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KMID : 0378019700130110073
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New Medical Journal
1970 Volume.13 No. 11 p.73 ~ p.80
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Clinical Observation of Tiuberculous Spondylitis and Pott´s Paraplegia
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Abstract
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171 cases of tuberculous spondylitis including 14 cases of Pott´s paraplegia treated at Pusan National University Hospital and Pusan Children´s Charity Hospital from March 1962 to September 1967 were reviewed. Discussions were mainly concerned with the historical aspect of treatment, various operative procedures along with their advantages and disadvantages, the periods of preoperative antituberculous drug therapy and postoperative immobilization, the causes of paraplegia, and the results of the treatment.
Various data obtained by this clinical review were as follows.
1) The modes of treatment: conservative treatment (20 cases), I & D (22 cases), focal debridement (6 cases), posterior spinal fusion (24 cases), costotransversectomy (2 cases), anterior spinal fusion. (93 cases), I & D-PSF (3 cases), and I & D-ASF (1 case). All were treated combined with drugs.
2) Age incidence : 1-5 years 29%, 6-10 years 15%, 11-20 years 22%, 21-30 years 14%, 31-40 years 10%, above 40 years 9%.
3) Sex ratio: male 47%, female 53%.
4) The number of involved vertebra: involvement of a single vertebra 18%, two vertebrae 63%, three vertebrae 12%, more than three vertebrae 7%. The most frequently involved vertebra was L3 (29%) and Tao (12%).
5) Pott´s paraplegia occurred in 14 cases (8.2%) among 171 cases of the tuberculous spondylitis.
6) The duration of paraplegia from onset to admission was average 3.2 months (10 days-15 months). All cases of paraplegia had lesions in thoracic vertebrae except one case who bad lumbar lesion.
7) The causes of paraplegia: pachymeningitis (l case), displacement of involved vertebra (2 cases), posteriorly displaced disc (1 case), tuberculous abcess and granulation tissue (10 cases).
8) All with paraplegia were treated with anterior spinal fusion. The results of anterior spinal fusion on discharge were improved in 6 cases, moderately improved in 2 cases and markedly improved in 6 cases. The average period of preoperative drug therapy was 3 weeks and of postoperative immobilization 6-9 weeks. The period of follow-up was average 3 years (2 months-5 years). 12 cases showed improvement of symptoms and free ambulation enjoying average normal life avoiding heavy work. 2 cases were in too short period after operation to evaluate the clinical results.
After all the author´s impression is that the anterior spinal fusion is one of the best treatment of tuberculous spondylitis and Pott´s paraplegia.
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