Case of Unusual Abscess Localization in Lumbar Pott’s Disease

In Pott’s disease, cold abscesses usually sit and spread along the psoas muscle. This case concerned a 60 years old man who came to us with bilateral lomboradicular pain and a swelling of inguinal area and the anterior part of the left thigh. We found a 2 years long lasting story of low back pain complaint. Physical examination showed good general health status, stiffness of lumber spine, a left psoitis and no neurological deficit. CT scan going downward from the lumbar spine to the pelvic region and femoral limb with coronal reconstruction demonstrated a huge disco-vertebral destruction of L2-L3 with translation, and bilateral paramedian psoas abscess migrating subfascially toward Scarpa triangle and cleaving anteriorly mainly muscles of the left thigh. After 12 months medical treatment, the evolution has been favorable with clinical cure. The localization of the cold abscess in the left thigh anterior muscles compatment is uncommon. It is why we report this case.

Multilevel Cervicothoracic and Lumbar Pott’s Disease: About Three New and Unusual Cases in the Rheumatology Department of the Teaching Hospital of Cocody in Abidjan (Côte d’Ivoire)

Pott’s disease usually affects two contiguous vertebrae or two spinal levels. The involvement of the three cervicothoracic and lumbar levels is rarely described. Only three cases have been described in the literature to our knowledge. The authors report three new cases of tuberculous spondylodiscitis of cervicothoracic and lumbar site. Our three cases were characterized by symptoms similar to the other topographical forms of Pott’s disease. A predisposing factor is often identified like the infection with human immunodeficiency virus. The definitive diagnosis was made in two cases by identifying acid and alcohol-fast bacilli for one case and by histology for the other case. For the third case, there was a diagnostic presumption reinforced by the satisfactory outcome on tuberculosis chemotherapy for a period of 12 months. The multilevel nature of diseases does not influence the effectiveness of treatment of this form of spinal tuberculosis.

Extra-Pulmonary Pott’s Disease with Intracranial Manifestations: An Inmate’s Story

Tuberculosis is a chronic disease that is the leading cause of infectious disease deaths worldwide. In developed countries, incidences are minimal and however, complicated manifestations of tuberculosis are becoming a trend within the prison system. This case report illustrates a patient within the United States correctional system who demonstrated a rare infection of tuberculosis despite absent pulmonary findings. Our Patient was a 39-year-old inmate presenting with fatigue, night sweats, weight loss, and progressive dyspnea. Pulmonary imaging and cultures of sputum were negative for tuberculosis. Further imaging and laboratory workups demonstrated extensive spinal infections along with intracranial lesions that were positive for tuberculosis. Neurosurgery declined operative medicine due to advancement of the disease and appropriate antibiotic therapy was immediately initiated. Tuberculosis continues to exist in developed countries with an increased emergence of complicated cases. Furthermore, incarceration dramatically increases an individual’s risk of worse infections. The clinical impact involves promoting awareness for a need to identify and prevent continued spread of disseminated infections. Therefore, further investigations of this trend in prisons are worth considering.

Atypical Presentation of Cervical Pott’s Disease: A Case Report

Tuberculous spondylitis, also known as Pott’s disease, is due to infection of the spine by mycobacterium tuberculosis (MTB) leading to vertebral body and inter-vertebral disc destruction. It is the most common form of musculoskeletal tuberculosis most frequently affecting the thoracolumbar spine and is commoner in young people. Onset of this condition is insidious and its clinical presentation is non specific. However, Pott’s disease may be complicated by neurologic deficits including paraplegia or even quadriplegia, with huge health, economic and psychological burden. Following is a case report of Pott’s disease involving the cervical spine in a 33-year old farmer presenting unusually with paraplegia and a negative Mantoux test. It is reported because this very uncommon condition is highly treatable, and there is need for a raised index of suspicion in order to diagnose this condition early, thus limiting its complications. The role of MRI in diagnosis of Pott’s disease is also highlighted.

C1-C2 Pott’s Disease, a Rare Location of Spine Tuberculosis

The authors report a new case of spine tuberculosis of C1-C2 occurred in a 58-year-old negative HIV patient that was responsible of inflammatory cervical pain with multidirectional stiffness and complicated by spastic quadriplegia. The diagnosis was made on the basis of presumptive elements, including cervical spinal CT scan, which showed atlan-to-axial subluxation (C1-C2) with destruction of the odontoid apophysis and lateral mass of the atlas and favorable evolution under specific antibiotic treatment with ethambutol, isoniazid, rifampicin, pyrazinamide and immobilization with brace cast, despite the absence of bacteriological and anatomo-pathological evidence of certainty. The evolution has been favorable, with the disappearance of cervical pain, progressive motor recovery and resumption of autonomy of walking.

