[Specific spondylitis]. / Spezifische Spondylitis.

Tuberculosis of the spine usually occurs with a latency period after primary infection with tuberculosis (TB) and the most frequent agent is Mycobacterium tuberculosis. The rate of TB has increased due to the impact of acquired immunodeficiency syndrome (AIDS) and more than 50% of skeletal tuberculosis is localized in the spine. Spinal tuberculosis was discovered by Pott in 1776. Magnetic resonance imaging (MRI) with gadolineum is the most sensitive imaging method. Diagnostic accuracy is given by direct detection of Mycobacterium tuberculosis by punction or biopsy. Granuloma of the spine can lead to abscesses, severe spinal deformity with instability and potentially paraplegia. Chemotherapy is effective with a minimum duration of 6-12 months. In cases with neurological deficits and severe deformity there is an additional indication for surgical therapy. In the acute phase a posterior instrumentation, anterior debridement and reconstruction of the defect is indicated. After recovery of the spinal tuberculosis Pott's kyphosis could remain and operative correction can be managed by pedicle substraction osteotomy.

Dorsal corporectomy in a Ewing sarcoma situated in the pedicle of the L5 vertebral body.

The clinical case of a 34-year-old patient is presented who was diagnosed with Ewing sarcoma in the right pedicle of the L5 vertebral body on the basis of persisting dorsolumbar pain. Staging examinations including CT scan of the thorax and abdomen as well as bone scintigraphy were inconspicuous. The patient underwent 6 cycles of neoadjuvant chemotherapy (VIDE, similar to Euro Ewing 99). Presurgically, embolisation of the L4 and L5 vertebral bodies was performed on both sides. The tumour was removed via a dorsal approach with corporectomy of L5 and resection of the right nerve root of L5. The defect was bridged by a titanium cage filled with bone cement; a dorsal L4-S1 instrumentation was performed. Early postoperative X-rays showed a screw dislocation in S1, making a revision intervention and screw replacement necessary. For additional fixation, S2 was instrumented. Histopathology classified the tissue samples as containing no active tumour cells. Surgery was followed by additional chemotherapy. The patient has remained free of recurrence until now. The aim of this case report is to call attention to the unusual site of the Ewing sarcoma as well as to discuss therapy options, especially dorsal corporectomy, and the prognosis together with a review of the most current literature.

Spondylodiscitis caused by Mycobacterium xenopi.

The infection with non-tuberculous mycobacterium correlates highly with immunodeficiency. Mycobacterium xenopi (M. xenopi) is most commonly isolated in the respiratory tract, as a cause of endogenous spondylodiscitis it occurs but rarely. Only seven such cases have been reported in literature. In this paper, we present the case of an about 28-year-old HIV-positive patient with a long history of back pain. MRI of the spinal column and Positron Emission Tomography with (18)F-fluorodeoxyglucose as a tracer (F18-FDG-PET) confirmed the suspected spondylodiscitis. After performing a CT-controlled abscess drainage the patient's condition improved. Because of the severe destruction of the spinal segment concerned and because of the epidural abscess formation a vertebrectomy of T10 and surgical debridement of the paravertebral soft tissue via thoracotomy became urgently necessary. The spine was stabilized by interposing a cage and an anterolateral monobar system. M. xenopi could be proven by PCR out of the intraoperative specimen. After operation and antituberculotic therapy there was a fast convalescence. Diagnostics, therapy, and clinical outcome are discussed.