1/7. burkholderia pickettii spondylitis.STUDY DESIGN: Case report describing burkholderia pickettii spondylitis in a healthy adult. OBJECTIVES: To describe this very rare form of spondylitis and to discuss some of the difficulties in the diagnosis of B. pickettii spondylitis.Setting:Department of Orthopaedic Surgery, Nayoro City General Hospital, japan. methods: A 48-year-old woman presented with a complaint of severe back pain radiating from the right side of her chest. Plain radiographs of the spine showed osteolytic destruction of the right side of the T10 vertebral body at T10 level, with an involvement of the pedicle. Magnetic resonance image of the spine showed a low signal intensity from the T10 vertebral body on a Tl-weighted image and an increased signal intensity on T2-weighted sequence image. These lesions were enhanced when a contrast medium was used. The patient underwent open biopsy and specimens were collected through the right pedicle. RESULTS: diagnosis was established on the basis of direct identification of the microorganism. Histological findings were consistent with examination of B. pickettii spondylitis. Chemotherapy (intravenous cefepime and per os minocycline) resulted in complete cure. CONCLUSION: B. pickettii is widely distributed in aqueous sources in nature and has not previously been considered to be an aggressive pathogen towards humans. This case report will help to improve our understanding of the ecology and virulent pathogenicity of this organism. A biopsy is an essential and reliable method for the early etiologic diagnosis, which will lead to prevent the development of more severe complications such as spinal cord compression.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
2/7. Spinal changes in association with sternocostoclavicular hyperostosis.A case of sternocostoclavicular hyperostosis was reported in a 63-year-old woman who had been followed for 15 years. Radiographic changes in the claviculo-sternal area were typical of this condition, and biopsy revealed abnormalities in the right clavicle and in the sternum compatible with infection. Radiographic changes in the thoracic and lumbar spine revealed findings compatible with infective spondylitis and a seronegative spondylarthropathy, respectively. The nature of these spinal changes as compared with those of diffuse idiopathic skeletal hyperostosis and seronegative spondylarthropathy is discussed.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
3/7. Anterior sacral meningocele and tuberculous spondylitis of the sacrum in a patient with neurofibromatosis. Case report and review of the literature.We report a case of an adult male with neurofibromatosis and chronic low back pain. Evaluation revealed an anterior sacral meningocele, pulmonary tuberculosis, and later in the course of his illness, an osteolytic tuberculous mass in the sacrum. The patient was treated medically with a good outcome. The nature of anterior sacral meningoceles and tuberculosis spondylitis, the differential diagnoses, and relevant treatment options are discussed.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
4/7. Spontaneous fusion of atlanto-axial dislocation in psoriatic spondylitis.A 36-year-old man, suffering from psoriatic arthritis from the age of 17 years, was found to have developed atlanto-axial dislocation at the age of 30. Spontaneous fusion took place over the next two years. An explanation for this finding is based upon a review of the literature regarding the nature of spinal involvement in psoriatic arthritis.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
5/7. Vertebral osteomyelitis: disk hypodensity on CT.The importance and role of computed tomography (CT) are discussed on the basis of 36 cases of vertebral osteomyelitis. The bone images themselves, the detection of lumbar disk hypodensity, and the exploration of soft paraspinal regions in the search for an abscess are factors that contribute to the superiority of this method in difficult cases. In cases where the diagnosis is already known, CT offers an excellent method to assess the extent of the lesions. Its accuracy, coupled with its rapidity and noninvasive nature, affects the role of conventional tomography, a method that is incomplete and involves higher radiation doses. CT offers an excellent method for follow-up after treatment of vertebral osteomyelitis.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
