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 103,950 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

To examine the atypical presentation of tuberculous spondylitis we evaluated seven cases seen in our hospitals during a five-year period (1989-1994) with procedures including MR imaging and CT scan. Three of the seven cases showed collapse of the single vertebral bodies with relatively spared disk spaces. Posterior elements were also involved on MR imaging in three cases, but the involvement of adjacent disks and vertebral bodies militated against metastases.
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PMID:Single vertebral compression and involvement of the posterior elements in tuberculous spondylitis: observation on MR imaging. 927 70

Diffusion weighted MRI was performed on patients with acute vertebral body compression. The usefulness of the apparent diffusion coefficient (ADC) in differentiating between benign and malignant fractures was evaluated. A total of 49 acute vertebral body compression fractures were found in 32 patients. 25 fractures in 18 patients were due to osteoporosis, 18 fractures in 12 patients were histologically proven to be due to malignancy, and 6 fractures in 2 patients were due to tuberculosis. Signal intensities on T(1) weighted, short tau inversion recovery (STIR) and diffusion weighted images were compared. ADC values of normal and abnormal vertebral bodies were calculated. Except for two patients with sclerotic metastases, benign acute vertebral fractures were hypointense and malignant acute vertebral fractures were hyperintense with respect to normal bone marrow on diffusion weighted images. Mean combined ADCs (ADC(cmb); average of the combined ADCs in the x, y and z diffusion directions) were 0.23 x 10(-3) mm(2) s(-1) in normal vertebrae, 0.82 x 10(-3) mm(2) s(-1) in malignant acute vertebral fractures and 1.94 x 10(-3) mm(2) s(-1) in benign acute vertebral fractures. The differences between ADC(cmb) values were statistically significant (p<0.001). The ADC is useful in differentiating benign from malignant acute vertebral body compression fractures, but there may be overlapping ADC values between malignant fractures and tuberculous spondylitis.
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PMID:Acute vertebral body compression fractures: discrimination between benign and malignant causes using apparent diffusion coefficients. 1193 12

This contribution outlines possibilities and limitations of whole-body MRI for investigating musculoskeletal diseases. Benefits and drawbacks of the novel whole-body MRI technology are discussed and a possible whole-body MRI sequence protocol for musculoskeletal examinations is proposed. Muscle, joint and bone diseases are discussed in which the application of whole-body MRI may be of advantage. Particularly, polymyositis, muscledystrophy, rheumatoid arthritis, spondylitis ancylosans, multiple trauma, skeletal metastases, multiple myeloma and malignant lymphoma are mentioned. Whole-body MRI opens new advantages for the examination of multifocal musculoskeletal diseases. The clinical benefit of this method for particular diseases has to be evaluated in further studies, however.
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PMID:[Possibilities of whole-body MRI for investigating musculoskeletal diseases]. 1534 30

Percutaneous vertebroplasty is a commonly used procedure for the treatment of painful vertebral fractures induced by osteoporosis or metastatic disease. It is generally considered to be safe and effective. However, infectious complications can be serious. We present a patient in whom pyogenic spondylitis developed 3 months after vertebroplasty. During the debridement, profuse bleeding was encountered from injury to the aorta and the patient was managed with primary closure. Two months after the initial surgery, an aortic aneurysm was detected. A wide resection of all infected tissue, including the bony lesion and aortic aneurysm was performed, and the descending thoracic aorta was replaced with a vascular graft. A titanium mesh cage filled with bone graft was employed for anterior reconstruction. Our patient illustrates that a life-threatening aortic aneurysm can indeed occur as an infectious complication of this minimally invasive procedure due to the proximity of the aorta to the thoracolumbar vertebra. The spine surgeon should be aware of the possibility of aortic wall erosion caused by long-standing spondylitis, and be prepared to manage an inadvertent injury to the aorta during surgical debridement.
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PMID:Aortic aneurysm complicated with pyogenic spondylitis following vertebroplasty. 1788 6

Metastatic disease, myeloma, and lymphoma are the most common malignant spinal tumors. Hemangioma is the most common benign tumor of the spine. Other primary osseous lesions of the spine are more unusual but may exhibit characteristic imaging features that can help the radiologist develop a differential diagnosis. Radiologic evaluation of a patient who presents with osseous vertebral lesions often includes radiography, computed tomography (CT), and magnetic resonance (MR) imaging. Because of the complex anatomy of the vertebrae, CT is more useful than conventional radiography for evaluating lesion location and analyzing bone destruction and condensation. The diagnosis of spinal tumors is based on patient age, topographic features of the tumor, and lesion pattern as seen at CT and MR imaging. A systematic approach is useful for recognizing tumors of the spine with characteristic features such as bone island, osteoid osteoma, osteochondroma, chondrosarcoma, vertebral angioma, and aneurysmal bone cyst. In the remaining cases, the differential diagnosis may include other primary spinal tumors, vertebral metastases and major nontumoral lesions simulating a vertebral tumor, Paget disease, spondylitis, echinococcal infection, and aseptic osteitis. In many cases, vertebral biopsy is warranted to guide treatment.
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PMID:Diagnostic imaging of solitary tumors of the spine: what to do and say. 1863 27

