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PubMed2003

Imaging of esophageal tuberculosis: a review of 23 cases.

PURPOSE: To evaluate the various radiological abnormalities in patients with proven esophageal tuberculosis. MATERIAL AND METHODS: The case records of 23 patients with proven esophageal tuberculosis were evaluated retrospectively for various radiological abnormalities. Twenty-two patients had secondary involvement of esophagus in the form of direct extension of mediastinal and pulmonary tuberculosis or spinal tuberculosis. Only 1 patient had primary involvement of the esophagus with no evidence of disease elsewhere. The diagnosis was confirmed by endoscopic and CT-guided biopsy/aspiration cytology in 7 and 6 cases, respectively. Diagnosis was made on the basis of surgical biopsy of lymph node and autopsy in 1 patient each. In the remaining 8 patients the diagnosis was based on radiological and endoscopic findings and the response to antituberculous treatment. RESULTS: Chest radiography (CXR) was abnormal in 65% patients. While the findings were non-conclusive for esophageal tuberculosis, characteristic lesions of tuberculosis in lungs or spine were suggestive of tuberculous etiology. In 15 patients, CT of the chest confirmed the corresponding CXR findings and also showed additional findings of mediastinal lymphadenopathy when CXR was normal. Fourteen patients showed mediastinal lymphadenopathy on CT of the chest. In all these patients, more than one group of lymph nodes was involved. The characteristic hypodense center of lymph nodes suggestive of tuberculosis was seen in 12 patients. Radiological abnormalities seen in barium swallow examination were extrinsic compression, traction diverticula, strictures, sinus/fistulous tracts, kinking and pseudotumor mass of esophagus in decreasing order of frequency. The middle third of the esophagus was found to be the most frequent site of involvement.

Adult↗
PubMed1994

Primary hyperparathyroidism masked by antituberculous therapy-induced vitamin D deficiency.

Antituberculous chemotherapy agents, particularly rifampicin and isoniazid, affect vitamin D metabolism and can create biochemical evidence of vitamin D deficiency. Vitamin D deficiency induces a state of resistance to parathyroid hormone. This study sought to explain the temporary resolution of hypercalcaemia and hypercalciuria, during antituberculous chemotherapy with rifampicin and isoniazid, in a subject with a surgically proven parathyroid adenoma and coincidental spinal tuberculosis. Serum ionized calcium, 25-hydroxyvitamin D and 1,25-dihydroxyvitamin D, plasma parathyroid hormone, and 24-hour urine excretions of calcium, inorganic phosphorus and hydroxyproline were sequentially measured over a 3-year interval that included 18 months of antituberculous chemotherapy. Initial serum ionized calcium was 1.52 mmol/l (normal 1.20-1.35 mmol/l), 24-hour urine calcium excretion was 9.40 mmol/day (normal 1.25 to 7.50 mmol/day) and plasma intact PTH was 9.2 pmol/l (normal 0.0-4.5 pmol/l). During antituberculous chemotherapy the serum ionized calcium and 24-hour urine calcium excretion were normal but the plasma PTH rose to higher levels. Following completion of the chemotherapy, hypercalcaemia and hypercalciuria returned with levels similar to those observed pretreatment. Serum 25-hydroxyvitamin D was low at 6.25 nmol/l (normal 20 to 90 nmol/l) during antituberculous chemotherapy, but was normal before and after. Serum 1,25-dihydroxyvitamin D was normal throughout the 3-year interval. We conclude that the antituberculous chemotherapy induced relative vitamin D deficiency and resistance to parathyroid hormone action, thereby masking the hyperparathyroidism and hypercalcaemia until the chemotherapy was completed.

Adenoma↗
PubMed1991

Atypical case of Pott's disease.

An unusual case of Pott's Disease in an adult, Australian born, caucasian male is reported. The typical and atypical radiological features of spinal tuberculosis are reviewed.

Aged↗
PubMed2000

Correlation of clinical course with magnetic resonance imaging in tuberculous myelopathy.