Tuberculosis of the spine

Pott’s spine,commonly known as spinal tuberculosis(TB),is an extrapulmonary form of TB caused by Mycobacterium TB.Pott’s paraplegia occurs when the spine is involved.Spinal TB is usually caused by the hematogenous spread of infection from a central focus,which can be in the lungs or another location.Spinal TB is distinguished by intervertebral disc involvement caused by the same segmental arterial supply,which can result in severe morbidity even after years of approved therapy.Neurological impairments and spine deformities are caused by progressive damage to the anterior vertebral body.The clinical,radiographic,microbiological,and histological data are used to make the diagnosis of spinal TB.In Pott’s spine,combination multidrug antitubercular therapy is the basis of treatment.The recent appearance of multidrug-resistant/extremely drug-resistant TB and the growth of human immunodeficiency virus infection have presented significant challenges in the battle against TB infection.Patients who come with significant kyphosis or neurological impairments are the only ones who require surgical care.Debride-ment,fusion stabilization,and correction of spinal deformity are the cornerstones of surgical treatment.Clinical results for the treatment of spinal TB are generally quite good with adequate and prompt care.

超声引导下连续腰交感神经节阻滞治疗下肢Buerger′s病的顽固性疼痛

目的观察超声引导下腰交感神经节阻滞治疗下肢Burger′s病的顽固性疼痛的疗效。方法 40例Buerger′s病患者随机均分为两组。超声引导下治疗组(A组):采用便携式彩色二维超声仪引导下行患侧连续腰交感神经节阻滞,置管两周;对照组(B组)给予抗抑郁药、抗惊厥药物治疗,观察期为两周。监测记录两组患者治疗前和治疗2周后的疼痛VAS评分、患肢皮温和有无血管神经及脏器损伤、恶心呕吐、感觉异常、运动减退、视物模糊、共济失调等不良反应的发生率。结果与B组比较,A组治疗2周后疼痛明显缓解,VAS评分显著下降,皮肤温度明显升高(P<0.01),且无其他严重并发症发生。结论超声直视引导下连续腰交感神经节阻滞技术,可提高穿刺成功率,减少并发症,可在下肢Buerger′s病所致神经病理性疼痛治疗中发挥短期效应。

First Use of Bedaquiline in Democratic Republic of Congo: Two Case Series of Pre Extensively Drug Resistant Tuberculosis

In this manuscript the authors have studied the first two patients who were successfully treated with the treatment regimen containing Bedaquiline as second-line drug. The patients were diagnosed with pre-extensively drug-resistant tuberculosis (preXDR TB) whose prognosis was fatal in Democratic Republic of Congo (DRC). Bedaquiline is arguably one of the molecules of the future in the management of ultra-resistant tuberculosis. However, a larger cohort study may help to establish its effectiveness. Case report: Patients 1, 29 years old, with a history of multidrug-resistant TB (MDR-TB) one year previously. He showed signs of TB impregnation again 6 months after the last treatment. Bascilloscopy was positive again. The pre-extensively tuberculosis (pre-XDR TB) diagnosis was made by the Hain test (GenoType&reg;MTBDRsl, Hain Lifescience). Patient 2, brother of the first patient, with a history of MDR TB a year before. He had low back pain with right parietal dorso swelling four months after the last treatment. The x-ray of the column showed L4-L5 disc disease. Parietal ultrasound showed a parietal abscess to the right of thoracic vertebrae with fistulization. Surgical biopsy and pus culture confirmed the diagnosis of Pre-XDR Extrapulmonary TB. The treatment regimen was the same for both patients: 6 months with Amikacin (Am) Bedaquiline (Bdq) Prothionamide (Pto) Paraamino Salicylic acid (PAS) Linezolid (Lzd) Cycloserine (Cs) Pyrazinamide (Z) and 14 months with PAS Lzd Cs Z. The side effects were minor. Bacteriological controls (smears and cultures) after 20 months of treatment are negative to date.

