Concluded Case

Tuberculous Discitis

New Case 81 yr , M, Diabetic 6 yrs, on single oral med , well under control , developed back pain 3 months, progressive difficulty in walking 3 weeks . Denied having any sensory / bowel/ bladder symptoms. No fever / loos of weight Or appetite.No symptons suggestive of upper limbs / bulbar involvement/ head ache / vertigo. Examination : general - normal.Intact peripheral pulses. Higher function , cranial nerves & upper limbs - normal. positive beevors sign.Lower limb power gr 3/ 5 with spsticity , hyper-reflexes with extensor plantars . Intact sensations. possible diagnosis ?

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CASE UPDATE. I am thankful to each and every one of you who answed the case. All of you have given the appropriate answers. Esr was 40mm/ hr. All tumor markers were - ve.xray chest , us abdomen were normal. Pt was transferred to spinal surgeon . Posreolateral decompression laminectomy with stabilization & screw fixation done .Drained the impending abcess. BIOPDY REPOR TUBERCULOUS DISCITIS. 2nd post op day the pt became unresponsive inn the icu with rapid AF. SEEN BY cardiologist, intensivist , tried resuscitation but unfortunately the patient passed away. MRI report;Intervertebral disc appears irregular with T2 hyperintense & T1 hypointense signal at D11-12 level..Area if heterogeneous marrow signals seen in the vertebral bodies at D11& D12 with reduced vertebral heights.The intervening end plateappears irregular with STIR hyperintensities.The ID disc appears mildly hyperintense in DW1 .Milf gibbus deformity causing spinalcord compression.Minimal AP diameter measures 6.5mm. Subtle T2 hyperintense signals seen in the cord atthis level.Small T2 and STIR hyperintense signal with no enhancement noted in prevertebral & left paravertebral location of D11. Imp: MRI of the spine show area of heterogeneous marrow signals at D11-12 with endplate irregularity and enhancing signals in the IV disc .Small prevertebral, left paravertebral and epidural collection at D11. Findings suggestive of SPONDYLODISCITIS .TUBERCULOSIS.

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Pott Disease D/D Spinal tumors Mycobacterium kansasii Nocardiosis Paracoccidioidomycosis Septic arthritis Spinal cord abscess Lab studies for confirmation Tuberculin skin test (PPD) - Results are positive in 84-95% of patients with Pott disease who are not infected with HIV Erythrocyte sedimentation rate (ESR) - May be markedly elevated (>100 mm/h) Microbiologic studies - Used to confirm the diagnosis With regard to the above-mentioned microbiologic studies, bone tissue or abscess samples are obtained to stain for acid-fast bacilli (AFB), and organisms are isolated for culture and susceptibility.

CASE UPDATE. I am thankful to each and every one of you who answed the case. All of you have given the appropriate answers. Esr was 40mm/ hr. All tumor markers were - ve.xray chest , us abdomen were normal. Pt was transferred to spinal surgeon . Posreolateral decompression laminectomy with stabilization & screw fixation done .Drained the impending abcess. BIOPDY REPOR TUBERCULOUS DISCITIS. 2nd post op day the pt became unresponsive inn the icu with rapid AF. SEEN BY cardiologist, intensivist , tried resuscitation but unfortunately the patient passed away. MRI report;Intervertebral disc appears irregular with T2 hyperintense & T1 hypointense signal at D11-12 level..Area if heterogeneous marrow signals seen in the vertebral bodies at D11& D12 with reduced vertebral heights.The intervening end plateappears irregular with STIR hyperintensities.The ID disc appears mildly hyperintense in DW1 .Milf gibbus deformity causing spinalcord compression.Minimal AP diameter measures 6.5mm. Subtle T2 hyperintense signals seen in the cord atthis level.Small T2 and STIR hyperintense signal with no enhancement noted in prevertebral & left paravertebral location of D11. Imp: MRI of the spine show area of heterogeneous marrow signals at D11-12 with endplate irregularity and enhancing signals in the IV disc .Small prevertebral, left paravertebral and epidural collection at D11. Findings suggestive of SPONDYLODISCITIS .TUBERCULOSIS.

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Destruction of Vertebral Structure and collapse with loss of Intervertebral space and cold abscess anteriorly compressing upon the spinal cord developing Paraparesis due to Compressive Myelopathy...

Paradiscal TB with cold abscess anteriorly and extradural compression posterioly UMN features in lower limbs Anterolateral decompression? Other options are laminectomy and pedicle screw fixation spanning the lesion ATT and fusion once lesion heals

Looks like infective process with collapse and compression Needs posterior predisposition screw stabilisation and posterolateral decompression under cover of AKT and antibiotics prior to surgery with HPE, Culture for MDR. If patient is not willing for surgery then AKT with antibiotics, DVT prophylactic dose heparin to improve perfusion, chymeral forte, vitamin C with graduated PELVIC TRACTION, organic raw food

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Probably Potts spine Other pathological fractures has to be ruled out

-It's seems to be POT'S SPINE Lumbar Vertebrae D/d- OSTEOPOROTIC Compression # -- Osteomyelitis Lumbar spine - Spine Biopsy Needed for Confirmation. - Still pt Bladder- Bowel fn is not compromise it's good sign in view of prognosis. - Spine Surgeon opinion/ consultation needed- may need surgical intervention subject to spine Biopsy findings. - Spine surgeon + Neurologist & post surgery physiotherapy will be helpful in better prognosis despite 81years age of pt. - nice case studies @Dr. Manorama Rajan madam

Potter, s disease and cord compression posteriorly

This patient probably has senile osteoporosis and compression collapse of the T 11T12 vertebrae causing spinal cord compression with paraparesis. The other possibilities are TB Spine Multiple Myeloma and spinal metastases from cancer. He needs to be investigated with Bone Densitometry and Isotope bone scan with biopsy.He needs surgical decompression and stabilisation. Medical treatment will include Zolendronate initially with Calcium supplements Vitamin D and nasal calcitonin.

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