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At least 1,189 records · Page 66Linked to original sources
PubMed1996

Patterns of anterior spinal canal involvement by neoplasms and infections.

PURPOSE: To show that retrovertebral extension of neoplastic and infectious disease proceeds in a predictable manner, with the anatomic superstructure determining the shape of the advancing process. METHODS: We examined 58 patients who had neoplastic (n = 44) and infectious (n = 14) processes that caused canal compromise. In total, 140 levels were examined by means of MR imaging only (48 patients), CT only (1 patient), CT plus MR imaging (3 patients), and MR imaging plus CT myelography (6 patients). RESULTS: At 136 levels, the retrovertebral disease process took the shape of a smoothly marginated, bilobulated mass that was broad-based against the posterior surface of the vertebra. Various degrees of mass effect were observed: symmetric on 108 levels and asymmetric on 28 levels; on 4 levels, expansion of the anterior epidural space was unilobar, reflecting unilateral canal invasion. With advanced stages of canal invasion, this bilobulated pattern was maintained but there was a tendency toward detachment of the midline septum (20 levels). CONCLUSION: The observed patterns are determined by the particular anatomy of the anterior epidural space. The shape of the mass is imposed by the posterior longitudinal ligament and by the attached lateral membranes, with the central tether produced by the attached midline septum. The two compartments expand independently.

Abscess↗
PubMed1996

Abdominal aortic aneurysm. A rare cause of destructive lesions of the spine.

A case of destructive vertebral and discal lesions in a patient with chronic, noninfected rupture of an abdominal aortic aneurysm is reported. The main rheumatic manifestations of abdominal aortic aneurysms are reviewed. Perianeurysmal inflammation may contribute to the development of destructive vertebral and discal lesions.

Aged↗
PubMed1994

Percutaneous diskectomy for disk space infections.

To diagnose and treat intervertebral disk space infection, we used percutaneous diskectomy in four patients to harvest a large amount of disk material and to decompress and lavage the infected disk space with a broad spectrum antibiotic solution. This treatment regimen rapidly diminished pain and shortened the acute clinical course of the process. The long-term course in this small number of patients, however, appears not to have been altered.

Acute Disease↗
PubMed1996

[Spinal tuberculosis. Study of clinical and radiological aspects from a series of 82 cases].

We present a retrospective study of 82 cases of spinal tuberculosis diagnosed over the last 30 years. An increasing incidence of this disease not related to HIV infection has become apparent since 1992. 24% of patients were born outside continental France. The intradermal reaction was negative in 10% of patients. Discovertebral lesions detected in 93% of patients was the most frequent radiological presentation. Spondylitis with osteolysis or bone sclerosis at single or multiple levels was seen in the others. Tuberculous lesion of the posterior arch was associated in 10% of patients. In most cases CT scan showed a fragmentary vertebral destruction which was characteristic of the disease. MRI revealed the precise extent of the lesions into the spinal canal. Morphologic features suggestive of the tuberculous nature of paravertebral abcesses could be demonstrated when slices were performed in the axial or coronal plan. Tuberculous involvement of the spine is still a frequent disease. The main clinical and radiological findings are presented.

Adolescent↗
PubMed1996

[Back pain in children: symptoms which should be taken seriously].

Back pain in children is a rare but serious problem. The varied etiologies and the necessary diagnostic workup are illustrated in 8 children. Infectious processes were found in 3 children, spondylodiscitis twice and epidural abscess once. Tumours (one eosinophilic granuloma and one spinal ependymoma) were present in 2 boys. One girl had a herniated lumbar disc. Malformations (spondylolysis and diastematomyelia) were the cause of symptoms in 2 children. Leading symptom in all 8 children was back pain lasting from 3 days to 2 years. Careful clinical neurological examination, parameters of inflammation in the blood and conventional radiography of the spine were helpful in guiding further investigations. Scintigraphy was useful for localization of infectious and tumorous diseases. MRI was superior to CT in evaluating tumours and malformations of the spinal cord. In most cases CT was sufficient in workup of infectious and osseous processes.

Adolescent↗
PubMed1996

Gout in the cervical spine: MR pattern mimicking diskovertebral infection.

We report the MR features of a surgically proved cervical spine involved with gouty tophi in a patient with a long history of hyperuricemia. Tophi appeared as sharply delineated areas of low signal intensity on T1 and T2 MR images and showed intense and homogeneous signal enhancement on post-contrast images.

Arthritis, Gouty↗
PubMed1996

Spondylodiscitis caused by Tropheryma whippelii.