Only 6 cases of pyogenic spondylitis following vertebroplasty or kyphoplasty have been reported, and their causes remained unclear. The authors report on 4 cases of delayed pyogenic spondylitis (DPS) following vertebroplasty or kyphoplasty for osteoporotic compression fractures and metastatic disease. Four patients presented with DPS after vertebroplasty or kyphoplasty and underwent surgical treatment. Clinical history, laboratory examination, and MR imaging confirmed the diagnosis of DPS. Anterior debridement, reconstruction, and posterior instrumented fusion were performed. The mean interval for the delayed occurrence of pyogenic spondylitis after surgery was 12.3 months. The infections were primarily bacterial in origin, but most patients also suffered diverse medical comorbidities. Despite successful treatment of the infections, comorbidity was and is a factor that compromises good results. Medical comorbidities associated with compromised immunity may increase susceptibility to DPS after vertebroplasty or kyphoplasty. In cases of incapacitating back pain after a pain-free period following either of these surgeries, evaluation of the erythrocyte sedimentation rate and C-reactive protein level and examination of contrast-enhanced MR imaging studies are essential to rule out delayed vertebral infection. Surgical treatment requires cement removal and anterior reconstruction with or without additional posterior instrumented fusion.
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PMID:Surgical treatment for delayed pyogenic spondylitis after percutaneous vertebroplasty and kyphoplasty. Report of 4 cases. 1892 23

The chest x-ray from a 37-year-old man with a history of back pain showed a mass in the left lower lung, which prompted an FDG PET/CT study to evaluate the nature of the mass and possible metastases. The images revealed peripherally increased FDG activity in the left lower lung mass. In addition, there was intense FDG activity in 2 adjacent thoracic vertebrae on PET images corresponding to the regions of bone destruction on the concurrent CT. Therefore, a possible diagnosis of lung carcinoma with bone metastases was suggested. However, subsequent tests demonstrated that the left lung mass was in fact a lung sequestration, whereas the spinal lesions were due to Pott disease (tuberculous spondylitis).
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PMID:Lung sequestration and Pott disease masquerading as primary lung cancer with bone metastases on FDG PET/CT. 1930 56

Anterior decompression and reconstruction have been used for the treatment of various conditions at the lumbosacral junction, particularly those necessitating corpectomy because of destruction due to primary or secondary bone tumour or infection. The authors conducted a prospective study on 15 consecutive patients who underwent L5 (L4-L5 in 3 cases) corpectomy for tumour or infection, between 2000 and 2005: 6 for tumour, 7 for tuberculous spondylitis, and 2 for pyogenic spondylitis. Corpectomy, bonegrafting (tricortical iliac bone graft or titanium mesh-bone graft) and anterior-only instrumentation (screw-plate or screw-rod) were performed via a retroperitoneal approach. One month of bed rest yielded additional stability. The patients were followed up for an average of 39.7 months (range: 7-73 months). Pain relief and neurological recovery were excellent. Solid fusion was obtained in all patients. There were no cases of plate or screw failure. Three patients with metastases died after 7, 17, and 13 months, in spite of successful fusion. No recurrence was noted in all 9 patients with spinal infection. The results observed indicate that grafting and anterior-only instrumentation and grafting is an effective and safe procedure for reconstruction of the lumbosacral junction following L5 (or even L4-L5) corpectomy; it may obviate the need for additional posterior stabilization in selected patients.
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PMID:Anterior-only instrumentation and grafting after L5 corpectomy for non-traumatic lesions. 2030 72

Treatment results of 32 patients with pathologic fractures of cervical vertebrae bodies were analyzed. Vertebral destruction was due to tumour metastases (18 patients), nonspecific spondylitis (12 patients) and fibrocystic displasia (2 patients). Myelopathy with local and radicular pain syndrome was registered in all cases before the operation. All patients underwent the destroyed vertebral body replacement by the carbonic implant with collapanoplasty. Pain was relieved in all cases, full and partial myelopathy regression was registered in 27 and 5 patients, respectively.
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PMID:[Treatment of cervical vertebrae bodies pathologic fractures]. 2033 46

Tuberculous spondylitis is a very rare disease, but it can result in bone destruction, kyphotic deformity, spinal instability, and neurologic complications unless early diagnosis and proper management are done. Because the most common symptom of tuberculous spondylitis is back pain, it can often be misdiagnosed. Atypical tuberculous spondylitis can be presented as a metastatic cancer or a primary vertebral tumor. We must make a differential diagnosis through adequate biopsy. A 30-year-old man visited our clinic due to back and chest pain after a recent traffic accident. About 1 year ago, he had successfully recovered from tuberculous pleurisy after taking anti-tuberculosis medication. We performed epidural and intercostal blocks but the pain was not relieved. For the further evaluation, several imaging and laboratory tests were done. Finally, we confirmed tuberculous spondylitis diagnosis with the biopsy results.
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PMID:Post-traumatic Back Pain Revealed as Tuberculous Spondylitis -A Case Report-. 2055 79


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