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 261,466 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The authors compared the different elements of diagnosis contributed by the clinical examination, and by laboratory and radiological investigations in 33 cases of Pott's disease and 46 cases of non-tuberculous spondylodiscitis. They show that certain elements indicate the diagnosis of Pott's disease : associated visceral tuberculosis, and a radiogram showing in particular a centro-somatic notch, recent primary infection, absence of pain, minimum signs of medullary compression ; other elements on the other hand, indicate a diagnosis of non-tuberculous spondylodiscitis : a negative cutaneous tuberculin test, a positive haemoculture, humoral signs of melitococcosis or of typhoid fever, any indication of possible means of entry of infection in the two months before the disease, radiological signs of reconstruction in the first four months of evolution, location of the lesion in the anterior upper part of the vertebra, and to a lesser degree, the acute febrile nature of the clinical picture. The authors recall that the existence of a large abscess, of which there were no examples in the present series, is an indication in favour of tuberculosis.
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PMID:[Etiological diagnosis of spondylitis. I. Clinical, biological and radiological aspects]. 117 22

Two hundred and seventy four patients had a lumbar spine fusion between 1949/1971. Seventy-five of them were available for review more than 10 years after the procedure. There were twenty spondylolisthesis, forty-eight degenerative discopathies, six cases of Pott's disease and one benign tumour. All the patients had been treated conservatively before the surgical procedure for an average of 7 years and were still complaining of chronic low back pain. All the cases reviewed had fused. The functional results were not related to the surgical technique, which varied during this period: eight posterior mid-line grafts, seventeen interbody fusions and fifty combined anterior and posterior approaches sometimes used because of a primary failure of fusion and no postero-lateral fusions. The average follow-up was 13 years with a range from 10 to 26 years. The clinical results were satisfactory in 74 p. 100 of the cases. There were thirteen failures. Seven of these patients had been operated on before the era of systematic preoperative discography and psychological evaluation and the failure was primary. Other failures were observed at about the tenth post-operative year. The results were better in spondylolisthesis with isthmic lesions, rather than in degenerative spondylolisthesis. They were better in pure low back pain than when the pain associated with sciatica. They were better when fusion was limited to one or two levels. Radiographs ten years after the procedure frequently showed evidence of degenerative lesions of the disc above the level of the fusion and, at the same time, some slipping of the upper vertebra. Fortunately, there was no correlation between the radiological appearances and the clinical results.
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PMID:[Lumbar arthrodesis: results after more than 10 years]. 293 Aug 71

A new case of sub-occipital Pott's disease is reported: a 26 year old, coloured male patient from Senegal was admitted for: cervical pain of 6 month duration, neck stiffness, dysphagia, left XII paralysis and left hemiparesis. The radiological study found an anterior atlanto-axial subluxation, basilar impression, and increased thickness of the retropharyngeal soft tissue, lysis of the left occipital condyle and the left lateral mass. CT scan study revealed a retropharyngeal mass and an epidural contrast-enhanced lesion at the C2 C3 C4 levels. Chest-X ray showed one tuberculous lesion at the right apex. The research of Acid Fast Bacilli in gastric secretion samples and the results of the retropharyngeal mass puncture were positive. An antituberculous trichemotherapy was started. After early reduction by skull tongs traction, an occipito-cervical arthrodesis by Roy Camille plates was performed, followed by the wearing of a minerva plaster jacket and then a plastic collar. Each one for a 5 month period. One year later, there remained only a left XII paralysis, but the bony reconstruction was not yet obvious on tomography. A survey of the literature of 70 cases of sub-occipital Pott's disease has pointed out these findings: cervical pain (98%), neck stiffness (82%), Atlantoaxial subluxation (68%), thickened prevertebral soft tissue shadow (77%), lateral mass lysis (48%) other tuberculous focus (29%). The main therapeutic trends are: early and long-lasting antituberculous poly-chemotherapy, early reduction of subluxations, prolonged contention for slight osteolytic lesions and for major: lytic lesions, a posterior surgical procedure either by bone graft combined with wires or preferably fusion by means of occipito-cervical plates. The removal of abscess is discussed.
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PMID:[Suboccipital Pott's disease]. 344 87