We describe the first case of spondylodiscitis caused by Tropheryma whippelii in which this so far unculturable organism was shown to be present at the site of infection in a patient without significant gastrointestinal symptoms. The methods used included broad-range PCR amplification with universal primers complementary to constant sequences of the gene coding for 16S rRNA, direct sequencing of the amplified fragment, and comparison of the sequence determined with those deposited in sequence databases. In addition to demonstrating the presence of this organism in the affected vertebral body, we found in our patient that the specific PCR is more sensitive than histology for detecting Whipple's bacilli in bowel biopsy specimens. Because histology of small bowel biopsies from the duodenum were-in contrast to PCR from the same site-not diagnostic for Whipple's disease in our patient, we recommend PCR whenever Whipple's disease has to be excluded.

Actinobacteria↗
PubMed1996

[Vertebral pain in advanced age: radiological diagnosis].

Vertebral pain is common in elderly patients. This article reviews indications and results of imaging in these patients. The differential diagnosis of degenerative disease and the mass important emergency situations are discussed. Standard radiographs are crucial for adequate diagnosis due to high spatial resolution and the excellent overview they provide. Computed tomography is useful in bone abnormalities and is an important diagnostic tool in this population. Magnetic resonance imaging is preferable in abnormalities of the cervical spine and in suspected spondylodiscitis. Myelography, CT myelography and discography are rarely indicated, but may be ordered for operative planning. Bone scintigraphy is useful in detection of multilocular lesions and can be used for assessing the activity of pathologic processes.

Aged↗
PubMed1997

Spinal instrumentation in the management of degenerative disorders of the lumbar spine.

The use of spinal instrumentation as an adjunct to fusion for the treatment of degenerative disorders of the lumbar spine is controversial. Instrumented lumbar fusions, in specific instances, may improve patient outcomes. For patients undergoing single level primary lumbar arthrodesis, the available data do not conclusively support the efficacy of spinal instrumentation. However, in the setting of previous failed lumbar surgery, iatrogenic or degenerative lumbar spondylolisthesis, spinal instrumentation may be useful as an adjunct to fusion. Possible advantages associated with the use of instrumentation include: correction of deformity in frontal and sagittal planes; decreased pseudarthrosis rates; prevention of progression of spondylolisthesis, and provision of spinal stability in the absence of intact posterior elements. Complications associated with the use of instrumentation include: increased cost; increased operative times; increased infection rate; increased reoperation rate; and a steep learning curve. Therefore, when instrumentation is to be used, the benefits must outweigh the risks. These risks can be minimized by the judicious use of instrumentation by experienced surgeons, for specific indications as supported by the literature.

Discitis↗
PubMed1996

[HIV infection manifesting as a pneumococcal spondylodiscitis].

In this report the authors describe a patient in whom pneumococcal spondylitis was the presenting manifestation of HIV infection and discuss bone and joint infections during HIV infection. The case report involves a 43-year-old man from Mali who was admitted for fever and back pain that occurred during upper airway infection. Pneumococcal spondylitis was diagnosed based on MRI images showing an epidural effusion and on positive hemocultures for Streptococcus pneumoniae. Initial standard x-ray findings were normal but repeat imaging revealed the disco-vertebral lesions. HIV serology was positive but there was no evidence of immunodepression or decreased CD4 lymphocyte levels. Since the introduction of antibiotics bone and joint involvement in pneumococcal disease has become uncommon in developed countries. In patients with HIV infection pyogenic arthritis is rare but the risk of pneumococcal disease is greatly enhanced and arthritic lesions can occur. Only eleven cases of pneumococcal arthritis associated with HIV infection have been reported in the literature. However the incidence of these infections seems higher in Black Africa where they account for 50% of pyogenic arthritis. The authors emphasize the lack of correlation between the stage of HIV infection and the onset of pneumococcal osteoarthritic infections which could account for occurrence of the latter as presenting manifestations of retroviral seropositivity.

AIDS-Related Opportunistic Infections↗
PubMed1996

[Infections of the cervical spine].

Diagnosis of infectious disease of the spine in an early stage ist difficult. Conventional X-ray examinations, often used as a basic screening study, will show the characteristic narrowing of the intervertebral disc space and the osteolytic and sclerotic changes in the adjointing vertebra only after two to eight weeks. Magnetic resonance imaging (MRI) has a sensitivity equivalent to bone scintigraphy and, due to its superior delineation of anatomic details, MRI has become the method of choice not only for the assessment of location, extent, and associated lesions in infectious bone disease, but also in the diagnosis of intradural infections including myelitis. MRI examination in the assessment of a successful therapy or osteomyelitis of the spine aims for the detection of regression of bone marrow edema, reappearance of fatty marrow, and less pronounced contrast enhancement. Computed tomography (CT) is mainly used for image-guided biopsy to obtain specimen for microbiologic culture or for the placement of a percutaneous drainage.

Abscess↗