Abstract
Delays in the diagnosis and treatment of spinal tuberculosis may lead
to vertebral fracture and spinal cord compression that may cause to the secondary
persistent neurological loss and spinal deformity.
52 year-old man admitted
to hospital with progressive back pain and paraparesis. There was weigth loss without
nigth fewer or nigth sweiting in his past history. His neurological exam revealed
paraparesis
and hypoesthesia under the T9 level. There was pathologic collaps a fracture and kyphosis in
T8 and T9 vertebrae in his radiological images. In laboratory tests C-reactive
protein and sedimentation values were close to normal. He was underwent stabilisation
surgery and histopatological exam of the tissue specimens revealed caseification
necrosis. On follow-up, patient's neurological symptoms were delayed at fourth postoperative
month and returned to normal daily life at the end of the third year.
Pott disease should also
be considered in pathological vertebral fractures even without weight loss,
night sweats, fever.
Keywords
References
- 1- Cormican L, Hammal R, Messenger J, Milburn HJ. Current difficulties in the diagnosis and management of spina ltuberculosis. Postgrad Med J. 2006; 82: 46-51.
- 2- Jain AK. Treatment of tuberculosis of the spine with neurologic complications. Clin Orthop 2002; 398: 75-84.
- 3- Moore SL, Rafii M. Imaging of musculoskeletal and spinal tuberculosis. Radiol Clin North Am 2001; 39: 329-342.
- 4- Rice ASC, Hill RG. New treatment for neuropathic pain. Annu Rev Med 2006; 7: 535-551
- 5- Bakhsh A. Medical management of spinal tuberculosis: an experience from Pakistan. Spine 2010; 35: 787-791.
- 6- Kotil K, Alan MS, Bilge T. Medical management of Pott disease in thoracic and lumbar spine: a prospective clinical study. J Neurosurg Spine 2007; 6: 222-228
- 7- Dunn R, Zondagh I, Candy S. Spinal tuberculosis: magnetic resonance imaging and neurological impairment. Spine 2011; 36: 469- 473.
- 8- Zimmerli W. Vertebral osteomyelitis. N Eng J Med 2010; 362: 1022-1029.
- 9- Govender S. Spinal Infections. J Bone J Surg [Br] 2005; 87: 1454-1458.
- 10- Chang MC, Wu HT, Lee CH, Liu CL, Chen TH. Tuberculous spondylitis and pyogenic spondylitis: comparative magnetic resonance imaging features. Spine (Phila Pa 1976) 2006; 31: 782-788.
- 11- Slucky AV, Eismont FJ. Spinal Infections. In: TheTextbook of Spinal Surgery. Bridwell KH, DeWald RL, (eds). Lippincott Raven, Philedelphia. 1997, pp: 2141-83.
- 12- Luk KDK. Tuberculosis of the spine in the new millenium. Eur Spine j 1999; 8: 338-345.
- 13- Moon MS. Spine update: Tuberculosis of the spine. Controversies and a new challenge. Spine 1997. 22(15): 1791-1797
Abstract
Spinal
tüberkülozun tanı ve tedavisindeki gecikmeler bu hastalığa bağlı gelişebilecek
komplikasyonlara (omurga kırığı, epidural apse gibi) ikincil omurilik
basılarına ve kalıcı nörolojik kayıplara ve omurgada şekil bozukluğuna yol açabilmektedir.
Bir
yıldır ilerleyici ve artan vasıfta sırt ağrısı ve bacaklarda güçsüzlük
şikayetleri ile gelen hastanın öyküsünde ateş ve gece terlemesi olmamasına
rağmen kilo kaybı ve sırt ağrısı vardı. Nörolojik muayenesinde alt ekstremite
kas gruplarında 2/ 5 kuvvet kaybı ve T9 seviyesi altında ileri hipoestezi
saptandı. Yapılan radyolojik görüntüleme tetkiklerinde T8 ve T9 omurlarında spinal
kanalı daraltan patolojik çökme kırığı ve kifoz tespit edildi. Laboratuar
tetkiklerinde C-reaktif protein ve sedimantasyon değerleri normale yakındı. Mevcut
güç kaybı ve radyolojik bulgular nedeniyle ameliyat edilen hastanın doku patolojisinde
nekrozitan granülomlar ve kazeifikasyon nekrozu görülmesi üzerine
anti-tüberküloz tedavi başlandı.Hastanın takibinde ameliyat sonrası dördüncü
ayda nörolojik bulgularının düzelmeye başladığı ve üçüncü yılın sonunda normal
günlük hayatına döndüğü gözlendi.
Sonuç
olarak, günümüzde nadir görünmekle birlikte patolojik omurga kırığı düşünülen
hastalarda tüberküloz ve Pott hastalığı da akla getirilmelidir.
Keywords
References
- 1- Cormican L, Hammal R, Messenger J, Milburn HJ. Current difficulties in the diagnosis and management of spina ltuberculosis. Postgrad Med J. 2006; 82: 46-51.
- 2- Jain AK. Treatment of tuberculosis of the spine with neurologic complications. Clin Orthop 2002; 398: 75-84.
- 3- Moore SL, Rafii M. Imaging of musculoskeletal and spinal tuberculosis. Radiol Clin North Am 2001; 39: 329-342.
- 4- Rice ASC, Hill RG. New treatment for neuropathic pain. Annu Rev Med 2006; 7: 535-551
- 5- Bakhsh A. Medical management of spinal tuberculosis: an experience from Pakistan. Spine 2010; 35: 787-791.
- 6- Kotil K, Alan MS, Bilge T. Medical management of Pott disease in thoracic and lumbar spine: a prospective clinical study. J Neurosurg Spine 2007; 6: 222-228
- 7- Dunn R, Zondagh I, Candy S. Spinal tuberculosis: magnetic resonance imaging and neurological impairment. Spine 2011; 36: 469- 473.
- 8- Zimmerli W. Vertebral osteomyelitis. N Eng J Med 2010; 362: 1022-1029.
- 9- Govender S. Spinal Infections. J Bone J Surg [Br] 2005; 87: 1454-1458.
- 10- Chang MC, Wu HT, Lee CH, Liu CL, Chen TH. Tuberculous spondylitis and pyogenic spondylitis: comparative magnetic resonance imaging features. Spine (Phila Pa 1976) 2006; 31: 782-788.
- 11- Slucky AV, Eismont FJ. Spinal Infections. In: TheTextbook of Spinal Surgery. Bridwell KH, DeWald RL, (eds). Lippincott Raven, Philedelphia. 1997, pp: 2141-83.
- 12- Luk KDK. Tuberculosis of the spine in the new millenium. Eur Spine j 1999; 8: 338-345.
- 13- Moon MS. Spine update: Tuberculosis of the spine. Controversies and a new challenge. Spine 1997. 22(15): 1791-1797
Details
| Subjects | Health Care Administration |
|---|---|
| Journal Section | Case Reports |
| Authors | |
| Publication Date | April 24, 2017 |
| Submission Date | January 12, 2017 |
| Published in Issue | Year 2017 Volume: 19 Issue: 1 |
Cite
Bu Dergi, Kırıkkale Üniversitesi Tıp Fakültesi Yayınıdır.