Challenges in the Diagnosis and Management of Spinal Tuberculosis: Case Series.

Though uncommon in developed countries, spinal tuberculosis must still be considered in patients with a suspicious clinical history, to avoid delays in treatment. This case series highlights the special considerations that need to be taken into account while tackling the diagnostic and therapeutic challenges associated with this disease. We present two interesting cases of spinal tuberculosis. The first case was a 26-year-old female who presented with chronic back pain and an initial misdiagnosis of ankylosing spondylitis. The second case was a 26-year-old male with new lower extremity weakness, numbness, and urinary retention. Both cases had clear indications for surgery, however, the first case was treated with medical management upon patient request. The patient was managed non-surgically and improved clinically though she may need surgery in the future. The second case was treated with emergency surgery and the patient regained full neurologic function at follow-up. These cases demonstrate the importance of considering spinal tuberculosis in the differential diagnosis of high-risk patients as well as individualizing treatment strategies for each patient.

Abdominal Lymphocele Following Anterior Lumbar Interbody Fusion: A Case Report.

Anterior lumbar interbody fusion (ALIF) is commonly utilized for surgical management of degenerative lumbar pathology. Although it is a reasonably safe procedure, it can potentially lead to major complications in case of neurovascular injuries. Occurrence of lymphocele after an ALIF is however rare. We present a case of a rare abdominal lymphocele in a 56-year-old man who underwent L3-S1 ALIF and subsequently developed an abdominal lymphocele. A lymphocele can manifest in numerous ways which can affect and possibly delay diagnoses. In addition to a high index of suspicion, numerous tests such as imaging studies, fluid analysis, gram stain and culture are used to confirm the diagnosis. Various options exist for the treatment of lymphoceles, including laparoscopic marsupialization, ultrasound-guided aspiration, sclerotherapy, peritoneal window, and external drainage. Timely diagnosis and treatment of a lymphocele results in a successful resolution in most cases.

Four-rod Instrumentation for Treatment of Charcot Spinal Arthropathy Causing Autonomic Dysreflexia: Case Report and Literature Review.

Late complications of spinal cord injury can include Charcot arthropathy, in which spinal instability occurs as a result of repetitive trauma in the insensate spine. In rare cases, this can present as autonomic dysreflexia. We present the case of a 60-year-old man with longstanding C6 quadriplegia who presented with six months of hypertension, diaphoresis and dizziness. After an extensive workup, the patient's symptoms were attributed to autonomic dysreflexia in the setting of spinal instability from Charcot spinal arthropathy. Computed tomography (CT) and magnetic resonance imaging (MRI) revealed instability with degenerative changes at L1-L2. We present our case with a literature review to discuss management of this uncommon situation. The patient underwent posterior fusion and instrumentation from T8-L5 with four rods, alternating screws and crosslinks with a good reduction and solid stabilization of the spine. Postoperatively, the patient experienced immediate relief of all symptoms. Our case demonstrates effective surgical treatment for Charcot spinal arthropathy causing autonomic dysreflexia. Stabilization with instrumentation and fusion of underlying Charcot spinal arthropathy removed the trigger of the autonomic dysreflexia and alleviated our patient's symptoms.

Isolated Spinal Metastasis with Spinal Cord Compression Leads to a Diagnosis of a Follicular Thyroid Carcinoma.

INTRODUCTION: Thyroid carcinoma initially presents with clinical symptoms due to metastatic lesions in less than 5% of cases. Spinal cord compression from an epidural metastatic lesion as a first symptom is extremely rare. One would expect such a presentation to occur much later in the course of the disease. METHODS: We are presenting a case report of a follicular thyroid carcinoma that presented with spinal cord compression from a thoracic epidural metastatic lesion in a previously healthy 55-year-old male. A single metastasis of follicular thyroid carcinoma presenting with posterior spinal cord compression is rare. In this particular case, our management included a mid-thoracic laminectomy, followed by resection of the epidural lesion. Once the surgical pathology confirmed the diagnosis of a follicular thyroid carcinoma, the general surgery team performed a near total thyroidectomy, after which he received radioactive iodine therapy. The patient is symptom-free at his three-year follow-up. CONCLUSION: Initial presentation of follicular thyroid carcinoma with symptomatic thoracic myelopathy from an epidural metastasis is very uncommon. An early diagnosis and prompt surgical intervention provided an excellent outcome.