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Background:Cystic echinococcosis (CE) is a zoonosis caused by the larve of Echinococcus granulosus. Cysts can develop in any part of the body, although the liver and lungs are most frequently involved. Bone echinococcosis is one of the rarest forms of the disease, accounting for 0.5 to 4.0% of all echinococcosis. Spinal cysts are disabling causing destruction similar to malignant bone lesions, with high risk of neurological deficit.Objectives:To increase awareness of this disease, the clinical data of eight patients with spinal CE were analyzed retrospectively.Methods:Clinical data of eight patients with spinal CE were analyzed retrospectively, collected over ten years on the department of orthopedics in the Military hospital of Tunis.Results:The mean age of the patients was 49 years. The median disease duration was five years. All patients presented with back pain and paresthesia without neurological deficit. Radicular pain was reported by two patients. The diagnosis of spinal CE was made after the diagnosis of visceral CE in two patients. Former X rays showed nonspecific abnormalities and patients were treated initially by symptomatic treatments based on paracetamol and nonsteroidal antiinflammatory drugs without any improvement. All of the patients needed Magnetic resonance imaging (MRI) to explore chronic back pain with paresthesia, revealing spinal CE. The typical MRI appearance is a multilocular cyst. Six patients had cervical and thoracic spinal cysts, one patient had a lumbar spinal cyst and one patient had cervical, thoracic and lumbar cysts. Further examinations with Computed tomography scans (CTscans) were needed before surgery for better examination bone destruction. All patients underwent surgery. Cysts were removed with spinal fixation. All the patients showed relapses and needed at least three surgical interventions.Conclusion:Bone echinococcosis is rare and often misdiagnosed. Radiographic and CT images lack disease-specific characteristics whereas MRI images offers a greater chance of direct diagnosis. Treatment of spinal hydatid disease is entirely surgical with high risk of relapses.Disclosure of Interests:None declared

Background:Low back pain is an extremely common patient complaint. Most cases resolve quickly after the acute episode. However, a significant number of patients develop chronic low back pain; a persistent disabling condition. Patients suffer from unremitting pain and often become functionally impaired.Objectives:The aim of this study is to describe the characteristics of chronic LBP, physical examination abnormalities, treatment strategies and the impact of LBP on the professional life of the patients.Methods:It was a an analytical cross-sectional study including 50 patients with at least three months of LBP, in the department of rheumatology and orthopedics at the Military Hospital of Tunis between January 1st and March 31, 2020. All patients had a standardized investigation and clinical assessment.Results:The study included 80% of active military serving members and 20% of administrative officers. The mean age of the patients was 41.9 ± 8.4 years and the sex ratio was 4.5. Four patients were suffering from diabetes; two patients were suffering from high blood pressure. All the patients were suffering from chronic LBP lasting for an average of 66.4 months. LBP was associated with radicular pain in 78% of the cases. It was a unilateral radicular pain in 72% of the cases and bilateral in 28% of the cases. The main triggering factors were: carrying heavy loads in 98% of the cases, standing or sitting for long periods in 90% and 76% of the cases, tremors in 74% of the cases. Neuropathic pain was found in 26% of patients. Physical examination showed paravertebral muscle tenderness in 66% of the cases and slack abdominal muscles in 56% of the cases. Assessement of range of flexion of the lumbar spine showed: fingertip to floor test was 18 ±12.2 cm [054cm], schober test was +3.8±1.2cm [16cm]. The extension of lumbar spine was painful in 80% of the cases. A trigger point was found in 28% of the cases. Lasegue sign was positive in 18% of the cases. Leri’s test was positive in 8% of the cases. Required treatments during the last episode of LBP were: Paracetamol (62%), nonsteroidal antiinflammatory drugs (26%), tramadol (4%), myorelaxant (4%) and pregabalin (2%). Half of the patients needed functional rehabilitation. Forty percent of the patients reported improvement; 46% of them reported improvement then recurrence of the pain, 8% of them reported no improvement and 4% reported worsening of the symptoms. Thirty six percent of the patients needed an average of 21 days of leave and 35% of them needed exemption from work for LBP problems. One patient needed an outplacement from his original work and one patient needed an early retirement.Conclusion:Chronic low back pain can cause significant functional disability, and commonly becomes frustrating for both patients and physicians to cope with and treat. There is still no consensus on the best way to manage chronic low back pain, and clinical guidelines are scarce. A combination of pharmacological agents and non-pharmacological methods is the most appropriate therapeutic regimen.Disclosure of Interests:None declared