Tuberculosis (TB) of the spine, or Pott's disease, is a rarely encountered clinical disorder in the United States today. However, Pott's disease should be strongly suspected in a person who presents with a destructive lesion of the spine involving adjacent vertebrae or a retropharyngeal mass which extends across the midline. The most common presenting signs and symptoms are pain and spinal deformity. The PPD skin test is usually positive, but unlike TB of the larynx, the chest roentgenogram is almost always negative. Diagnosis may be confirmed by needle aspiration or incisional biopsy and culture. The otolaryngologic literature has not previously addressed this clinical entity, thus, our experience with a patient with a retropharyngeal mass and quadriplegia diagnosed as Pott's disease will be presented. Subsequent medical therapy, stabilization, and odontoidectomy resulted in resolution of his neurological deficit. The incidence, pathogenesis, clinical features, and management of Pott's disease will be discussed.
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PMID:Manifestations of Pott's disease in the head and neck. 370 63

The resurgence of pulmonary tuberculosis in the United States has been paralleled by a concomitant rise in tuberculosis of the spine (Pott's disease). The appearance of drug-resistant strains of tuberculosis, infection in large numbers of immunocompromised hosts, newer imaging modalities, and the development of more effective spinal reconstruction techniques have raised important issues regarding the management of Pott's disease. In spite of this, there has been little published recently on the modern management of Pott's disease in developed countries. We report our experience with the management of 20 patients with Pott's disease in the past 5 years, 16 of whom were admitted during the last 18 months of this retrospective study. The mean patient age was 49 years. Sixteen (80%) were men. Nineteen (95%) had a positive tuberculin skin test, and 13 (65%) had pulmonary tuberculosis. Symptoms consisted of spinal pain, weakness, sensory complaints, and flank mass in order of decreasing frequency. Ten patients were neurologically intact; the remainder had motor deficits of variable severity. The thoracic spine was involved in 13 patients, the lumbar spine was involved in 4, the cervical spine was involved in 2, and the thoracolumbar spine was involved in 1. Spinal deformity was present in 11 patients, spinal epidural compression was present in 13, and a paraspinal mass was present in 18. Operative indications included motor deficits, spinal deformity, nondiagnostic computer tomographic-guided needle biopsy, and noncompliance with, or lack of, response to medical therapy. Eleven patients underwent operations. Six patients had vertebrectomy and bone grafting with posterior instrumentation when indicated; three had laminectomy, debridement, and abscess drainage; one had laminectomy and posterior instrumentation; and one had paraspinal abscess drainage. Two patients have died; the remainder have been monitored for at least 1 year and are neurologically improved or normal without residual infection. The average angulation decreased from 31 to 24 degrees by the follow-up examination. In selected patients, early operative treatment with instrumentation, when indicated, minimizes neurological deterioration and spinal deformity, allows early ambulation, and results in excellent neurological outcome.
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PMID:Modern management of spinal tuberculosis. 770 73

This study reports 7 cases of cervical Pott's disease, gathered during 6 years in the department of neuro-surgery of Ibn Rochd U.H.C. 4 females and 3 males, aged between 9 and 52 years were included. All the patients complained of cervicobrachial pain and weakness of the limbs. Clinical features were: deterioration of general status, rachidian syndrome and neurological impairement with motor and sensitive deficit. Radiological analysis found a destructive and extensive lesion, cervical kyphosis from 10 degrees to 60 degrees, retropharyngeal abscess and intraspinal canal extension of infection. Diagnosis was confirmed by histological study in all cases. In addition to antituberculous therapy and preoperative cervical traction in 4 cases, all the patients had spinal fusion using an anterior approach. Post operative immobilization in a cervical collar varied from 9 to 12 months. All 7 patients had full neurological recovery, 6 patients had an excellent bony fusion and cervical kyphosis was corrected. For the remaining patient, the bone graft was mobilized without neurological disorders. This study confirms anterior arthrodesis efficiency. This procedure in conjunction with preoperative traction, allowed stabilization of the spine and healing of vertebral lesions with excellent kyphosis correction.
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PMID:[Anterior approach of cervical spine in Pott's disease. Apropos of 7 cases]. 945 97

