Modern imaging methods including plain radiography, computed tomography (CT), magnetic resonance imaging (MRI) and bone scan improve the diagnostic accuracy of Pott's disease. However, atypical forms of Pott's disease are often misdiagnosed. There are a few reports available on multifocal Pott's disease. To the authors' knowledge, there are no domestic reports of multifocal Pott's disease with a concomitant spinal involvement of the posterior element. This article describes two rare cases of multifocal Pott's disease, with a review of the relevant literature.
Magnetic Resonance Imaging ; Radiography ; Tuberculosis, Spinal*

Acute transverse myelitis (TM) is a neurological syndrome caused by inflammation of the spinal cord. TM is rare but is frequently caused by viral or bacterial infections. TM caused by tuberculosis (TB) is extremely rare and there are no reports of TM caused by multidrug-resistant TB (MDR-TB). We report a case of acute TM due to MDR-TB in a 40-year-old man. The patient had been diagnosed with pulmonary TB and was started on the first-line anti-TB treatment. However, the chest radiographic findings were aggravated and neurological symptoms such as weakness in both lower extremities, sensory changes, and voiding difficulty were newly developed. The T2-weighted magnetic resonance image of the spine showed diffusely increased signal intensity in the spinal cord, particularly at the lower cervical and upper thoracic levels, without any definite evidence of myeloradicular compression, which is consistent with a diagnosis of TM. A drug susceptibility test revealed MDR and second-line anti-TB drugs were prescribed. The chest radiographic findings showed improvement after treatment, the mycobacterial culture converted to negative, the MRI findings improved, and there was partial improvement in the low extremity weakness. The patient has been prescribing second-line anti-TB medications for 14 months.
Adult ; Bacterial Infections ; Diagnosis ; Drug Resistance, Multiple ; Extremities ; Humans ; Inflammation ; Lower Extremity ; Magnetic Resonance Imaging ; Mycobacterium tuberculosis ; Myelitis, Transverse* ; Radiography, Thoracic ; Spinal Cord ; Spine ; Tuberculosis ; Tuberculosis, Multidrug-Resistant*

Intradural extramedullary (IDEM) tuberculoma of the spinal cord is uncommon entity and moreover, few reports have been documented on concurrent IDEM and intracranial tuberculomas. Authors report a case of IDEM spinal tuberculoma having intracranial lesion simultaneously. A 49-year-old woman suffered from paraparesis and urinary incontinence while being given medical treatment for tuberculous meningitis. Magnetic resonance imaging (MRI) revealed an IDEM mass lesion between the T1 and T2 spinal levels, and multiple intracranial tuberculous granulomas. Surgical resection of the IDEM tuberculoma followed by anti-tuberculous medication resulted in good outcome.
Brain/radiography ; Case Report ; Female ; Follow-Up Studies ; Human ; Magnetic Resonance Imaging ; Middle Age ; Mycobacterium tuberculosis/isolation & purification ; Spinal Cord Diseases/radiography* ; Tuberculoma/surgery ; Tuberculoma/radiography ; Tuberculoma/drug therapy ; Tuberculoma/complications* ; Tuberculosis, Meningeal/surgery ; Tuberculosis, Meningeal/radiography ; Tuberculosis, Meningeal/drug therapy ; Tuberculosis, Meningeal/complications*

Twenty-nine patients with spinal tuberculosis were evaluated by computed tomography (CT). The contiguous involvemnt of the vertibral bodies as well as the detailed localization of the destruction were analyzed. Our result disclosed that there was a higher incidence of the destruction of pedicles(68 percent) and an involve-ment of posterior elements (13 percent). Frequent patterns were fragmentation, sequestrae, disc space narrowing reactive sclerosis, paravertebral mass (abscess) and calcification. CT also p--vided precise information about the rim, density and size of the soft tissue mass, particularly following intravenous contrast infusion. CT was found to be helpful in the evaluation of the extent of osseous and soft tissue involvement as well as the destructive pattern. We conclude that CT can be used to detect the extent of osseous and paravertebral soft tissue involvement and to differentiate spinal tuberculosis from a neoplastic lesion.
Adolescent ; Adult ; Child ; Child, Preschool ; Contrast Media/administration and dosage ; Female ; Human ; Male ; Middle Age ; Support, Non-U.S. Gov't ; *Tomography, X-Ray Computed ; Tuberculosis, Spinal/*radiography