Child Spinal Cord Compression without Trauma about 113 Cases in Senegal

Introduction: No-trauma spinal cord compressions are serious conditions not often described in children population. This study will discuss the epidemiological, clinical, biology and radiology assessment, the etiologies, the therapeutic and evolutionary aspects of this condition in children in Senegal. Patients and Methods: 113 children aged between 15 months and 18 years were managed in a 10 years period (from January 2005 to July 2015) for a non-traumatic spinal cord compression (average 8.3 years). Results: There was 66 males (58%) and 47 females (42%) with sex ratio of 1.40. The main reasons for consultation were spinal deformity (90 %). The syndrome was complete in 52 patients (46%) and incomplete in 61 patients (54%). Plain radiography performed in 63 patients. The CT scan was performed in 21 patients and myelography performed in 4 patients. MRI was performed in 22 patients. There was intradural extramedullary process (33.33%), the extradural lesions (14.28%) and intramedullary process (28.57%). Dorsal lesions were predominant (46%) followed by the lumbar spine (27%). The majority of the etiology was Pott’s disease (80%) followed by tumors (17%). Spondylitis to banal germs (2%) and parasitic spinal cord compression (1%) were rare. The histology of 6 patients was revealed 5% neurofibroma Type II, 5% extramedullary intradermal arachnoid cyst, 5% intramedullary arachnoid cyst with cytochemistry of the CSF—like content, 5% Anaplastic pilocytic astrocytoma, 5% ganglioneuroma I terminal cone and 5% meningothelial meningioma. Pott’s disease has been cured by TB chemotherapy associated with a corset in 88.89% of cases. 2 patients of this group had benefited fixation after laminectomy. 68% of the patients had a favorable recovery, and 20% had completely recovered after an average of 7 months of treatment and three (3) patients had died. The compression by bilharzias is be cured by myelotomy and praziquantel with a favorable outcome. We have 94.74% decompressive laminectomy or laminotomy with tumor resection and four (4) Patients of this group benefited fixation;the patients who had intramedullary tumor benefited myelotomy and tumor resection;3 patients in this group had benefited fixation after laminectomy 58% of patients had good recovery and 1 pateint had died. Conclusion: In Africa, particularly in the tropics, Pott’s disease remains the first etiology followed by vertebra-medullary tumors for no traumatic spinal cord compression of child.

Tuberculous Spondylitis: Clinical Features of 36 Patients

We report 36 cases of spinal tuberculosis who were evaluated at the Internal Medicine Department of Istanbul University between January 1990 and March 2016. Twelve cases were accompanied by active pulmonary tuberculosis while ten patients had a previous history of tuberculosis. Eight patients had diabetes mellitus;six patients were on chronic steroid treatment with a mean dose of 24 mg/day while two patients used azathioprine and methotrexate. The dominant symptom was back pain that was present in 64% of the subjects followed by low grade fever (42%), and malaise (38%). Lytic and destructive lesions were noted in various vertebrae in all of the cases while four patients had spinal compression, and two patients had iliopsoas abscess. The preliminary diagnosis was myeloproliferative disease with vertebral metastasis in eight patients. Tuberculin test was over 15 mm in 20 patients (58.8%) while ERS and Creactive protein were highly elevated in 78%, and 84% of the patients. Diagnosis of tuberculosis was confirmed by culture of aspirated material from intervertebral disc space, collection under CT guidance, sputum or bronchial lavage, and by retrospective anti-tuberculous treatment response. MRI revealed compatible findings with spinal tuberculosis in 30 (80%) patients. In endemic countries, tuberculous spondilitis should be considered in immunosuppressed patients with back pain. Current or past tuberculosis infection is not a reliable indicator for Pott’s disease in these patients. Laboratory findings were not usually useful to support the diagnosis. The low sensitivity of the tuberculin test may lead to an erronous diagnosis. Sensitivity of vertebral radiography and CT was low. MRI was the most useful radiologic investigation for the diagnosis of spinal tuberculosis. Tuberculosis of the spine is a diagnostic impasse notably in immunodeficient patients for the clinician.

