's elevation. In this case the term of the stationary treatment of the III group patients was reduced by 2 times as compared with the I group and by 22--I day as compared with the 2 group. Long-term results were studied from 6 months to 7 years. In the first group there were excellent results in 67%, good in 20% and bad in 13% of cases. In the patients of the 2 and 3 group there were excellent results in 96%, good in 3.4% and bad in 0.6% of cases, when there was observed resolution of transplant with 1 patient of the 2 group.

[Surgical reconstruction of the spine in tuberculous spondylitis in young children]. / Khirurgicheskaia rekonstruktsiia pozvonochnika pri tuberkuleznom spondilite u detei mladshego vozrasta.

Results of reconstructive bone-plastic operations are presented which were performed on 170 children of younger age with tuberculous spondylitis. The method of operative procedures is described followed by an assessment of the results obtained.

Transthoracic approach for Pott's disease.

Spinal tuberculosis with paraplegia, although decreasing in incidence, remains a problem in certain sections of the United States and in most underdeveloped nations. Evacuations of the tuberculous abscess, debridement of necrotic bone, and fusion of the anterior spine are maneuvers performed increasingly by thoracic surgeons. Twenty-two patients with Pott's disease and symptoms of back pain, gibbous deformity, and neurological deficit underwent thoracotomy. Nine were paraplegic prior to operation. Postoperatively, spinal fusion occurred in all cases. All paraplegic patients can walk now, and 17 of the 22 treated operatively have been completely rehabilitated and are in school or working. The average hospital stay was 2.4 months. There was 1 operative death. Medical treatment for Pott's disease consisted of bed rest and chemotherapy and resulted in progressive neurological deficit in 2 patients with an average hospital stay of 2.2 years. We believe operative treatment offers two distinct advantages: excellent reversal of even long-standing paraplegia and markedly shortened hospital stay.