Sixty cases of spinal tuberculosis with neurological deficit treated with 'middle path regimen' were analysed and therapeutic response was correlated with the magnetic resonance imaging (MRI) observations. Tuberculous lesions were found to be more extensive than seen on plain X-ray in 60% of the cases. MRI showed the involvement of one or both pedicles in nearly 90% of the cases, in addition to the vertebral body lesion as seen in the X-rays. The patients showing predominantly extradural collection of fluid with relatively preserved cord size, and MRI evidence of myelitis/oedema, improved neurologically with treatment. The myelomalacia of cord was found to be a poor prognostic sign for neural recovery. The magnitude of thinning of cord did not always correlate with severity of neural deficit, however, thinning of cord in association with myelomalacia carried a bad prognosis. The complete neural recovery is not expected in patients with syrinx formation proximal or distal to the diseased spine, either with antitubercular drugs or after mechanical decompression. MRI changes in dura-subarachnoid complex suggesting arachnoiditis generally correlated with poor neural recovery. MRI provided a reliable guide to the level and extent of surgical decompression, and prognostication of the outcome of therapeutic measures.

Adolescent↗
PubMed2003

[Use of carbon-carbonic implants in surgery of tuberculous spondylitis].

For surgical treatment of spinal tuberculosis, carbon-carbonic implants were used for anterior spondylosis in 29 patients; in 14 of them bone autografts were additionally applied. Carbon-carbonic implants reliably fixed the operated part of the vertebral column, prevented an increase in kyphotic deformity, and, in combined plastic repair, created favorable conditions for consolidation of bone autografts. A bone-carbon block formed in the late postoperative period.

Adult↗
PubMed2003

[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.

Adolescent↗
PubMed2004

Bilateral extraordinary huge, multi-compartmental tuberculous abscesses: a case report.

OBJECTIVE: To illustrate computerized tomography (CT) and magnetic resonance imaging (MRI) findings of tuberculous spondylitis with extensive abscess collections. METHOD: A review of one patient with tuberculous spondylitis and extensive paraspinal, subligamentous, retroperitoneal, and subcutaneous abscesses including pertinent history, important physical examination, CT and MR imaging findings was performed. RESULT AND CONCLUSION: This case demonstrates multiple patterns of tuberculous abscess formation secondary to spinal tuberculosis; included are paraspinal, subligamentous, retroperitoneal, and subcutaneous locations. The extension of the abscess should be kept in mind when treating a patient with tuberculous spondylitis. MR imaging is a modality of choice to illustrate full extension of the disease process, which is necessary for therapeutic decision making and planning.

Adult↗
PubMed1995

Transpedicular drainage of Pott's abscess. A report of two cases.

The treatment of Pott's disease remains controversial. The authors present two cases of spinal tuberculosis treated with posterior stabilization and supplementary abscess evacuation via the pedicular route with subsequent chemotherapy. The aim of this procedure was to increase the healing rate. Radiographic evidence of bone healing without any sequelae was demonstrated at 13 and 14 months.

Abscess↗
PubMedDate not supplied

Transpedicular fixation in the treatment of various spinal disorders.

36 patients with 157 inserted pedicular screws are presented. The patients are evaluated in 5 different groups; group I: fractures, group II: spinal tuberculosis, group III: spinal tumours, group IV: spondylolisthesis and group V: scoliosis. The mean age and the mean follow-up of the groups are respectively 42 years and 10.8 months. Cotrel-Dubousset instrumentation (CD), Alici Instrumentation, Fixateur Interne (Dick) or Steffee plate are used to stabilize the spine. The low complication rate of pedicular screw insertion is related to the used technique.

Adolescent↗
PubMed1997

Short-course chemotherapy in the treatment of Pott's paraplegia: report on five year follow-up.

