Spinal Caries Research Articles

Efficacy and safety of instrumentation in caries spine

Background: Spinal instrumentation may be used in tuberculosis of spine for prevention or correction of deformity. Methods: Thirty eight patients of caries spine underwent surgery with spinal instrumentation in the last 3 years. Out of these patients, 30 cases have completed a minimum follow-up of 9 months (Range 9 to 39 months, mean 12.8 months). The regional distribution was 1 in the craniocervical junction, 7 in the subaxial cervical spine, 3 in the cervicothoracic junction, 3 in the thoracic region, 4 in the thoracolumbar junction and 8 in the lumbar region and 1 in the lumbosacral junction. All the cases had anterior lesions except one, which had both anterior and posterior lesions. All of them had decompression, debridement of the lesion and instrumented fusion. Indication of surgery was caries spine with neurodeficit and /or osseous destruction and deformity, which was not responding to conservative treatment of one month. Results: Results were analyzed keeping in mind the clinical and radiological criteria. The former included recovery of pain, and neural deficit with a feeling of general well being. The latter included correction of deformity and evidence of fusion. There was no case which had wound healing/infection related problems. Complications included one case of implant failure and one case of transient neurological deterioration. Results were excellent in 20, good in 5, fair in one and poor in one patient. Majority of the patients were very satisfied with the surgery and all the patients had full anti-tubercular chemotherapy for one year. Conclusions: In properly selected patients, spinal instrumentation is justified because of its safety and efficacy in achieving deformity correction and solid fusion.

Microsurgical interruption of dural arteriovenous fistula at the foramen magnum

We report two rare cases of progressive congestive myelopathy caused by dural arteriovenous fistulae (DAVF) at the foramen magnum. The first, a 69-year-old male with a 2-year history of progressive myelopathy, had symptoms unrecognized due to a past history that included spinal caries and congenital dislocation of the hip. The second, a 60-year-old male, had a recurrence of the myelopathy three months after endovascular occlusion of the DAVF feeding artery. Both patients were successfully treated by direct microsurgical interruption of the arterialized medullary vein with functional and radiological improvement. The clinical manifestations of DAVF at the foramen magnum are nonspecific, mimicking those of cervical spondylotic myelopathy or cervical neoplasm. Accurate and early diagnosis followed by complete obliteration of the fistula is mandatory to avoid permanent neurological deficit.

Comparative study of plain abdomen and ultrasound in non-traumatic acute abdomen

The comparative study of plain x-ray film abdomen and ultrasound in non-traumatic acute abdomen was done in 50 patients with acute abdominal pain seen in the Department of Radiodiagnosis and Imaging of Govt. Medical College, Amritsar during the year 2000-2001. Ultrasound was highly accurate in diagnosing the exact cause of acute abdomen with high overall predictive accuracy of 98.3% and sensitivity of 90%. Plain x-ray abdomen was 100% diagnostic in GIT perforation, GIT obstruction, psoas abscess (caries spine) and renal colic with overall predictive accuracy of 4.1% and sensitivity of 60%.

The Dawn of Bronchoscopy

The Dawn of Bronchoscopy

Intravesical BCG-Therapy for Superficial Bladder Cancer: Its Effectiveness and Adverse Effects

The aim of this investigation was to study the most significant complications of intravesical bacillus Calmette-Guérin (BCG) immunotherapy as well as the short-term effectiveness of the therapy on 174 patients with superficial transitional cell carcinoma of the bladder (Tis, Ta, or T1) treated in our hospitals. Six weekly instillations of 80 mg of BCG were given to 103 patients, six weekly and then four monthly instillations of the same dose to 55, and six weekly and then four monthly instillations of 40 mg to 16. The CR rate for Tis tumors was 79.2 % with those according to the treatment regimen being 73.5 % in the 6-week course and 88.2 % in the 6-week and then 4-month course. Bladder irritability occurred in 104 (60 %) of 174 patients, of whom 5 (3 %) had grade 3 or 4 severity according to WHO criteria. Hematuria was transiently observed in 40 (23 %) of the patients and prostatitis arose in 10 (6 %) of them. Fever over 38 °C was seen in 31 (18 %) patients, and in all but four, it was alleviated by the next day. Arthritis, skin rash, and liver dysfunction were found in some patients. As severe and troublesome complications, a contracted bladder occurred in three patients. Spinal caries and interstitial pneumonitis were respectively seen in one patient. We consider BCG immunotherapy as a very effective treatment method for superficial bladder cancer but many complications relating to BCG can occur.

上位胸椎疾患に対する手術的治療の経験

During the past 7 years, we have surgically treated 3 patients with upper thoracic spinal lesions using the anterior approach. 2 of these cases had the sternum-splitting approach, one for C7-T3 anterior decompression and interbody fusion due to spinal caries, the other for T2-T3 fusion for disc herniation. The last case had the transpleural approach for T3-T6 fusion to treat spinal caries. Regarding sternal splitting, we were able to achieve a satisfactory operating field by only cutting the manubrium.

