后路脊柱去松质骨截骨治疗Pott′s角状后凸畸形的安全性及有效性

目的：探讨不使用传统钛网支撑植骨的后路脊柱去松质骨截骨术（posterior vertebral column decancellation,PVCD）治疗Pott′s角状后凸畸形的安全性及有效性。方法 ：回顾性分析2010年8月~2014年5月于我院行PVCD治疗且资料完整的26例Pott′s角状后凸畸形患者的临床资料,其中男11例,女15例,年龄24.8±7.6岁（14~46岁）。后凸顶点位于胸椎6例,胸腰段18例,腰椎2例。术前ASIA分级C级1例,D级4例,E级21例。记录并分析手术前后及末次随访时的后凸Cobb角、顶椎区域前柱和后柱长度变化、手术时间、术中出血量、手术并发症。结果：手术时间为306.2±59.5min（200~420min）,术中出血量为2046.2±742.4ml（1000~4000ml）。5例患者围手术期出现并发症,其中一过性神经症状2例,脑脊液漏3例。术前后凸Cobb角为91.3°±17.5°（66°~140°）,术后为17.1°±6.2°（4°~30°）,矫正74.2°±18.1°,矫正率为（80.9±6.6）%。截骨部位前柱增加3.6±3.1cm（0~8.4cm）,后柱短缩2.7±1.1cm（1.3~4.8cm）。所有患者均获随访,随访时间为30.8±16.5个月（12~60个月）。末次随访时后凸Cobb角为20.3°±6.1°（9°~33°）,矫正平均丢失3%。末次随访ASIA分级C级患者恢复为D级,3例D级患者恢复为E级,1例D级患者无恢复。结论：不使用传统钛网支撑植骨的PVCD技术是治疗Pott′s后凸畸形的一种安全有效的方法。

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.

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.

Case report of tubercular spondylodiscitis with paraplegia managed by posterior transpedicular decompression and pedicle screw fixation

Pott’s paraplegia is still prevalent in this part of the world. Early onset paraplegia can be improved by timely surgical intervention under ATT cover. The disease mostly affects the thoraco-lumbar spine. Classically, the diseased area is addressed by anterior thoracic or thoraco-lumbar approach and after curettage of the diseased and necrotic material the anterior column is reconstructed by rib or fibular strut graft or metallic cage and supplemented by posterior instrumentation and fusion. Laminectomy, as a method of decompression, was greatly discouraged in spinal tuberculosis with compressive myelopathy except in posterior element involvement. We present a case of a 35 years old lady with Pott’s paraplegia treated by hemilaminectomy and transpedicular limited anterior decompression of the cord and pedicle screw fixation with fusion who improved vastly in terms of motor power.

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.

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.

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.

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®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.

Pott骨折35例手术治疗体会

目的探讨Pott骨折切开复位内固定的手术治疗方法和疗效。方法自2006年5月至2008年3月,对35例Pott骨折行开放复位内固定术,术中根据骨折类型,选择手术入路和固定方法。结果全部患者均得到随访,随访时间6～36个月,平均18个月,采用Baird等评定标准进行疗效评估,优良率达94.3%,疗效满意。结论对于Pott骨折,应选择开放复位内固定,其手术入路,方式与内固定的选择是手术成功的要点。

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.

“东方的哈佛”——圣约翰大学简论

圣约翰大学是美国圣公会在上海创办的一所大学,曾经寄托着万千学子的憧憬和梦想,享有“东方的哈佛”之美誉,无论在上海城市史上还是中国近代教育史上都占有突出的地位。本文简要论述了圣约翰73年曲折的办学历程,归纳分析了圣约翰大学的特色和传统,最后将圣约翰大学成功的奥秘归结为四个一,即一个睿智的校长,一群出色的教师,一套严密的管理体制和一座现代化的大都市。

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。

Brief introduction to Professor Gao Wei-bin's needling technique of ‘Ten Acupuncture Skills'

‘Ten Acupuncture Skills＇ refers to ten types of needling techniques for difficult and intractable neurological diseases. It has been summarized by Prof. Gao Wei-bin, a famous traditional Chinese medicine expert in China, based upon his clinical experience for years, including neck acupuncture for bulbar palsy, neck acupuncture for laryngeal muscular paralysis, stuck needling technique for ocular muscular paralysis, electric field therapy at Jiaji（EX-B 2） points for incomplete spinal paraplegia, electroacupuncture（EA） for urination disorder, electric neck acupuncture for waking up and treating various cerebral and nuchal diseases, EA at Jiaji（EX-B 2） points for intractable hiccup, EA at Jiaji（EX-B 2） points for cervical and lumbar spondylopathy, antagonistic EA for post-apoplectic hemiplegia, and EA for facial paralysis. The ten acupuncture skills are summarized in order to guide the clinical application.

中草药对老鼠脊柱损伤、脊髓断离截瘫的治疗观察（传统的F．S药物对老鼠脊柱骨折脊髓断离损伤并截瘫后恢复的影响）

目的：研究传统的中草药（中草药自配制品，简称F．S药）对老鼠脊柱损伤、脊髓横切断并截瘫后的治疗。方法：人为使实验动物脊柱骨折脊髓被横切断后造成外伤性截瘫（一般横断都在T8-12的脊髓组织中），用自行研制传统的F．S药物灌胃治疗。结果：用F．S药物灌胃治疗后截瘫老鼠双后肢恢复行走功能。结论：传统的F．S药物具有治愈外伤性截瘫的功效。

中草药对动物脊柱、脊髓损伤并截瘫的治疗探索（传统的F．S药物对实验老鼠脊髓横切断离并截瘫后恢复的影响）

目的：探索脊柱骨折脊髓损伤并截瘫的治疗。方法：人为的使实验鼠脊柱骨折脊髓损伤并截瘫后，用自行研制的传统的F．S药物伤处即手术处皮下肌注治疗。结果：用F．S药物治疗后，截瘫鼠已被横切断的神经再次衔接并恢复其功能，后肢又恢复其跳跃行走活动。结论：传统F．S药物具有传统所说的能治愈外伤性截瘫的功能。