脊柱结核脓液中结核分枝杆菌耐利福平基因检测的实验研究

目的:探讨脊柱结核脓液中结核分枝杆菌对利福平(RFP)的耐药机制;评价聚合酶链反应-单链构象多态性(polymerasechainreactionsingle-strandconformationpolymorphism,PCR-SSCP)在脊柱结核检测耐RFP基因中的临床应用价值。方法:将脊柱结核病灶中的脓液经预处理后接种于改良罗氏培养基上,对所培养出的菌株应用PCR-SSCP进行检测。检测包括核心区域(耐药决定区域)在内的rpoB基因。结果:PCR-SSCP检测耐RFP菌株的灵敏度和特异性均为100%,与常规经典药物敏感试验无差异(P<0.05),但检测时间明显缩短,仅用2d。结论:rpoB基因突变是结核分枝杆菌对RFP耐药的重要机制,应用PCR-SSCP检测具有较高的灵敏性、特异性及快速性,是一种对脊柱结核耐RFP菌株快速检测的方法。

智能腰椎治疗仪计算机控制系统的开发

本文介绍了新开发的智能腰椎治疗仪的控制系统。由于计算机数控系统具有可靠、控制功能强和易于使用等特点 ,CNC系统除在机床领域被广泛使用外 ,在其它领域的应用也越来越广泛。重点介绍了实现基于中医传统物理治疗腰椎病的计算机数控智能腰椎治疗仪的控制软件的开发和硬件平台的构建。根据该治疗仪的使用环境和操作人员的专业背景特点 ,本文选择采用“工业计算机 +数控系统”为硬件平台 ,以“VC +PLC +CNC”语言为软件平台构成计算机控制系统 ,控制软件采用模块化结构 ,界面友好 ,具有与其它信号接口的功能。

腰型休门氏病的影像学与临床分析

目的探讨腰型休门氏病的影像表现特征及临床意义。方法回顾性分析60例腰型休门氏病的影像及临床资料。结果CT诊断24例，MRI诊断36例。临床上均伴腰背部疼痛，影像上表现为腰椎多发Schmorl’S结节。Schmorl’S结节主要位于L1-4椎体，CT后处理及MRI图像均以矢状位显示最佳。本组累及2个椎体（3处Schmorl’s结节）9例，3个椎体（3～5处）38例，4个椎体（4～7处）11例，5个椎体（5～8处）2例。结论腰型休门氏病以腰椎多发许莫氏结节为特征，认识腰型休门氏病的影像学表现有助于诊断及鉴别诊断。

腰椎旋转中心的研究进展及联合评估

近年来,随着社会发展增速,腰椎疾病的发病率逐年升高,其手术方式繁多,这种杂而多的治疗方式标志着手术经验的积累和医疗技术的发展,但同时又引发了新的问题——如何对腰椎疾病及其术后康复的程度进行评估,医生与患者对建立腰椎疾病术前检查及术后康复标准的量化指标有了迫切需求。现有研究表明,腰椎旋转中心(center of rotation,COR)的测定和人体表面肌电(surface electromyography,s EMG)检查在腰椎疾病治疗中能够在评价临床疗效时减少误差,应用价值较高。综述腰椎COR与腰椎病症的关系、腰椎COR及其s EMG联合指标对临床手术及术后康复的评估作用。

后路截骨矫形仿生骨植骨融合内固定治疗胸腰椎Kummell病并后凸畸形

目的观察后路截骨矫形加仿生骨植骨融合内固定治疗胸腰椎Kummell病并后凸畸形的疗效。方法回顾性分析自2012年3月至2016年6月经由后路扩大式经椎弓根截骨（mPSO）加仿生骨cage植骨融合内固定手术治疗的11例胸腰椎Kummell病并后凸畸形患者资料，男3例，女8例；平均年龄61．2岁；术前及术后2周、1个月、3个月、6个月、12个月分别以视觉模拟评分（VAS）、日本骨科协会（JOA）评分、美国脊髓损伤协会（ASIA）损伤分级进行评估。结果所有患者术后获10～13个月（平均11．4个月）随访。术后2周、末次随访时的VAS评分[（2．1±0．5）分、（1．1±0．2）分]、JOA评分[（23．6±3．8）分、（25．5±3．2）分]、cobb角（8．1°±1．5°、13．8°±2．1°）分别与术前[（8．1±0．6）分、（12．1±3．6）分、51．3°±9．8°]比较差异均有统计学意义（P〈0．05），但术后2周和末次随访时间比较差异均无统计学意义（P〉0．05）。ASIA分级末次随访结果：1例由术前C级改善至术后D级，3例由术前D级改善至术后E级；末次随访时患者植骨区均可见骨眭融合，融合率为100％。结论对于进展至合并后凸畸形的胸腰椎Kummell病患者，后路截骨矫形加仿生骨植骨融合内固定手术治疗可以取得良好的疗效。