Spondylitis

PURPOSE: Tuberculous spondylitis, i.e. Pott's disease with relentless progress, shares the common clinical presentation with low back ache, seems to be of trivial nature may end in catastrophic complication i.e, "paraplegia".

METHODS: A total of 45 patients (n=45), age 15-60 years both sex with proven tuberculosis. The clinical and imaging details assessed in all 45 cases.

RESULTS: Distribution of tuberculosis lesion in the order of frequency was cervical & cervicodorsal region (n=3,7%) dorsal/dorsolumber region (n=17,37.8%), Lumber (n=19,42%), Lunbosacral & sacral region (n=6,13%). The lamina were most commonly involved (24 patients, 53.3%; 8 bilateral, 16 unilateral) followed by pedicles 10 patients, 22.2%s%; 6 bilateral, 4 unilateral), articular processes (6 patients, 13.3%; 3 bilateral, 3 unilateral), spinous process (3Patients,6.7%), and transverse processes (2 cases, 4.4%; 1 bilateral, 1 unilateral). Bone destruction and marrow changes were seen in all patients. Involvement of the entire posterior arch was seen in six patients. A total of 14 patients revealed extraspinal soft tissue collections.,Intraspinal extradural granulation tissue/ abscess was seen in 11 patients. Spinal cord was either displaced or compressed in 6 patients, and abnormal high signal intensity intrinsic cord changes were seen in eight patients. Gait may be limping with variable degree of muscle wasting. Off & on low grade fever was associated. Laboratory investigations had elevated ESR, relative lymphocytosis low hemoglobin & few with tuberculin reaction conversion detected. Plain x-rays had irregular erosion of the end plate of adjacent vertebral bodies & narrowing of the intervening disk spaces. CT & MRI had revealed the nature of the lesion. With anti tubercular drugs on empirical ground, added diagnostic yield, with following outcome. 1. Individuals diagnosed on empirical (ATD), 10-15% 2. Diagnosis established on clinical manifestations only (Patients with poor economy could not afford expenses of investigations), 5-10% 3. Financially stable patients, diagnosis established on CT/MRL 75-85%.

CONCLUSION: A large tubercular abscess compressing on spinal cord is a medical emergency, may result in irreversible paraphrases.

CLINICAL IMPLICATIONS: Patients with Pott's disease has characteristic early insomnia from spasm of para spinal muscles, and late insomnia resulting from urinary bladder distension.

DISCLOSURE: Mohammad Ishaq Khan, None.

Mohammad M. Ishaq Khan MD * Imran Khan MD Sameera M. I MD Al-Junaid Hospital, Nowshera, Pakistan

COPYRIGHT 2005 American College of Chest Physicians
COPYRIGHT 2005 Gale Group