Spinal tuberculosis characteristically involves the paradiscal area of vertebral bodies with a narrowing of the disc space. In this study, we reported four atypical forms of Pott's disease, including one hundred and eighty-four patients treated between 1985 and 1998. Two cases presented with noncontiguous multilevel involvement, where one case had transverse process involvement alone and the other had involvement of the neural arch. Atypical tuberculosis of the spine was found in 2.1% of the patients.
Adolescence ; Adult ; Case Report ; Human ; Magnetic Resonance Imaging ; Male ; Middle Age ; Spine/radiography ; Spine/pathology ; Tomography, X-Ray Computed ; Tuberculosis, Spinal/diagnosis*

OBJECTIVETo investigate perioperative features and results of surgical treatment of spinal tuberculosis in aged.

METHODSReview the clinical data of 36 aged with spinal tuberculosis from May 1998 to June 2005 retrospectively. The average age was 70.2 years. The sites of infection included 3 cervical, 9 thoracic, 13 thoracolumbar and 11 lumbar. 28 patients suffered 1 or more complications at least and among of them, there were 18 patients have cerebral or heart vascular disease, 16 patients have diabetes mellitus. Before operation, all patients consulted with internal stuff for the proper treatment of concomitant disease. The surgical procedures include: CT guided percutaneous catheter drainage in 3 patients, anterior debridement and bony grafting with anterior instrumentation fixation in 12 patients, anterior debridement and bony grafting with posterior fixation in 5 patients, posterolateral costotransversectomy debridement and interbody fusion with posterior fixation in 7 patients, posterior debridement and posterior fixation in 9 patients. The mean followed-up period was 3 years and 10 months (from 1.5 to 6 years).

RESULTSOne died at two week after the operation. Tuberculous infection was controlled in other patients and no recurrence. Two patients died because of myocardial infarction and cerebral hemorrhage respectively at 1.5 and 2.5 years after operation. Bone fusion was achieved in 31 patients. The deformity was partial corrected at the final follow-up. Among 20 cases with neurologic deficit, 11 cases were completely recovered, 5 cases were partly improved.

CONCLUSIONSIf the associated disorders and postoperative complications are properly handled, aged patients can endure surgical treatment for spinal tuberculosis. Instrumentation fixation provides adequate stability and promote recovery.

Aged ; Aged, 80 and over ; Bone Transplantation ; Debridement ; Female ; Follow-Up Studies ; Fracture Fixation, Internal ; Health Services for the Aged ; Humans ; Male ; Middle Aged ; Radiography ; Retrospective Studies ; Spinal Fusion ; Spine ; diagnostic imaging ; surgery ; Treatment Outcome ; Tuberculosis, Spinal ; surgery

OBJECTIVETo investigate the value of MRI follow-up in pediatric patients with spinal tuberculosis.

METHODSFrom February 2004 to April 2013, MRI imaging data in 21 children with spinal tuberculosis by pathologically and clinically proven were retrospectively analysed. There were 11 males and 10 males, with an average age of 9.4 years old ranging from 2 to 14 years old. Eighteen patients were received conservative treatment, 3 patients were treated by surgical operation. The course of disease ranged from 2 months to 3 years. All cases underwent two or more MRI examinations for follow-up. MRI findings of the first and second examination were comparatively analyzed,including signal changes of vertebral body and intervertebral, paraspinal abscess and the change of kyphosis angle.