OBJECTIVE: To assess the efficacy of 9-month short-course chemotherapy (SCC) and to study the pattern of neurological recovery in patients with Pott's paraplegia. DESIGN: Patients with recent onset of spastic paraplegia due to clinically and radiologically active spinal tuberculosis involving vertebral bodies of level D4-L1 were treated with streptomycin, rifampicin, isoniazid and ethambutol daily for the first 2 months, followed by rifampicin plus isoniazid twice weekly for the next 7 months. The study was conducted in 2 phases. In the first phase 10 patients were admitted to the open trial where all patients had undergone modified Hong Kong surgery in addition to chemotherapy. In the next phase 23 patients enrolled in the study were randomly allocated to receive either chemotherapy alone or surgery plus chemotherapy. All the patients were followed for 5 years from the start of treatment. A scoring system was devised to predict neurological recovery. RESULTS: In all, 33 patients were admitted and treated with SCC. Thirteen patients were allocated to the chemotherapy (CHEM) regimen; of these 3 patients had to be operated upon for clinical deterioration; the remaining 20 had surgery plus chemotherapy; 4 were excluded for various reasons, leaving 29 patients in the analysis. None relapsed requiring treatment. CONCLUSION: A combination of surgery (when indicated) and SCC of 9 months' duration is effective in the treatment of Pott's paraplegia. All patients had neurological recovery by the end of 9 months; 8 recovered with chemotherapy alone. Complete motor recovery was seen in 62% by the 3rd month and 90% by the 6th month.

Adolescent↗
PubMed2000

Atypical tuberculosis of the spine.

Spinal tuberculosis characteristically involves the paradiscal area of vertebral bodies with a narrowing of the disc space. In this study, we reported four atypical forms of Pott's disease, including one hundred and eighty-four patients treated between 1985 and 1998. Two cases presented with noncontiguous multilevel involvement, where one case had transverse process involvement alone and the other had involvement of the neural arch. Atypical tuberculosis of the spine was found in 2.1% of the patients.

Adolescent↗
PubMed2001

Predictive factors in the evolution of neural deficit in tuberculosis of the spine.

This study was conducted to determine the factors involved in predicting the onset of paraplegia in tuberculosis of the spine. A cross-sectional, case control review of 85 cases of spinal tuberculosis was conducted at the National Tuberculosis Centre in Kuala Lumpur. Sixty-nine of these cases were normal neurologically, whilst 16 cases experienced neural deficit. The data was analysed using backward logistic regression and Fishers exact probability test. The factors studied included symptoms and signs of spinal tuberculosis, common investigations for tuberculosis, and physical factors of the disease. Only the erythrocyte sedimentation rate (ESR) showed a significant difference between the neural deficit and neurologically normal groups. This suggests that the ESR may be a factor in predicting evolution of paraplegia in spinal tuberculosis. In addition, it was noted that a low proportion of patients had positive sputum smear results and bacterial culture growth for mycobacterium tuberculosis suggesting these tests are of limited value for tuberculosis of the spine.

Adolescent↗
PubMed1995

Posterior instrumentation and anterior interbody fusion for tuberculous kyphosis of dorsal and lumbar spines.

STUDY DESIGN: Thirty-nine adults and five children with active spinal tuberculosis and resulting kyphosis of the dorsal and lumbar spine who had combined posterior instrumentation and anterior interbody fusion were observed to determine whether the corrected spinal deformity could be maintained until solid fusion. OBJECTIVE: To evaluate the effectiveness of the combined two-stage procedure for treating kyphosis due to active spinal tuberculosis. SUMMARY OF BACKGROUND DATA: Until 1970, with all methods of treatment, kyphosis due to active spinal tuberculosis tended to increase during therapy. Most of the patients treated with these methods were not happy with this residual kyphosis, even though their disease was arrested or cured. Kyphosis became their main concern regarding further treatment. METHODS: A combined two-stage procedure, under the cover of 18 months of triple chemotherapy, was used for all patients. For posterior stabilization, the Harrington distraction system, Rush nails or Steinmann pins and wires, and Texas Scottish Rite Hospital instrumentation were used. The diagnosis of successful interbody fusion was made if there was no loss of correction, no graft resorption or graft bed resorption, and if there was visible graft remodeling, such as trabeculation between the graft beds and graft and the graft hypertrophy. RESULTS: In the 39 adults, average preoperative, immediate postoperative, and last follow-up kyphosis angles were 37 degrees, 16 degrees, and 18 degrees, respectively. In four children, the average preoperative, immediate postoperative, and last follow-up kyphosis angles were 55 degrees, 28 degrees, and 31 degrees, respectively. The loss of correction did not exceed 3 degrees. For one-segment spondylodesis, the average fusion times were 4 months in adults and 3.5 months in children. For a two-segment fusion, the average fusion times were 6 months in adults and 6.3 months in children. CONCLUSION: Posterior instrumental stabilization and anterior interbody fusion were found helpful in arresting the disease early, providing early fusion, preventing progression of kyphosis, and correcting the kyphosis.