Background:Common low back pain (LBP) is a common health problem affecting 50 to 80% of working age adults. It is one of the common and costly health problems in Tunisia. Actually, the role of the immune response and inflammatory cytokines in the pathogenesis of chronic pain has been of growing interest.Objectives:The aim of this study was to assess whether pro and anti-inflammatory cytokines could be detected in serum in patients with LBP compared with healthy subjects and whether they could be related to pain severity and to clinical findings.Methods:It was a an analytical cross-sectional study including 50 patients with at least three months of LBP, in the department of rheumatology, orthopedics and immunology at the Military Hospital of Tunis between January 1st and March 31, 2020. All patients had a standardized clinical assessment.Levels of serum cytokines IL-6, IL-8, IL-1β and TNF- α, were measured using the chimiluminescence technique. Serum concentration of IL-10 was assayed by the enzyme-linked immunosorbent assay technique (ELISA). The normal levels of cytokines were determined in 50 healthy controls.Results:The mean age of the patients was 41.9 ± 8.4 years and the sex ratio was 4.5. LBP duration was 66.4 months. The mean lumbar visual analog scale (VAS) was 4.5 ± 1.9, and the root VAS was 2.6 ± 2.5. Neuropathic pain was found in 26% of patients. The average BMI was 27 ± 3.7 kg/m2. Only serum level of IL-8 was significantly higher in subjects with LBP compared to healthy controls (p Conclusion:Interleukin-8 is a biomarker of common low back pain and correlate with anxiety and functional disability. These results suggest that IL-8 may be a therapeutic target to reduce chronic back pain and reduce the social and profession impact.Disclosure of Interests:None declared

Background:Common low back pain (LBP) is a common health problem affecting 50 to 80% of working age adults resulting in significant personal, social and occupational impairment. Chronic pain has a negative impact on quality of life and psychological well-being.Objectives:The aim of this study was to examine the relationship between anxiety, depression and pain intensity in patients with low back pain in a population made of military agents.Methods:It was an analytical cross-sectional study including 50 patients with at least three months of LBP, in the department of rheumatology and orthopedics at the Military Hospital of Tunis between January 1st and March 31, 2020. All patients had a standardized clinical assessment. Patients completed the «hospital anxiety and depression scale» (HADS) and the «Fibromyalgia Rapid Screening Tool» (FIRST) to evaluate psychological impact of chronic LBP. Pain intensity was assessed using a visual analog scale (VAS).Results:The mean age of the patients was 41.9 ± 8.4 years and the sex ratio was 4.5. LBP duration was 66.4 months. The mean lumbar visual analog scale (VAS) was 4.5 ± 1.9, and the root VAS was 2.6 ± 2.5. Neuropathic pain was found in 26% of patients. Abnormal level of anxiety and depression were found in 58% and 62% of the patients respectively. Out of them 20% and 26% were borderline abnormal for anxiety and depression respectively, while 38% (16.4%) and 36% were certainly abnormal for anxiety and depression respectively. Twelve percent of the patients had fibromyalgia syndrome associated with LBP as they had a FIRST score ≥5. Positive correlations were found between lumbar VAS and HAD anxiety/depression scores (r = 0.35; pConclusion:The results of this study showed that anxiety, depression and fibromyalgia syndrome are not only frequent with patient suffering from chronic LBP but they are also correlated to the pain intensity. As a consequence, assessment of and intervention in anxiety, depression symptoms and fibromyalgia syndrome is crucial in the provision of pain-relief nursing treatment in patients with low back pain.Disclosure of Interests:None declared

Introduction: Skull base and neck osteomyelitis are rare but very dangerous infections. Usually it complicates persistent otitis externa. Diagnosis and therapeutic management are very difficult especially because of the complexity of the anatomical region. Instability of the head neck junction after osteomyelitis is not commonly reported. Presentation case: We report a case of a 35-year-old man who presented a skull base and cervical vertebrae osteomyelitis initiated by otitis externa. Adapted antibiotherapy led to clinical and biological improvement. Follow up imaging demonstrated an important instability of the head-neck junction. Surgery fixation was indicated and the patient had an instrumented occipital-neck arthrodesis. Follow-up showed a good clinical situation, no infection recurrence and reparative bone changes. Discussion: Bone lesions and the infiltration of the soft tissue could bring up the fear of a latent malignant process. The biopsy piece have always to be sent to microbiology as well as histology examination. Surgical arthrodesis wasn't commonly reported in literature but was indicated in our case, after total healing, because the instability of the head-neck junction. Conclusion: Skull base and cervical vertebrae osteomyelitis is a severe disease. Early diagnosis and appropriate antibiotherapy are desirable to offer the better chances for healing and to prevent potential complications. The indication of surgical arthrodesis was appropriate regarding the clinical and radiological result, but further supervision is necessary given the risk of infection recurrence. Keywords: Osteomyelitis, Skull base, Cervical vertebrae, Otitis externa