RESULTSIn the 21 cases with tuberculosis, 85 vertebral bodies were affected in total, including 10.6%(9/85), 49.4%(42/85) and 40%(34/85) vertebral bodies separately in the cervical,thoracic, lumbosacral spine. Follow-up MRI showed vertebral body shape and signal had no obvious change during or after treatment, 15 cases with vertebral bodies changed flat or cuneate, 10 cases with disc involvement,and intervertebral space became narrowing at different level. Among 13 patients with kyphosis angle greater than 0°, 7 were located on thoracic, 2, 3, 1 were on thoracolumbar, lumbar and cervical spine, respectively. Among 18 cases with conservative treatment,kyphosis angle were 0° on the first and the follow up MRI of 8 patients. One case of mild (<10°) kyphosis,follow-up MRI during therapy showed the angle slightly increased; 5 cases with moderate (10° to 30°), follow-up MRI during therapy showed no obvious change; 4 cases with severe (>30°), follow-up MRI during and after therapy showed kyphosis increased in varying degrees.

CONCLUSIONFollow-up MRI can make a big difference in the spinal tuberculosis of children; it can clearly show the change of the vertebral body and intervertebral space, paraspinal abscess and the kyphosis angle after the treatment,which can provide reference for clinical treatment and estimating prognosis.

Adolescent ; Anti-Bacterial Agents ; therapeutic use ; Child ; Child, Preschool ; Drug Monitoring ; Female ; Follow-Up Studies ; Humans ; Magnetic Resonance Imaging ; Male ; Radiography ; Retrospective Studies ; Spine ; diagnostic imaging ; Tuberculosis, Spinal ; diagnostic imaging ; drug therapy ; surgery

According to the literature, thoracic outlet syndrome (TOS) secondary to the malunion of displaced fractures of the clavicle is rare. Various surgical methods, including simple neurolysis, resection of the first rib or clavicle and corrective osteotomy, have been reported. We report a case of TOS secondary to malunion of the clavicle that was treated by an anterior and middle scalenectomy without a rib resection.
Adult ; Humans ; Low Back Pain/etiology ; Lumbar Vertebrae/surgery ; Male ; Postoperative Complications/*microbiology ; Spondylitis/etiology/*microbiology ; Thoracic Vertebrae/*microbiology/pathology ; Tuberculosis/drug therapy/*microbiology ; Tuberculosis, Spinal/complications/drug therapy/*microbiology ; Adult ; Clavicle/*injuries ; Fractures, Malunited/*complications ; Humans ; Male ; Thoracic Outlet Syndrome/etiology/radiography/*surgery

OBJECTIVETo study the curative effect of surgical treatment of drug-resistant spinal tuberculosis.

METHODSFrom March 2005 and April 2009, the clinical data of 60 patients with drug-resistant spinal tuberculosis were retrospectively analyzed. Including 36 males and 24 females; aged from 5 to 79 years with an average of 47.3 years. Thirty-four patients had neurological deficits, among them, 2 cases were grade A, 5 cases were grade B, 13 cases were grade C, 14 cases were grade D according to ASIA standard. According to the severity and location of the infection, the patients underwent anterior, posterolateral costotransversectomy or posterior debridement and bone grafting and internal fixation. The antituberculous chemotherapy for a total of 12 to 18 months was guided by conventional and genotypic drug susceptibility testing. Tubercular relapse, neurological function, spinal fusion were observed by ASIA grade, X-ray and CT scan.

RESULTSAll cases were followed up from 1 to 5 years with an average of 3.1 years. Recurrence was found in 2 cases who were cured after second operation. 34 cases with neurological deficits recovered totally or partially. X-ray or CT films showed spinal fusion in 57 patients.

CONCLUSIONThe therapeutic effect of individuall operative options is good in treating drug-resistant spinal tuberculosis after antituberculous chemotherapy based on conventional and genotypic drug susceptibility testing.

Adolescent ; Adult ; Aged ; Antitubercular Agents ; therapeutic use ; Child ; Child, Preschool ; Drug Resistance, Bacterial ; Female ; Humans ; Male ; Middle Aged ; Mycobacterium ; drug effects ; genetics ; Radiography ; Retrospective Studies ; Spine ; Tuberculosis, Multidrug-Resistant ; diagnostic imaging ; drug therapy ; microbiology ; surgery ; Tuberculosis, Spinal ; diagnostic imaging ; drug therapy ; microbiology ; surgery ; Young Adult