Pott's disease in Senegal

Abstract

The purpose of this study is to report our experience on Pott's disease in Senegal, which belongs to the group of least-developed countries .In these countries, tuberculosis is still a public health issue. Regarding spine tuberculosis, we attempted to implement a diagnostic and therapeutic approach appropriate for our conditions of medical practice. The authors reported a retrospective epidemiological and clinical study of 255 patients suffering from tuberculosis of the spine. Theses patients were hospitalized at the University Hospital of Fann in Dakar from January 1986 to July 1998. Sixty percent came from the capital, the mean age was 34.9 years, there were 136 males for 119 females, and antituberculosis immunization were not done every time. Associated extra-spinal tuberculosis, predominantly tuberculosis of the lung, was observed in 28.2 patients (59%). Of 37 patients tested for human immunodeficiency virus (HIV) infection, only one was positive. Patients came late to the hospital, leading to a high percentage of neurological complications (79.2%). Our diagnostic strategy was based on epidemiological and clinical criteria already defined by Martini. Thoracic spine (53.8%) and lumbar sacral spine (21.7%) were the column vertebral segments most frequently involved. All patients received antituberculosis chemotherapy, and only 39 patients underwent surgery with laminectomy without posterior instrumentation. Functional outcome study was done for 89 paraplegic patients: 26 (29%) went to Frankel grade D or E and, among 27 operated patients, nine entered theses grades. Seventeen patients (11.5%) died. We developed the concept of "spinal-cord rescue," which focuses more on neurological rather than biomechanical issues.