Concluded Case

Potts spine ?

A 74 years old male with Parkinson's disease, hypertension , ALD presents with severe pain upper back - not responding to conventional analgesics since 1 month A MRI scan of dorso- lumbar spine reveals an infective spondylo- discitis with sub - chondral bone marrow destruction at D10 level . How to proceed further. Valuable opinion required as most likely it is tubercular - Potts spine

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Concluded answer
If patient is not having paraparesis, get a CT guided FNAC done for tissue diagnosis. Start with ATT. Absolute bed rest. Calcium and vitamin supplement. Post images and clinical findings for better advice.
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Old man with Parkinsonism and hyper tension having pain upper back MRI of dorso lumbar spine findings discitis with subchondral bone marrow destruction at D10 label. Discitis at this age is unusual because it is haematogenous involvement usually happens to be with younger patient. Most likely to be a case of tuberculosis of spine Rule out associated HIV Diagnosis to be confirmed by history. MT DNA amplification polymer chain reaction helps in acurate diagnosis Biopsy CT guided is most confirmatory Treatment Two modalities of treatment A. With neurological feature B. Without neurological feature This particular pt has no neurological feature conservative treatment To start anti tuberculous drug 4 drug regime for two months then combination Of Rifampicin and Isonizide to continue at least another 9 months Pt must be absolute rest without any spinal movement by a brace spinal. As there is degenerative changes with slight thecal compression and no nerve compression to be treated with spinal brace may be supported by full spinal brace with supportive treatment.
Valuable opinion
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Pt is in advance age and suffering from Parkinson's disease and hypertension If facing restless than according to MRI Two conditions are to be adressed 1 lesion at D9D10 WHICH is likely Potts and to be confirmed if he is confirmed put him on ATT with spinal jacket for dorsolumbar spines With suitable NSAIDs 2 lumbar spondylitis with radiculopathy As spinal jacket advise is to be prepared from shoulder to pelvis which will cover both diseased regions Put him on tab gabapentin 300mg+nortryptiline 10mg 1od Tab neurobion forte 1od Eterocoxib+thiocholchisone 8mg 1tds Review every fortnightly
Valuable opinion
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If patient is not having paraparesis, get a CT guided FNAC done for tissue diagnosis. Start with ATT. Absolute bed rest. Calcium and vitamin supplement. Post images and clinical findings for better advice.
Valuable opinion
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Spinal decompressive surgery advised Along with ATT Discotomy of bulging discs Cap Gabapentine 300 mg bd for pain
Thank you doctor
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Spinal infections often require long-term intravenous antibiotic or antifungal therapy and can equate to extended hospitalization time for the patient. Immobilization may be recommended when there is significant pain or the potential for spine instability.
Please post images.
Rhus tox hypericum