Patients are said to have inflammatory spinal pain if they fulfill at presentation 4 of the following 5 criteria: duration of spinal discomfort for at least 3 months, spinal morning stiffness, age less than 40, insidious onset of symptoms, and no relief from pain with rest, but improvement with exercise. Inflammatory spinal pain is typical of the spondylarthropathies. Only in a minority of the cases it is found in other rheumatic disorders such as rheumatoid arthritis, fibromyalgia or infectious spondyilitis. Tuberculous spondylitis is rarely mentioned as a possible cause of inflammatory spinal pain. We describe 4 patients with tuberculous spondylitis seen over a 3-year period who met the clinical criteria for inflammatory spinal pain at presentation. We conclude that inflammatory spinal pain may be a presenting feature, albeit rare, of tuberculous spondylitis. Awareness of this finding should help facilitate the proper diagnosis and the institution of appropriate therapy.
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PMID:Tuberculous spondylitis as a cause of inflammatory spinal pain: a report of 4 cases. 963 55

Tuberculosis (TB) of the spine (Pott's disease) is both the most common and most dangerous form of TB infection. Delay in establishing diagnosis and management cause spinal cord compression and spinal deformity. This study investigated the data on all cases of Pott's disease reported in Turkey from 1985 to 1996. A total of 694 cases were included. Out of the patients evaluated, 19% were reported in the first half of the period (1985-1990) and 81% in the second half (1991-1996). Tuberculosis affecting the spine was commonly localized in the thoracic region and involved the vertebral body. The presenting symptoms were leg weakness (69%), gibbus (46%), pain (21%), and palpable mass (10%). Decompressive surgery plus anti-TB chemotherapy remains the best mode of therapy for Pott's disease. Follow-up information was available in 414 of the 694 patients and there were ten deaths (2%), one occurring intraoperatively and the other nine postoperatively. This meta-analysis demonstrates that in Turkey Pott's disease remains a serious problem, causing paraplegia. It should be considered when patients present with neurological findings suggesting spinal cord compression and spinal deformity. In the present study, it was concluded that the neurological involvement due to Pott's disease is relatively benign if urgent decompression is performed at the onset of the disease.
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PMID:Spinal tuberculosis (Pott's disease): its clinical presentation, surgical management, and outcome. A survey study on 694 patients. 1133 71

We report a case of a surgical treatment with anterior instrumentation in tuberculous spondylitis (Pott's disease), in a 71 years old woman, that was in treatment for pulmonary tuberculosis, with lumbar pain, progressive disability to walk, kyphotic deformity and vesical dysfunction. Magnetic resonance image presents a lesion in the bodies of T12 and L1, with paravertebral abscess. The patient was treated surgically by transthoracic-abdominal approach. The vertebral bodies were cut off and the spine were instrumented anteriorly with a mesh cage and a Z plate. This procedure permits a good arthrodesis and a immediately stabilization of the spine, without any complication of the infection. The patient was seen a year after the surgery and is free of infection, without motor deficit, pain or reminiscent kyphosis.
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PMID:[Anterior instrumentation of spine in tuberculous spondylitis: Pott's disease: case report]. 1196 25

A 22 year old man from Ethiopia suffered from progressive left inguinal pain and weight loss for ten months. The pain aggravated with leg movement, in particular with flexion of the left hip. ESR and CRP were slightly elevated, and a PPD was strongly positive. Abdominal ultrasound was normal but CT-scan revealed a left sided psoas abscess. Pott's disease was suspected and tuberculostatic therapy with INH, PZA, ETH, RIF was initiated immediately. A MRI of the spine excluded spondylodiscitis. Primary Tb psoas abscess was diagnosed. Treatment response after 5 weeks was clinically insufficient and CT-scan showed enlargement of the abscess. Treatment adherence was verified by drug prescriptions and INH urinary stix testing. M. tuberculosis, suspected microscopically in the puncture fluid, grew in culture and was fully drug sensitive. After 12 weeks, surgical abscess debridement had to be performed due to disease progression. The patient's health state improved considerably the first two postoperative months, inflammatory markers normalized, although a small residual abscess was still visible on CT. Subsequently, three months after surgery, pain reemerged, CT showed abscess progression. The patient had to be reoperated. Tb psoas abscess was a frequently described complication of Tb spondylodiscitis (Pott's disease) the first half of the last century and became rare thereafter in the Western hemisphere. However, the last two decades, due to migration policies and a worldwide increase of Tb epidemic because of socioeconomic destabilization and spread of the HIV-pandemic, Tb reemerged in Western countries. Therefore, physicians should be aware of atypical manifestations of tuberculosis. Primary Tb psoas abscess is extremely rare. Only four cases are described in the literature. In analogy to Pott's disease, therapy consists of tuberculostatic treatment, supported by surgical debridement.
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PMID:[22-year-old patient with left groin pain]. 1208 49


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