Scrofuloderma of the Scalp, Psoas Abscess, and Caries Spine: An Unusual Association

An unusual association of scrofuloderma of the scalp, psoas abscess, and caries spine was seen in a 4-year-old girl. The diagnosis was confirmed by relative and absolute criteria. The peripheral T-lymphocytes and their subsets were within normal limits, although her immunohistopathological changes indicated an intermediary response across the spectrum depicting an unstable immunity. This may have been responsible for the silent spread of Mycobacterium tuberculosis and the current association.

The radical treatment of tuberculosis of the spine.

The technique of radical treatment of tuberculosis of the spine at various levels is described. Eighty cases out of 158 of spinal caries underwent radical surgery over a period of 7 years. Caseous pus, sequestra, granulation tissue and discs were excised. Rib grafts were used in the dorsal spine and iliac strut grafts in the cervical and lumbar spine, through a direct anterior approach. Sound bony fusion was achieved in 90% of cases. The procedure is technically difficult but recovery is fast and the majority were fit to resume work within 6 months.

Spinal meningitides with radiculo-myelopathy: Part 2. Pathology and pathogenesis

1. (1) Pathological details and comments upon pathogenesis are presented in respect of 50 cases of spinal leptomeningitis, which fell into the following four groups: (i) 25 cases of primary subacute leptomeningitis mostly of tuberculous origin; (ii) 14 cases of spinal leptomeningitis secondary to intracranial tuberculous meningitis; (iii) 8 chronic cases of spinal “arachnoiditis” due to known irritative mechanisms; (iv) 3 cases of tuberculous leptomeningitis secondary to spinal caries. 2. (2) The variations of the pathological reaction in the spinal leptomeninges are detailed, and gradations from the overtly caseous, to the granulomatous, to the chronic inflammatory and finally, to the fibrosing variety are presented. Both local and extensive tubercular leptomeningitis occurred. The reasons why acid-fast bacilli were seldom isolated are discussed. 3. (3) Four main mechanisms leading to cord involvement are described: (a) oedema of border zones of the cord probably secondary to venous impediment due to pressure from the meningitis; (b) ischaemic myelomalacia resulting from vasculitis or post-thrombotic occlusion of meningeal vessels; (c) infrequent total infarction of cord resulting from such vascular involvement; and (d) the formation of intra-medullary tuberculoma with pericentral necrosis above and below. 4. (4) The close similarity between spinal meningo-myelopathy occurring as a primary lesion in the CNS on the one hand and its occurrence secondary to intracranial tuberculous meningitis or to vertebral caries on the other is stressed.

尿路感染症に関する研究

Tuberculosis of the left kidney was found when a 42 year-old woman was being treated for spinal caries. Nephrectomy in combination with chemotherapy cured this case. Two kinds of Gram-negative rods could be isolated from muddy substances in solitary caseous lesions in the removed kidney. Analysis of the properties of the rods yielded the following results:1) This case was a typical mortar kidney whose pathohistological findings completely agreed with those noted in this case.2) No tubercle bacilli could be demonstrated in relatively large solitary caseous lesions and the renal parenchyma, but many Gram-negative rods were found in such lesions and walls covering them.3) Two kinds of Gram-negative rods were isolated from caseous muddy substances, and the properties of the rods were studied. However, these rods could not be identified with other Gram-negative rod.4) The agglutination reaction was done using as antigens living microorganisms of two kinds of Gram-negative rods isolated from the case. The case showed a high agglutination value, but the agglutination value was low in healthy persons, and 5 of 15 cases of cystitis exhibited relatively high agglutination values.5) The above-mentioned two kinds of unidentifiable Gram-negative rods were identical with the unidentifiable Gram-negative rods described in the preceding report.6) This case was a typical mortar kidney. Isolated two kinds of Gram-negative erods can be interpreted as mixed infection with such a kidney.

Statistical Investigation on Operation Treatnnen for Spinal Caries

Statistical Investigation on Operation Treatnnen for Spinal Caries

Experience of Focal Débridement of Spinal Caries in Childhood

Experience of Focal Débridement of Spinal Caries in Childhood

Tuberculosis of the spine.