6/7. magnetic resonance imaging for the diagnosis of tuberculous spondylitis.OBJECTIVES. The purposes of this study were to evaluate the nature of the paraspinal soft tissue mass and the location of the lesion involved using magnetic resonance imaging and to correlate these observations with surgical findings. SUMMARY OF BACKGROUND DATA. In the past, tuberculous spondylitis was diagnosed by plain radiography and since the 1970s, computed tomography has been a useful method for assessing tuberculous spondylitis. In contrast to most imaging methods, MRI has the advantages of improved contrast resolution for bone and soft tissues and versatility of direct imaging in multiple planes. methods. medical records and magnetic resonance imaging studies of 22 patients with bacteriologically and/or histologically proved tuberculous spondylitis were reviewed. In each patient, the numbers of vertebrae involved were evaluated as well as which columns of vertebrae were affected and the signal intensities of lesions. In addition, an attempt was made to determine if granulation tissue differed from the abscess based on magnetic resonance imaging appearance and to compare the outcome with surgical findings. RESULTS. The average number of vertebrae involved per patient was 2.8 and T8 and T9 were the vertebrae most frequently affected. The destruction of vertebrae and discs was easily identified in both sagittal and axial planes. The peripheral margins were exclusively enhanced in all cases. Of particular interest, the posterior aspect of the vertebral body was predominantly involved. Mostly the involvement of both anterior and middle columns was noted. With the aid of intravenous administration of magnetic resonance contrast agents, magnetic resonance imaging was highly accurate in distinguishing the granulation tissue from the cold abscess. CONCLUSIONS. magnetic resonance imaging demonstrated excellent images of bone destruction and soft tissue mass, and provided information in multiple planes, thereby delineating the extent of involvement in tuberculous spondylitis. magnetic resonance imaging is most helpful in planning a surgical approach to tuberculous spondylitis.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
7/7. Spondylectomy, microsurgical decompression and osteosynthesis in the treatment of complex disorders of the cervical spine.In 44 patients with complex degenerative, traumatic, neoplastic and infectious disorders of the cervical spine an aggressive surgical approach was used, consisting of spondylectomy, radical microsurgical decompression and osteosynthesis. The patient group consisted of 23 patients with multisegmental cervical spondylosis, 9 patients with primary or metastatic malignant tumour disease spread along the cervical spine, 6 patients with complex cervical trauma and 6 patients with infection affecting one or more cervical segments. Considering the heterogeneity of the group of patients treated, a multitude of neurological symptoms and signs were present. Excruciating pain was the predominant symptom in 84% of the patients, followed by sensory and motor signs of varying degrees in 77% and 65% respectively. Involvement of the long tracts was present in 51%, gait disturbance in 49% and bladder disfunction in 28%. Considering the nature of the underlying disease, in the group with multisegmental cervical spondylosis (MSCS), advanced cervical myelopathy was the predominant clinical symptom, whereas in those patients with trauma, tumour or infection, pain was the leading symptom, followed by disturbed motor and/or sensory function. Altogether 59 vertebrae have been removed in the 44 patients. In 28 patients spondylectomy was performed at one level, in 15 patients at two levels and in one female tumour patient at three levels. In 34 patients an iliac crest bone graft was used and in 10 patients bone cement. Within the observation period, solid fusion was achieved in all patients. In one tumour patient screw loosening was demonstrable at follow-up, but the fusion remained stable. 2 patients with infectious disease required re-operation due to significant loosening of screws and plates. However, after re-stabilization solid fusion was achieved. Considering amelioration of specific pre-operative symptoms and signs, excruciating pain responded best to the stabilizing procedure, with improvement in over 90% of the patients, followed by improvement of sensory and motor deficits in 85% and 82% respectively. Improvement in pre-operative gait disturbance could be achieved in 81% of the patients, while disturbance of bladder function is less likely to improve after surgery with a positive response in only 58%. None of the patients became neurologically worse after surgery. With regard to the underlying disease, patients with MSCS and tumour had the best results with overall improvement in 62% and 75% respectively. While in patients with infection improvement could be achieved in 58%, improvement in trauma patients was demonstrable in only 34% while in 66% the pre-operative clinical status remained unchanged.(ABSTRACT TRUNCATED AT 400 WORDS)- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |