الملخص
RESUMEN La enfermedad de Pott es un problema de salud en países en desarrollo y su diagnóstico en niños es un desafío. Presentamos el caso de un niño de dos años de edad, con enfermedad de Pott que compromete vértebras torácicas de T1 a T3. El cuadro clínico se caracterizó por dificultad para caminar, fiebre, tos y disnea. Al examen físico, se evidenció cifosis y prominencia ósea en la región cervicodorsal. Se obtuvo una prueba de tuberculina positiva y se aisló Mycobacterium tuberculosis en el cultivo del aspirado gástrico. La resonancia de columna vertebral mostró un absceso frio, destrucción de dos vértebras y compresión de la médula espinal. El paciente presentó mejoría con la terapia antituberculosa. Resaltamos la importancia de tener en cuenta la sospecha clínica para la detección temprana de esta condición, así como un inicio rápido del tratamiento antituberculoso, para evitar la discapacidad y mortalidad asociada a esta enfermedad.
ABSTRACT Pott's disease is a health problem in developing countries and its diagnosis in children is a challenge. Here we present the case of a two-year-old boy with Pott's disease involving T1 to T3 thoracic vertebrae. The clinical presentation was characterized by difficulty walking, fever, cough, and dyspnea. At physical examination, kyphosis and bony prominence were observed in the cervicodorsal area. A positive tuberculin test was obtained, and Mycobacterium tuberculosis was isolated via culture of the gastric aspiration sample. The spine MRI showed a chronic abscess, destruction of two vertebrae, and bone marrow compression. The patient experienced some improvement with anti-TB therapy. Here, we emphasize the importance of giving consideration to the clinical suspicion for the early detection of this condition, as well as a quick TB-treatment start so as to avoid the disability and mortality associated to this disease.
الموضوعات
Child, Preschool , Humans , Male , Thoracic Vertebrae , Tuberculosis, Spinal , Tuberculosis, Spinal/diagnosis , Tuberculosis, Spinal/drug therapyالملخص
Introducción: La Tuberculosis Espinal corresponde a una infección causada por Mycobacteriun tuberculosis localizada en la región vertebral. El tratamiento farmacológico de esta patología no está exento de complicaciones, principalmente dado por la toxicidad hepática. El caso clínico a presentar se centra en el tratamiento farmacológico en un paciente con Insuficiencia Hepática. Presentación del caso: Paciente de 58 años con antecedentes de Insuficiencia Hepática, inició cuadro de 3 meses de evolución caracterizado por dolor lumbar progresivo con escasa a nula respuesta a tratamiento analgésico. Al examen físico destacó dolor axial de columna lumbar, paresia M4 en L5, Lasegue y Tepe (-). Se solicitaron exámenes de imagenología y laboratorio, confirmándose probable diagnóstico de Tuberculosis Espinal. Se inició tratamiento antituberculoso alternativo. Discusión: El tratamiento universalmente aceptado es la asociación de Isoniazida, Rifampicina, Pirazinamida, Etambutol. En relación al caso clínico y a la Insuficiencia Hepática se recomienda no utilizar Pirazinamida y ante riesgo alto reemplazar el uso de Isoniazida por Fluoroquinolona. Además se recomienda medir enzimas hepáticas al inicio del tratamiento y durante su mantención. En caso de encontrarse elevadas, se recomienda iniciar un esquema con mínimo riesgo de toxicidad hepática, asociando Estreptomicina - Etambutol, mientras se normalizan las alteraciones. En el caso clínico presentado el esquema antibiótico considera la asociación de Estreptomicina, Etambutol y Fluoroquinolona. Es importante reconocer la clínica de la Tuberculosis Espinal, con el fin de proporcionar un tratamiento oportuno y eficaz, considerando el riesgo de hepatoxicidad de éste y su indicación en pacientes con diagnóstico de Insuficiencia Hepática.