Adolescent↗
PubMed1994

Application of internal fixation in the treatment for tuberculosis of the spine.

This is a study of 18 patients who had surgical treatment for spinal tuberculosis. All patients were admitted with the spinal tuberculosis and treated with a combination of anterior debridement and bone graft with posterior internal fixation using the Luque or Dick technique. The patients were able to walk within a few days postoperation. Three to seven years follow-ups show no recurrence, kyphosis and/or solid fusion.

Adolescent↗
PubMed2001

Tuberculous spondylitis: analysis of 69 cases from Saudi Arabia.

DESIGN: Retrospective chart and radiographic review of all cases admitted to the authors' hospital and diagnosed to have tuberculous spondylitis. OBJECTIVE: To identify the frequency, presenting features, utility of diagnostic tests, and treatment outcome of spinal tuberculosis in a tertiary care center. METHODS: All cases of spinal tuberculosis treated in the authors' hospital over 14 years were reviewed. Only those with histologic or microbiologic confirmation or those who responded to antituberculous spondylitis therapy were included. Outcome was assessed according to predefined criteria. RESULTS: Between 1985 and 1998, 69 cases of tuberculous spondylitis were found, i.e., 5% of all tuberculous spondylitis cases diagnosed. The mean age was 52.8 years (range, 15-80 years), and 37 (53.6%) were male. Only five patients had a history of tuberculosis. The most frequent symptoms were backache (84%) and fever (32%), and the most frequent sign was spinal tenderness (45%). Nineteen (28%) patients had paraparesis and 12 (17%) had kyphosis. Except for elevated sedimentation rate (94.5%), the laboratory workup was not helpful. Both computed tomography and magnetic resonance imaging were found to be helpful in diagnosis, often with complementary information. Thirty-eight patients (55%) had thoracic spine involvement and 55 patients (80%) had paraspinal abscesses. Tissue aspirates had a yield of 70%, 35%, and 57% for granulomas, acid-fast bacilli smear, and culture, respectively. Medical therapy alone was given in 37 cases (54%), whereas 32 patients (46%) required additional surgical intervention, mainly those with spinal cord compression, spinal deformity, or risk of spinal instability. There was definite improvement in 63 cases (91%). The best outcome was in those patients presenting early before the occurrence of spinal deformity or neurologic symptoms. CONCLUSION: Tuberculous spondylitis is prevalent in the authors' hospital. Both computed tomography and magnetic resonance imaging are extremely helpful for diagnosis, and tissue aspirate is a good confirmatory method. A good outcome is expected if the diagnosis is made in early stages before the appearance of spinal deformity and neurologic symptoms. Surgical intervention can be avoided in these cases regardless of the presence or absence of paraspinal abscesses.

Adolescent↗
PubMed2002

Treatment of tuberculosis of the spine with neurologic complications.

Neurologic complications are the most dreaded complication of spinal tuberculosis. The patients who have paraplegia develop in the active stage of tuberculosis of the spine require active treatment for spinal tuberculosis and have a better prognosis than the patients who have paraplegia develop many years after the initial disease has healed. Neurologic dysfunctions in association with active tuberculosis of the spine can be prevented by early diagnosis and prompt treatment. Prompt treatment can reverse paralysis and minimize the potential disability resulting from Pott's paraplegia. When needed, a combination of conservative therapy and surgical decompression yields successful results in most patients with tuberculosis of the spine who have neurologic complications. The vertebral body primarily is affected in tuberculosis; therefore, decompression has to be anterior. Laminectomy is advocated in patients with posterior complex disease and spinal tumor syndrome. Late onset paraplegia is best avoided by prevention of the development of severe kyphosis. Patients with tuberculosis of the spine who are likely to have severe kyphosis develop (< 60 degrees) on completion of treatment should have surgery in the active stage of disease to improve kyphus.

Algorithms↗