Treatment of spinal tuberculosis by decompression and anterior spinal fusion: case report and review of the literature

The treatment of a young man with lumbar spinal tuberculosis and neurological involvement is described. Decompression and anterior spinal fusion were performed. Dramatic improvement in the patient's condition was obtained following surgery. The literature on the treatment of tuberculosis of the spine is reviewed (AU)

Pott's disease with multi-drug resistant mycobacteria - abstract

Tuberculosis and its extrapulmonary manifestations are no longer on the decline in the United States. This is in part due to impaired immunity induced by HIV infection, immigration from countries with extremely high prevalence rates and earlier misdiagnosis with delay in treatment. This, combined with increasing drug resistance, poses a serious threat to public health. We report on a patient, a native of Washington D.C., who had no evidence of immunodeficiency and who developed Pott's disease. Cultures revealed Mycobacterium tuberculosis resistant to all first line chemotherapeutic drugs. Surgical drainage and appropriate use of alternative drugs ensured a gradual recovery. Pott's disease caused by multi-drug resistant M. tuberculosis has not been previously described (AU)

Some lesions of the spine in immigrants

This paper is based on some radiographic appearances in the spine seen in immigrants to Britain. Most patients were Asian or West Indian. In this account Britain's 'white' population will be referred to as 'Caucasian' (AU)

Pyogenic osteomyelitis of the spine - an important differential diagnosis of tuberculosis of the spine - abstract

Pyogenic osteomyelitis of the spine can very easily be confused with tuberculosis of the spine. It is important that these two conditions be differentiated and this can be done by a careful assessment of the clinical and radiological features of each. 18 cases of pyogenic osteomyelitis of the spine seen at the University Hospital of the West Indies over the last 10 years are reviewed. The age incidence varied from 23 years to 65 years with an average age of 54 years. There were 14 males and 4 females. The lesions were distributed as follows - 13 lumbar, 4 thoracic and 1 cervical. There was an associated urinary tract pathology or surgical intervention on the urinary tract in 11 cases. There was only 1 case with diabetes and none with abnormal haemoglobin. There were no cases of typhoid osteomyelitis. There were no local abnormalities of the spine, apart from mild osteoarthritic changes and osteoporosis consistent with the age of the patient. Pyogenic osteomyelitis of the spine is a fairly rare condition. The chief aetiological factor in the development of this condition is urinary tract infection (AU)

Pott's disease in children - abstract

The authors present their experience with the treatment of tuberculosis of the spine in children during the past ten years in Haiti. Two hundred and fifty-three patients under the age of fifteen have been treated. Initial treatment has consisted of bed rest and chemotherapy. Isoniazid and para-aminosalicylic acid in appropriate dose have been continued for two years. Most were begun on streptomycin initially, but this was usually discontinued after two to three months. One hundred and ninety patients had a surgical fusion. Sixteen of these were re-explored for pseudoarthrosis. One patient died postoperatively and one has a persistent pseudarthrosis; the remainder showed solid fusion within four months on a continued postoperative program of bed rest and chemotherapy. Ninety-eight patients had neurological involvment ranging from slight spasticity to total paraplegia. None had any emergency surgery and ninety-two patients recovered with no serious residuum. Of the remaining six all were able to walk although three who has long-standing paraplegia still required crutches anbd braces for ambulation. No laminectomies were done. Many children, even with several vertebrae involved, will not get well on a program of supportive, recumbent therapy with chemotherapy. The authors' indications for surgical fusion now are: (1) failure to heal properly on conservative therapy, (2) increasing deformity during treatment, (3) lumbar destruction likely to impair stability, (4) to ensure immobilization when the follow-up treatment is doubtful. (Au)

Skeletal tuberculosis in Jamaica

One hundred and six cases of skeletal tuberculosis seen in the University College Hospital of the West Indies have been reviewed: The disease often has an acute onset, but if this is survived, the progress is remarkably slow and the prognosis is good. Treatment is therefore primarily conservative, operation being employed only for stabilisation, correction of deformity, or drainage of abscesses. However, direct attack on the diseased vertebral body has been done in paraplegics, with remarkably satisfactory results. Advanced disease of the hip joint may also be treated by curretage of the lesion itself, combined with corrective osteotomy. The importance of early diagnosis has been emphasized. Deformity and disability can be prevented by starting treatment early in the course of the disease. (Summary)