Introduction: Spinal Tuberculosis corresponds to an infection caused by Mycobacterium tuberculosis located in the vertebral region. The pharmacological treatment of this pathology is not free of complications, mainly due to liver toxicity. The clinical case to be presented focuses on the pharmacological treatment in a patient with Hepatic Insufficiency. Case report: A 58-year-old patient with a history of Hepatic Insufficiency, started a 3-month evolution characterized by progressive lumbar pain with little to no response to analgesic treatment. Physical examination revealed lumbar spine axial pain, M4 paresis in L5, Lasegue and Tepe (-). Imaging and laboratory tests were requested, confirming the probable diagnosis of Spinal Tuberculosis. Alternative antituberculous treatment was started. Discussion: The universally accepted treatment is the association of Isoniazide, Rifampin, Pyrazinamide, Ethambutol. In relation to the clinical case and Hepatic Insufficiency, it is recommended not to use Pyrazinamide and at high risk to replace the use of Isoniazide with Fluoroquinolone. It is also recommended to measure liver enzymes at the start of treatment and during maintenance. In case of being elevated, it is recommended initiate a scheme with minimal risk of liver toxicity, associating Streptomycin - Ethambutol, while the alterations are normalized. In the clinical case presented, the antibiotic scheme considers the association of Streptomycin, Etambutol and Fluoroquinolone. It is important to recognize the clinic of Spinal Tuberculosis, in order to provide timely and effective treatment, considering the risk of hepatoxicity thereof and its indication in patients diagnosed with Hepatic Insufficiency
الموضوعات
Humans , Female , Middle Aged , Tuberculosis, Spinal/drug therapy , Tuberculosis, Spinal/diagnostic imaging , Magnetic Resonance Spectroscopy , Hepatic Insufficiency , Metabolic Side Effects of Drugs and Substances , Mycobacterium tuberculosisالملخص
Introducción: El absceso del psoas es un cuadro infrecuente cuyo principal agente etiológico es el Staphyloccocus aureus, y que con baja frecuencia puede ser de etiología tuberculosa como complicación de una afección vertebral por Mycobacterium tuberculosis. Presentación del caso: Mujer de 58 años, mapuche, con antecedentes de enfermedad pulmonar obstructiva crónica y alcoholismo crónico, consultó por cuadro de dos meses de evolución de dolor lumbar, baja de peso y paresia de extremidad inferior derecha que impedía la marcha. Tomografía computada (TC) de columna evidenció espondilodiscitis y absceso del psoas derecho, iniciándose tratamiento antibiótico cubriendo Staphyloccocus aureus. Los hemocultivos y los cultivos de la colección resultaron negativos por lo que se decidió mantener tratamiento ambulatorio. Paciente consultó cuatro meses después por exacerbación de su disnea basal de dos semanas de evolución, radiografía de tórax y TC de tórax de alta resolución compatibles con tuberculosis pulmonar con diseminación miliar bilateral, por lo cual, se inició tratamiento antituberculoso, realizándose baciloscopías que resultaron negativas. Además, se solicitó identificación del bacilo de Koch mediante reacción de polimerasa en cadena que resultó positiva, con lo que se confirmó el diagnóstico de tuberculosis miliar y mal de Pott. Se decidió reevaluar con TC de columna una vez finalizado el tratamiento antituberculoso para decidir conducta quirúrgica. Discusión: Es importante la sospecha activa de etiología tuberculosa ante una espondilodiscitis y un absceso del psoas, pese a su baja frecuencia. El inicio del tratamiento en forma precoz puede modificar la progresión de una infección que puede ser invalidante e incluso mortal.
Introduction: The Psoas abscess is an infrecuent condition which main ethiology is the Staphyloccocus aureus and with less frequency can be a vertebral tuberculosis complication caused by Mycobacterium tuberculosis. Case Report: a 58 years old female, Mapuche, with Chronic Obstructive Pulmonar Disease and chronic alcoholism antecedents, was admitted in the emergency room with a two month old lumbar pain, loss of weight and right inferior extremity paresia which didn't allowed her to walk. The column's Computed Tomography (CT) showed spondylodiscitis and a right psoas abscess, the antibiotherapy, covering Staphyloccocus aureus, was started. The hemoculives and abscess' cultives were negative, so it was decided to continue with ambulatory treatment. The patient was admitted four month later because of two weeks of exacerbation of her basal dysnea. The thorax Radiography and high resolution CT were compatibles with pulmonary tuberculosis with bilateral miliar disemination. Antituberculosis treatment was started, bacilloscopies were negative, also, a Polymerase Chain Reaction identification of Koch's bacillus was performed, resulting positive, confirming the diagnosis of miliar tuberculosis and Pott's disease. Once antituberculosis treatment was finished, a new column's CT was requested to decided surgical conduct. Discussion: Is important to actively suspect of tuberculosis ethiology in presence of spondylodiscitis and psoas abscess, despite it's low frequency. The early treatment start may modify the progresion of an infección that can be invalidating and even mortal.
