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PubMed1991

Tiny Tim remembered.

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Diagnosis, Differential↗
PubMed1985

Transoral approach for epidural craniocervical pathological processes.

Transoral surgery for ventral craniocervical pathology is an integral part of modern neurosurgery. This approach should be considered in many more cases than in current practice. On the basis of our experiences with 15 operations in 13 patients we feel able to improve the surgical technique in some small details, as 1. the double, two flap incision of the posterior wall of the pharynx, 2. the method of "deep" resection of the odontoid in its high upward and backward position, and 3. insertion of bone grafts and chips in the cavity of tumorous vertebrae for fixation. Admittedly, these cases are not encountered every day in neurosurgical units. An exact knowledge of the anatomical, neurological, pathological, radiological and surgical details is of vital importance and constitutes the basis of this account. This method should not be confined to specialised regional neurosurgical centres, but is within the technical capacity of all trained neurosurgeons.

Adult↗
PubMed1999

Pott's disease with unstable cervical spine, retropharyngeal cold abscess and progressive airway obstruction.

PURPOSE: Retropharyngeal abscess formation has the potential for acute respiratory compromise from obstruction or secondarily from rupture. The initial attempt to secure the airway is of paramount importance. We describe a patient with an unstable cervical spine secondary to Pott's disease who developed progressively obstructing retropharyngeal cold abscess. CLINICAL FEATURES: A 33-yr-old man with an unstable C-spine in halo traction presented with progressive airway obstruction secondary to retropharyngeal abscess extending from the cervical to the mid-thoracic vertebrae. After review of computerized tomography (CT) and magnetic resonance (MR) studies, preparations were made to secure the airway through fibreoptic assisted intubation. A conservative approach was chosen to secure the airway before surgical airway control as a first line approach. Following local and topical anesthesia, awake endoscopy was performed to assess the extent of obstruction and possibility of intubation without abscess rupture. A narrow tract along the lateral pharynx was identified to continue inferiorly to the epiglottis, from which point the cords were visualized. Extensive edema and abscess formation otherwise distorted the normal anatomy and prevented visualization from other directions. The airway was successfully secured without trauma with a well-lubricated 7.0 mm ID endotracheal tube. CONCLUSION: This report suggests that selected cases of tense obstructing retropharyngeal abscesses can be effectively managed with fibreoptic endoscopy for assessment and subsequent intubation before requiring surgical airway control as a first line strategy.

Adult↗
PubMed2004

Tuberculous osteomyelitis of the lumbosacral region: a spinal epidural abscess with presacral extension.

INTRODUCTION: Tuberculous osteomyelitis in the lumbosacral region is an uncommon occurrence, and its treatment is not well-defined in the literature, particularly when it is associated with abscess formation. We present the outcome of a patient who had an epidural abscess with presacral extension. MATERIALS AND METHODS: A 30-year-old man had microbiologically confirmed tuberculous infection of the lumbosacral vertebrae complicated by extensive abscess formation. After a trial of chemotherapy, the infection proved refractory, and the treatment proceeded with abscess drainage through the anterior route. RESULTS: Approximately 1 year after surgery, the patient was symptom-free and did not show any significant radiologic changes. CONCLUSION: Antituberculous chemotherapy combined with anterior surgery seems to be beneficial in the setting of lumbosacral osteomyelitis complicated by epidural abscess formation with presacral extension.

Adult↗
PubMed2005

An unusual spinal arachnoiditis.

Cryptococcal spinal arachnoiditis occurs in patients with meningitis and usually when they are immunocompromised. Spinal symptoms in cryptococcosis are rare and a very exceptional entity in the immunocompetent population. We present a young immunocompetent male who developed progressively increasing paraparesis due to primary cryptococcal arachnoiditis, who showed significant improvement after antifungal therapy. Although extremely rare, spinal arachnoiditis in an immunocompetent individual can be caused due to cryptococcus, as in our case. This case illustrates and emphasizes the necessity for an exhaustive and complete investigation, with a high index of suspicion for fungal etiology in patients presenting with spinal arachnoiditis or other disabling, progressive spinal cord syndromes of unknown etiology. Awareness of this presentation is necessary to avoid delay in diagnosis and management of this potentially curable condition.

Amphotericin B↗
PubMed2006

Imaging of infectious spinal disorders in children and adults.

The aim of this review article is to outline the imaging of infectious disorders of the spine in adults and children. The clinical presentation, potential routes of infection and the pathogens commonly identified are discussed. The value of different imaging modalities in the diagnosis of spinal infection is presented including radiographic, CT, MR imaging and Nuclear Medicine including PET. The use of image guided techniques for diagnosis and subsequent treatment is briefly covered. The major differential diagnoses of infectious disorders of the spine are identified and contrasted with the typical findings in infection. The use of follow up imaging is evaluated.

Adult↗
PubMed2006

Pott's disease occurring after percutaneous vertebroplasty: an unusual illustration of the principle of locus minoris resistentiae.

We report an unusual case of a multifocal tuberculous spondylitis that has been diagnosed after several percutaneous vertebroplasty. This event supports the theory that surgical or radiological intervention such as a percutaneous vertebroplasty should be considered as an intentional traumatism that can lead to the initiation of a locus minoris resistentiae, probably by reactivating an inactive tuberculous lesion.

Aged↗
PubMed1978

The radiological changes in infections of the spine and their diagnostic value.

This study describes the early radiological changes which occur in infections of the spine, by examination of the initial radiographs in 45 patients with proven spinal infection. The commonest radiological change in infection of the spine was a symmetrical lesion involving the adjacent surfaces of two vertebrae, with a variable degree of reduction in height of the disc space. A paravertebral abscess was a common associated finding. No radiological pattern was completely reliable in distinguishing tuberculous from non-tuberculous infections, but in white patients the formation of new bone strongly suggested a pyogenic lesion. The presence or absence of a paravertebral abscess was not helpful in distinguishing the variety of infection.

Adolescent↗