\Ve are indebted to Dr Dobson for a comprehensive analysis of the results we can expect from the best conservative treatment of tuberculosis of the spine. It is because Dr Dobson’s figures and opinions will carry great weight throughout the world that I venture to indicate a number of points on which one could legitimately disagree with his conclusions. Firstly, he does not stress sufficiently the serious nature of spinal caries. In his summary he says that the mortality was 18’7 per cent, but this is the mortality during treatment. At the three-year follow-up the mortality was at least 27 per cent (155 out of 569-assuming the 103 cases untraced were unselected) and possibly 38 per cent (256 out of 672 if all the untraced patients were dead) . These figures include children and adults ; there are reasons for believing that the five-year mortality in adults is higher still, especially in thoracic lesions. I also feel that Dr Dobson underestimates the evil effects of abscess formation-surely the mediastinal abscess is a frequent cause of both reactivation and of spread to other vertebrae, and it should be treated strenuously by open drainage and removal of necrotic tissue ; aspiration alone is inadequate. The presence of an abscess is one important cause of failure of spinal-fusion operations ; either fusion fails to occur or the disease recurs at the same or a different level. This is important in the prevention of late onset paraplegia, and I am sorry that Dr Dobson does not differentiate early and late onset paraplegias as the two types differ in so many important respects. Late onset paraplegia is unlikely to occur if there is sound healing, bony fusion and slight deformity ; a well-timed spinal graft will usually lead to this desirable condition. In failing to consider both the timing of the fusion operation and the presence or absence of an abscess, I feel that Dr Dobson has hardly been fair to operative treatment. My reason for writing this letter is not to criticise or belittle Dr Dobson’s work, for which I have a great respect. It is because I fear that the weight of his authority may lead orthopaedic surgeons to accept his opinions both on prognosis and treatment as fixed and permanent, and they may fail to recognise that operative interference has a place as an aid to conservative treatment in cases of tuberculosis of the spine.

The Methods of Focal Débridement in the Spinal Caries

The Methods of Focal Débridement in the Spinal Caries

On the Direkt Front Focuselimination for Spinal Caries, Especially for Thoracic Spinalcaries

On the Direkt Front Focuselimination for Spinal Caries, Especially for Thoracic Spinalcaries

Curettage of Tuberculous Vertebral Disease in the Treatment of Spinal Caries

Curettage of Tuberculous Vertebral Disease in the Treatment of Spinal Caries

Discussion on Spinal Caries with Paraplegia

Discussion on Spinal Caries with Paraplegia

Spinal caries simulating peroneal type of progressive muscular atrophy

Spinal caries simulating peroneal type of progressive muscular atrophy

Paravertebral abscess with rupture into the pleura or lung

Six cases are described in which a paravertebral abscess, dependent upon spinal caries, ruptured into the pleura or lung. Five of these cases were due to tuberculosis and one to actinomycosis. An analysis is made of the clinical course followed by these patients. It is shown that prodromal symptoms suggestive of rupture of the abscess into the pleura or lung were manifested in each instance, and were present for a sufficient length of time to permit of therapy, which might on occasion prevent that catastrophe. Diagnosis, prognosis and therapy are discussed.

A Mimicry of the Turricephalic Skull in Children Treated on a Bradford frame

THE importance of abnormal pressure and traction in the production of skull deformities has been recognized for many years. In 1834, Stern (7) called attention to peculiarities in skull contour which seemed related to scoliosis. Certain trades (blacksmith, porter) have also been known to modify the shape of the head by asymmetrical tension of the muscles of the neck upon their attachments in the skull (4). In such instances, one usually finds the normal contour of the head on the side of less muscular strength, while the calvarium becomes less prominent on the side of greater muscular development. Brachycephaly and dolichocephaly have been produced by laying infants in one position or another (2) and by using hard and soft pillows (5). In addition, unilateral temporomandibular joint dysfunction, developing in childhood, may produce peculiar asymmetrical changes as the result of unequal tension of the muscles of mastication upon the skull (3). Probably the most bizarre deformities of the skull are the deformities arbitrarily produced because of barbaric or tribal custom (6). The purpose of this report is to record skull changes in children treated for tuberculosis of the spine by hyperextension. Spinal immobilization by fixation in the hyperextended position (Fig. 1) for Pott's disease has been a recognized therapeutic procedure for years. The knowledge that this position in time may modify the shape of the skull has been unknown to us and we were unable to find any reference to such skull changes in the literature. Our attention was accidentally directed to the association of Pott's disease and skull changes by roentgen evidence suggesting turricephaly with increased intracranial pressure in a child with spinal caries. The child (Fig. 1), almost five years of age, had been on a Bradford frame since admission to the hospital, two years and three months prior to the present study. Because of tuberculous changes in several bones other than the spine, it was decided to study the entire skeleton in an effort to identify early unrecognized foci in other parts of the skeletal system. It was this roentgen survey that directed our attention to the changes in the head (Fig. 2), which were described as follows: “The bones of the calvarium are thin. The lambdoidal and squamosal sutures are wide, suggesting increased intracranial pressure. While the general configuration of the skull suggests turricephaly, the absence of roentgen evidence of premature synostosis militates against such a diagnosis.” Clinically, there was no evidence of craniostenosis or increased intracranial pressure. The diet and vitamin intake were normal. Knowing that the child had been on a Bradford frame for many months, it occurred to us that the skull changes were postural in origin. Roentgenograms of two other children treated by hyperextension were obtained and similar turricephalic changes observed.