الموضوعات
Humans , Female , Middle Aged , Tuberculosis, Spinal/complications , Tuberculosis, Spinal/drug therapy , Psoas Abscess/etiology , Psoas Abscess/diagnostic imaging , Tuberculosis/complications , Tuberculosis, Spinal/etiology , Radiography, Thoracic , Discitis , Tomography, X-Ray Computed , Psoas Abscess/drug therapyالملخص
Cada año mueren alrededor de dos millones de personas a causa de la tuberculosis y se estima que un tercio de la población mundial está infectada con el bacilo que la causa, pero solo entre 5 y 10 % desarrolla la enfermedad. El riesgo de que la enfermedad progrese al estado activo depende de factores endógenos y exógenos. Las comunidades indígenas son un grupo con un alto riesgo de infectarse y enfermar de tuberculosis; además de factores como el aislamiento geográfico, el abandono social y cultural y la desnutrición, se han identificado en ellos polimorfismos genéticos que los hacen más propensos a la infección. La tuberculosis vertebral es la forma más destructiva de la enfermedad y representa cerca de la mitad de los casos de tuberculosis esquelética. Se presenta el caso de un paciente indígena colombiano con tuberculosis vertebral y resultado negativo para HIV. El diagnóstico se basó en los hallazgos clínicos y en los estudios de imaginología, y se confirmó mediante la prueba molecular rápida Genotype MTBDR plus ® y de la reacción en cadena de la polimerasa PCR IS6110; el cultivo fue negativo a las 16 semanas de incubación. Se discuten brevemente la patogénesis, el diagnóstico y el tratamiento, y se comentan algunos aspectos relacionados con la situación de la tuberculosis en las comunidades indígenas colombianas.
Approximately 2 million people die each year from tuberculosis. One third of the world´s population is estimated to be infected with the tuberculosis bacillus, although only 5-10% will develop the disease in their lifetime. The disease progression risk depends on endogenous and exogenous factors. Indigenous communities are a high-risk group for infection and development of tuberculosis. In addition to factors such as geographical isolation, social and cultural neglect and malnutrition, susceptibility to genetic polymorphisms has been identified in them. Spinal tuberculosis is the most destructive form of the disease, which represents approximately half of all cases of skeletal tuberculosis. The case of an HIV negative, indigenous Colombian man is presented. His diagnosis was done based on clinical and image findings, and it was confirmed with the rapid molecular assay Genotype MTBDRplus ® and IS6110 PCR.The culture in solid media was negative after 16 weeks. We briefly discuss the pathogenesis, diagnosis and treatment. Finally, we comment on some aspects of the situation of tuberculosis among indigenous Colombian communities.
الموضوعات
Humans , Male , Middle Aged , Tuberculosis, Spinal/epidemiology , Discitis/diagnostic imaging , Indians, South American , Lumbar Vertebrae , Tuberculosis/epidemiology , Tuberculosis, Spinal/surgery , Tuberculosis, Spinal/drug therapy , Tuberculosis, Spinal/diagnostic imaging , Discitis/surgery , Discitis/drug therapy , Tomography, X-Ray Computed , Drainage , Colombia/epidemiology , HIV Seronegativity , Combined Modality Therapy , Drug Resistance, Multiple, Bacterial , Disease Susceptibility , Lumbar Vertebrae/diagnostic imaging , Anti-Bacterial Agents/therapeutic use , Mycobacterium tuberculosis/isolation & purification , Mycobacterium tuberculosis/drug effects , Antitubercular Agents/therapeutic useالملخص
INTRODUCCIÓN: El absceso del psoas (AP) es una patología infrecuente de difícil diagnóstico. Se clasifica en primario o secundario teniendo como factor de riesgo común la inmunodeficiencia. PRESENTACIÓN DEL CASO: Paciente masculino de 40 años sin antecedentes mórbidos. Consulta por cuadro de un mes de evolución caracterizado por dolor lumbar derecho que aumenta al flexionar el muslo ipsilateral. Se asocia compromiso del estado general, dolor abdominal, sensación febril no cuantificada y bradipsiquia. La Tomografía computada (TC) de abdomen y pelvis mostró hipodensidad en relación al músculo psoas derecho diagnosticándose AP primario. El paciente evoluciona con shock séptico, siendo manejado con antibióticos de amplio espectro sin mejoría. Se realizan exámenes generales, Punción lumbar (PL) y Test de Elisa para VIH (TEVIH), resultando la PL compatible con Tuberculosis meníngea y el TE positivo. Se inició tratamiento empírico anti-tísico en espera del cultivo de Koch. Paciente evoluciona favorablemente. Se realiza una TC de control luego de dos semanas de tratamiento, que muestra imagen similar a la inicial, agregándose compromiso vertebral L4-L5, diagnosticándose Enfermedad de Pott (EP) y AP secundario. Se realiza punción y drenaje del absceso y se toma cultivo de Koch que resulta positivo. Paciente evoluciona asintomático, con buena respuesta al tratamiento. DISCUSIÓN: El AP secundario a EP es una entidad poco sospechada. Sin embargo, con métodos diagnósticos como la TC es posible realizar un diagnóstico precoz. Mycobacterium tuberculosis es una causa infrecuente de abscesos del psoas, pero debido al aumento de la población VIH positiva, es probable que aumente su incidencia.
