[Vertebral osteosynthesis in dorsolumbar Pott's disease in the adult; indications and results].
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The authors review 24 medullary complications which they encountered while treating scoliosis and kyphosis over a period of 8 years. They studied separatly the complications encountered in the pure kyphosis and those encountered in the scoliosis. 7 medullary complications occured while treating pure kyphosis, 5 Potts disease, 1 achondroplasia and 1 Morquio disease. All the kyphosis were of importance with a mean curve over 100 degrees. In 6 cases the medullary symptoms occurred during elongation prior any surgery. The authors distinguished between Pott disease where the symptoms occurred after minimal reductions and the chondrodysplasia where the symptoms occurred after important reductions. Thus the stiff Pott kyphosis where elongation results in medullary symptoms because of medullar compression before any correction, appears to be different from reductible kyphosis where the strong medullary tension is responsible for the symptoms. Two complications occurred after a vertebral osteotomy one immediatly and one after an elongation of a pelvic halo.
Tuberculosis psoas muscle abscess is currently an uncommon clinical entity in industrialized countries. It was considered the predominant cause of these abscesses in the early part of the 20th century as a result of complicated Potts disease. We describe the case of a psoas abscess caused by the combination of Mycobacterium tuberculosis and Staphylococcus aureus. In this patient, the abscess was not associated with Potts disease but with osteomyelitis of the iliac crest, in which the evaluation with magnetic resonance imaging was very specific in determining the extent and regional spread.
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The CT appearance of eight cases of culture-positive spinal tuberculosis is reviewed. Three patients had single level vertebral involvement, while five others showed multilevel involvement. In seven of eight cases, paraspinal soft tissue involvement was seen. In two, the process caused neurologic symptoms by extending into the epidural space. In three patients the paraspinal extension was not only local, but spread along multiple levels. The CT appearance can be highly suggestive of TB in cases where the diagnosis has not been suspected. In cases where the diagnosis is suspected by plain films, CT can display unsuspected extension of the disease and be helpful in needle localization for aspiration.
Between 1973 and 1988, 108 patients with a preoperative diagnosis of spinal tuberculosis were treated by anterior extirpation and interbody fusion at Ankara University Medical Faculty, Orthopedic Surgery and Traumatology Department. In 96 cases the operations were performed intrapleurally, as Hogston described. For 12 patients who had spinal involvement at lower thoracic and upper lumbar segments an extrapleural and extraperitoneal approach was used. The extrapleural approach is strongly recommended for patients who have compromised pulmonary reserve. When this approach is used adequate exposure can be obtained and postoperative rehabilitation of patients is facilitated. Advantages and disadvantages of the extrapleural approach and the results obtained from 108 patients are presented.
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We report an unusual case of a multifocal tuberculous spondylitis that has been diagnosed after several percutaneous vertebroplasty. This event supports the theory that surgical or radiological intervention such as a percutaneous vertebroplasty should be considered as an intentional traumatism that can lead to the initiation of a locus minoris resistentiae, probably by reactivating an inactive tuberculous lesion.
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