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[A case report of atypical tuberculous spondylitis].

A 22-year-old male was admitted to our hospital because of progressive weakness of bilateral lower limbs on October 29, 1992. He also complained of cough, sputum and back pain for 6 months. He had no history of underlying disease. His family history disclosed that his elder brother had tuberculous peritonitis. Chest radiogram on admission showed an abnormal shadow around the right first arch. Computerized tomogram revealed osteolytic lesions of the vertebral corpus and posterior elements at the level of C3, Th5, and Th11. Metastatic bone tumor was strongly suspected and surgical decompression was done on November 12. Histologic findings of the bone showed caseation and Langhans's giant cells, and acid fast bacilli were isolated. He was treated with anti-tubercular chemotherapy and showed remarkable relief of his symptoms over a period of 6 months therapy. This was a case of atypical tuberculous spondylitis. The main locus existed at the posterior elements of the vertebra and the distribution of vertebral lesions was multiple including cervical spine.

Adult↗

Granulomatous spinal infections: MR imaging.

The value of magnetic resonance (MR) imaging in evaluating granulomatous spinal infection was retrospectively assessed in 81 patients with proved disease; 27 were reexamined after administration of gadolinium diethylenetriaminepentaacetic acid, and 25 underwent follow-up studies. Blinded interpretations were correlated with clinical, microbiologic, and surgical findings. MR imaging enabled prediction of the presence of neurologic complications in 93% of patients and diagnosis of the type of infection in 94%, and correlated well with surgical findings in 24 of 27 patients. Vertebral intraosseous abscesses, meningeal involvement, subligamentous spread, and paraspinal abscess location were best identified on contrast-enhanced studies and were seen most frequently in tuberculous spondylitis. High signal intensity on T1-weighted images of previously affected vertebrae suggested healing and correlated well with symptoms. The authors conclude that MR imaging may be useful as the method of first choice for the initial assessment and posttherapy follow-up of patients with granulomatous spinal infection.

Adult↗

Intramedullary spinal cord abscess: case report.

Intramedullary spinal cord abscesses are rare lesions with a poor prognosis unless diagnosed and treated promptly. We report a case of a Nigerian man with tuberculous meningitis that was complicated by an intraspinal cord abscess and was treated surgically. The literature regarding this uncommon clinical entity is reviewed.

Abscess↗

The cervical spine after halo-pelvic traction. An analysis of the complications of 83 patients.

This retrospective study assesses the complications affecting the cervical spine after halo-pelvic traction in 83 patients who were followed up for a minimum of five years. Forty-four patients (53 per cent) had significant cervical complications such as radiological degenerative changes, avascular necrosis of the dens, loss of movement, pain or spontaneous fusion. The most important predisposing factors were a long period in the halo-pelvic apparatus, tuberculous kyphosis, stiffness of the spinal deformity and an age of 15 years or more at the time of application.

Adolescent↗

Brucellar and tuberculous spondylitis. A comparative study of their clinical features.

The clinical data from 19 patients with brucellar spondylitis and 15 with tuberculous spondylitis were compared. The former disease affects males whose occupations expose them to Brucella. The lumbar spine is usually involved and there are other symptoms of brucellosis. Tuberculous spondylitis is not usually accompanied by general symptoms. The dorsal spine is more frequently affected and may exhibit vertebral collapse and paraspinal abscesses. These differences permit a presumptive aetiological diagnosis, but the definitive diagnosis depends upon bacteriological tests.

Adult↗

Tuberculous hypertrophic pachymeningitis involving the posterior fossa and high cervical region--case report.

A 44-year-old female presented with a rare tuberculous hypertrophic pachymeningitis involving the posterior fossa and high cervical region manifesting as progressive multiple cranial nerve pareses and myelopathy developing over 6 months. Magnetic resonance imaging demonstrated the thickened dura mater and associated syrinx. Despite decompressive craniectomy and antituberculous treatment, she died of disseminated intravascular coagulation. Hypertrophic pachymeningitis is probably best treated by the most extensive excision of affected dura mater possible, unless medical treatment can be instituted for an identifiable underlying causative disease.

Adult↗

Osteomylelitis of the spine.

A study of a series of 82 cases of pyogenic osteomyelitis of the spine has shown that the clinical features at the initial stage of the disease often present such a varied picture that the correct diagnosis may easily be overlooked for a long time. Once radiographic changes are demonstrated, the primary consideration in differential diagnosis is tuberculous spondylitis. Bacteriological verification by needle biopsy or surgical exploration is recommended in order to institute an adequate antibiotic therapy. Surgical evacuation is advocated in cases with extensive vertebral destruction. The majority of patients recovered within 1 year from the onset of illness. In slightly more than half of the cases the spinal lesions healed with spontaneous interbody fusion. This tendency was most pronounced in cases of cervical and upper thoracic involvement. No deaths occurred as a result of the spinal disease.

Adolescent↗

Primary hydatid disease of the spine: an unusual cause of progressive paraplegia. Case report and review of the literature.

Although rare, spinal hydatid disease is a manifestation of hydatid infestation. The authors present the report of a patient who presented with primary spinal hydatid disease. This disease is often misdiagnosed as tuberculous spondylitis, and thus patients may subsequently receive inappropriate treatment. The patient in this case presented, with an increasing weakness in the lower limbs, to a different clinic from an area in India where hydatid infections are endemic. The infection was misdiagnosed as tuberculous spondolytis based on evaluation of plain x-ray films, and the patient underwent antituberculous chemotherapy and a posterior surgical decompressive procedure. The patient presented to the authors' clinic with increasing paraparesis 1.5 years later. Radiographs and a magnetic resonance image of the spine were obtained, which strongly suggested hydatid disease. Examination of serum levels confirmed the diagnosis. The patient underwent a decompressive procedure of the spine in which stabilization was performed. Postoperatively her paraparesis resolved, and good control over the disease was achieved by chemotherapy. The authors conclude that primary spinal hydatid disease of the spine, although a rare manifestation, should be considered in the differential diagnosis in patients with infectious and destructive lesions of the spine in regions in which the disease is endemic. Advanced imaging studies should be performed to diagnose the disease. Early decompressive surgery with stabilization of the spine, in addition to adjuvant chemotherapy, is the treatment of choice for these patients.

Adult↗

Tuberculous epidural granuloma simulating a herniated lumbar disc.

A case of tuberculous epidural granuloma producing L5 root compression in a 37-year-old Negro male is presented. Excision of the granuloma and the administration of anti-tuberculous therapy was followed by complete recovery. Tuberculous epidural granuloma simulating a radicular syndrome is rarely seen. A search of the literature revealed only five previously reported cases.

Diagnostic Errors↗