INTRODUCTION: Psoas abscess is an uncommon disease with difficult diagnosis. It can be primary or secondary; immunodeficiency is among risk factors. CASE REPORT: 40 year-old male with no past medical history. He presented to the emergency department with right lumbar pain worsened with flexion of ipsilateral thigh. Involvement of general condition, abdominal pain, unquantified fever and bradypsychia were also present. Computed tomography (CT) scan of the abdomen and pelvis showed an hypodense lesion in the right psoas muscle. Primary psoas abscess was first diagnostic impression. Patient evolved to septic shock and was treated with broad spectrum antibiotics without improvement. General examinations were performed, lumbar puncture supported meningeal tuberculosis and HIV ELISA test was positive. Empirical quintuple therapy for tuberculosis was started before cerebrospinal fluid culture results, with favorable clinical evolution. Control CT scan was similar compared to first one but with L4 L5 vertebrae involvement. Pott disease and secondary psoas abscess was diagnosed. Kochs Bacillus culture from abscess puncture were positive. Patient had clinical improvement with antituberculous therapy. DISCUSSION: Psoas abscess is a rarely suspected patology, but with diagnostic methods as CT is possible to make an early diagnosis. Even though Mycobacterium tuberculosis is a rarer cause of psoas abscess, but more cases are expected due to the increased incidence of HIV positive patients, more cases are expected eventually.
الموضوعات
Humans , Male , Adult , Psoas Abscess/etiology , HIV Infections/complications , Tuberculosis, Spinal/complications , Tuberculosis, Spinal , AIDS-Related Opportunistic Infections , Antiretroviral Therapy, Highly Active , Enzyme-Linked Immunosorbent Assay , Immunocompromised Host , HIV Infections/drug therapy , Tomography, X-Ray Computed , Tuberculosis, Spinal/drug therapyالملخص
Background: Tuberculous spondylodiscitis is relatively uncommon but represents the most common location of osseous tuberculosis. Aim: To describe clinical features, imaging studies and laboratory tests to establish the diagnosis in a group of patients living in Cádiz (Spain). Material and Methods: Retrospective analysis of medical records of patients with tuberculous spondylodiscitis diagnosed between 2000 and 2009. The diagnosis was based on microorganism recovery from vertebral samples obtained by imaging guided biopsies. Results: Six patients with positive Mycobac-terium tuberculosis cultures from vertebral samples, were identified (10 percent of extra-pulmonary tuberculosis). In only 2 patients the Ziehl-Nielsen stain was positive, and histology was compatible in 4 cases. Four patients were females, their mean age was 54.3 years and the mean duration of symptoms was 7.3 months. Three patients had lumbar location and a positive Mantoux test. A soft tissue abscess was present in 4 cases. None of these patients had neurological complications. The treatment with four tuberculostatic agents (isoniazid, rifampicin, pyrazinamide and ethambutol) was effective in 5 patients. Conclusions: Tuberculous spondylodiscitis may become a serious disease due to diagnostic and treatment delays. The main examinations to establish diagnosis are magnetic resonance imaging and biopsy with microbiological culture. Generally, antituberculous therapy is effective in this clinical situation.
الموضوعات
Adult , Aged , Aged, 80 and over , Female , Humans , Male , Discitis/diagnosis , Tuberculosis, Spinal/diagnosis , Antitubercular Agents/therapeutic use , Discitis/drug therapy , Retrospective Studies , Spain , Tuberculosis, Spinal/drug therapyالموضوعات
Adult , Humans , Male , AIDS-Related Opportunistic Infections/diagnosis , Tuberculosis, Spinal/diagnosis , AIDS-Related Opportunistic Infections/drug therapy , Anti-HIV Agents/therapeutic use , Antitubercular Agents/therapeutic use , Diagnosis, Differential , Drug Therapy, Combination , Magnetic Resonance Imaging , Tuberculosis, Spinal/drug therapyالملخص
A 42-year-old male complaining of thoracic spine pain was admitted to the hospital for evaluation. An X-ray and computer tomography of the thoracic spine showed spondylodiscitis of the L3 lumbar and L2-L3 intervertebral disk. The tuberculin skin test (PPD) was strongly positive. A radioscopy-guided fine needle aspirate of the affected area was cultured but did not reveal the cause of the disease. Two biopsy attempts failed to reveal the cause of the disease by culturing or by acid-fast-resistant staining (Ziehl Neelsen) of the specimens. A third biopsy also failed to detect the infectious agent by using microbiological procedures, but revealed the presence of a 245-bp amplicon characteristic of the Mycobacterium tuberculosis complex after PCR of the sample. The result demonstrates the efficacy of PCR for the identification of M. tuberculosis in situations in which conventional diagnosis by culturing techniques or direct microscopy is unable to detect the microorganism. Following this result the patient was treated with the antituberculous cocktail composed by rifampicin, pirazinamide and isoniazid during a six-month period. At the end of the treatment the dorsalgia symptoms had disappeared.
الموضوعات
Humans , Male , Adult , Antitubercular Agents/therapeutic use , Discitis/microbiology , Mycobacterium tuberculosis/genetics , Polymerase Chain Reaction , Thoracic Vertebrae/microbiology , Tuberculosis, Spinal/diagnosis , Biopsy , Drug Therapy, Combination , Discitis/diagnosis , Discitis/drug therapy , Isoniazid/therapeutic use , Mycobacterium tuberculosis/isolation & purification , Pyrazinamide/therapeutic use , Rifampin/therapeutic use , Tuberculin Test , Tuberculosis, Spinal/drug therapyالملخص
In a high tuberculosis TB prevalence country, mortality due to miliary TB is not unknown but the treatment outcome in general is good. We describe a previously healthy man with miliary TB who did not respond to 2-months antituberculous therapy with 4 drugs. Persistent complaints of backache, which antedated chest symptoms, resulted in a diagnosis of Pott's disease. Culture of bronchial aspirate yielded multidrug resistant Mycobacterium tuberculosis that responded slowly to streptomycin, ethionamide, cycloserine, clofazimine, ofloxacin, paraaminosalicylic acid and isoniazid. The association of multidrug resistant miliary TB with Pott's disease in an immunocompetent patient is yet to be highlighted
الموضوعات
Humans , Male , Tuberculosis, Miliary/drug therapy , Tuberculosis, Spinal/drug therapy , Immunocompetence , Drug Therapy, Combinationالملخص
To present our experience in the management of 22 patients with thoracolumbar spine tuberculosis [TB] using a chemotherapy regimen and locally custom-made spinal brace. Twenty-two patients with thoracolumbar spine TB had been treated conservatively by chemotherapy and locally custom-made spinal brace and followed for 36-48 months from June 1996 to June 2000 in the Department of Orthopedics and Trauma, Algamhoria Teaching Hospital, Aden, Republic of Yemen. In 14 cases, 2 vertebrae were involved, whereas in 8 cases involvement was only of one vertebra. All had persistent back pain: 2 had neurological deficit, Frankel grade A and B [9%], and 12 [54%] had gibbus deformity. At the end of the observation period, all patients had no pain [based on the adjective rating scale]. Fourteen thoracic and 3 psoas abscesses resolved by 18 months. Four cases [18%] had deterioration of the angle of kyphosis. Five cases [22.5%] had progressive vertebral loss. Twelve cases [84%] had bony fusion at 36 months. Chemotherapy regimen and locally custom-made spinal brace is not costly, needs neither admission nor surgical intervention that demands skills and experience and can be recommended for uncomplicated thoracolumbar spinal TB
الموضوعات
Humans , Male , Female , Braces , Antitubercular Agents , Tuberculosis, Spinal/drug therapy , Thoracic Vertebrae , Lumbar Vertebraeالملخص
Os autores apresentam um caso de crianca de oito anos com queixa de dor e deformidade em regiao cervical com duracao de tres meses, alem de sinais de compressao medular...
الموضوعات
Humans , Male , Child , Neck Pain , Neck Pain/etiology , Tuberculosis, Spinal/diagnosis , Drug Combinations , Magnetic Resonance Spectroscopy , Tuberculosis, Spinal/drug therapy , Tuberculosis, Spinal/therapyالملخص
Reportamos 2 casos de espondilitis tuberculosa en mujeres de 51 a 65 años de edad respectivamente quienes presentaron dolor en la columna vertebral acompañado de síntomas generales, una de ellas con compromiso neurológico. Ambas tuvieron lesiones osteolíticas, y espondilodiscitis en la resonancia magnética. En el segundo caso, además hubo evidencia de abscesos fríos en cuerpos vertebrales y músculos paravertebrales que requirió debridación y descomprensión medular más artrodesis de columna. Recibieron tratamiento con agentes antituberculosos con buena evolución.
الموضوعات
Humans , Female , Middle Aged , Paraparesis, Tropical Spastic , Magnetic Resonance Spectroscopy , Tuberculosis, Spinal/diagnosis , Tuberculosis, Spinal/drug therapy , Tuberculosis, Spinal/therapyالملخص
Os autores relatam caso de tuberculose de coluna vertebral (mal de Pott) associado a meningoencefalite tuberculose em paciente de 51 anos, sexo masculino, com história crônica de confusao mental e dor em regiao lombar. Ressaltam o valor de tomografia computadorizada (TC), da ressonância nuclear magnética (RNM) e da cintilografia óssea (CO) como métodos diagnósticos auxiliares na avaliaçao do comprometimento do sistema nervoso central e coluna vertebral.
الموضوعات
Humans , Male , Middle Aged , Tuberculosis, Meningeal/complications , Tuberculosis, Spinal/complications , Tuberculosis, Meningeal/diagnosis , Tuberculosis, Meningeal/drug therapy , Tuberculosis, Spinal/diagnosis , Tuberculosis, Spinal/drug therapyالملخص
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.
الموضوعات
Humans , Adult , Male , Spinal Fusion , Spine/surgery , Tuberculosis, Spinal/surgery , Tuberculosis, Spinal/complications , Tuberculosis, Spinal/drug therapyالملخص
Se hizo una revisión sobre pacientes afectados por tuberculosis vertebral de febrero de 1987 a mayo de 1991, tratados en el Hospital de traumatología y Ortopedia "Lomas Verdes". De un total de 38 pacientes, se incluyó en la presente serie a 30, de uno y otro sexo y con edad mayor de 15 años. A 17 enfermos se les administró el tratamiento clásico con hidrazida del ácido isonicotínico (HAIN) y etambutol durante 18 meses, además de estreptomicina solamente los primeros dos meses. El llamado tratamiento corto, se aplicó durante un periodo de seis meses con pirazinamida, rifampicina y estambutol en ocho casos. Finalmente, el tratamiento para las recaídas consistió en un programa de HAIN y rifampicina durante 12 meses y se aplicó en otros cinco pacientes. Si los pacientes no trníasn destrucción ósea masiva, daño neurológico, ni fomación de abscesos o fístulas, se les aplicó tratamiento ortopédico conservador, que consistió en un corsé o reposo en cama durante un periodo de tres a cuatro meses. Este método se aplicó en 13 enfermos. En cambio, si existían las lesiones señaladas, se aplicó tratamiento quirúrgico que consistió en desbridamiento, descompresión y artrodesis anterior con injerto óseo autólogo de ilíaco. Este tratamiento quirúrgico primario se realizó en los restantes 17 enfermos, de los cuales 12 tenían paraplejía. Se requirió cirugía adicional en 12 de aquellos 17 enfermos, por destrucción masiva e inestabilidad espinal, que consistió en simple artrodesis posterior de dos y artrodesis con instrumentación de Luque en 10. Hubo mejoría del daño neurológico sólo en siete de los 12 pacientes. Por otra parte, hubo dos que presentaron daño neural después de la cirugía. El resultado global fue bueno en 23 casos (76 por ciento), regular en cinco y malo en dos. A mayor duración de la enfermedad la capacidad de recuperación de los enfermos fue menor.