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Transverse myelitis typically extends two or less spinal segments, whereas longitudinal extensive transverse myelitis (LETM) extends three or more spinal segments in length and may occasionally span all the segments of the spinal cord. We present a case of spinal tuberculosis presenting with LETM with true lower motor neuron-type flaccid paraplegia.

Background/objectives: Spinal tuberculosis (TB) is a destructive extra-pulmonary disease manifestation of Mycobacterium tuberculosis infection. It is responsible for many cases of paraparesis and quadriparesis in developing countries where patients seek treatment late. The aim of this study was to understand and analyze the clinical and radiological profile of patients with spinal TB and correlate it with the anatomical site affected by it., Methods: A retrospective, observational study of 100 cases of spinal TB admitted over a period of three years. Data on demography, clinical signs and symptoms and investigations were analyzed., Results: Incidence of spinal TB was found to be the highest in the third and fourth decade of life (45%). Incidence among males was 64% and females was 36%. Low socioeconomic class (72%) and past history of pulmonary TB (34%) were found to be risk factors for spinal TB. Average duration between onset of symptoms and time of presentation to the hospital was 154±15.5 days. Patients with bone involvement presented later than those without bone involvement. Paraplegia (91%) and backache (62%) were the most common clinical presentation. Thoracic spine involvement (36%) and vertebral wedging and destruction (58%) were the commonest X-ray findings. 69% patients had compressive lesion with vertebral body destruction being the commonest cause of compression., Conclusions: Spinal TB with neurological deficits affected the thoracic spine. Compressive spinal cord lesions were the common form of presentation of spinal TB. Paraplegia with backache and neurological bladder-bowel involvement were the most prevalent neuro-deficits. Magnetic resonance imaging of the spine proved to be the most useful investigation to differentiate and localize the site of tubercular lesions., (Copyright © 2018 Tuberculosis Association of India. Published by Elsevier B.V. All rights reserved.)

Purpose: To investigate the causes of late-onset, progressive neurological deficits in patients with severe angular kyphosis caused by spondylitis secondary to tuberculosis (TB spondylitis)., Methods: From 2000 to 2011, 36 patients with severe angular kyphosis secondary to TB spondylitis (TB kyphosis) were enrolled in the study. All patients had late-onset, progressive neurological deficits. The causes of these deficits were classified with respect to the level of the causative lesion. Group A (n = 25, 69.4%) comprised patients whose neurological deficits resulted from the kyphosis itself. Patients in group B (n = 11, 30.6%) had developed neurological symptoms related to a lesion cephalad or caudal from the kyphosis. Surgical intervention was performed in 23 patients; 13 patients were treated conservatively. Clinical outcomes were evaluated using the American Spinal Injury Association (ASIA) impairment scale., Results: The late onset of neurological deficits was attributed to cord compression, pure cord distraction, stenosis, and instability above or below the level of the angular kyphosis. An improvement of the neurological symptoms at the cord level after surgical intervention, as indicated by a change from a non-ambulatory (ASIA impairment scale A/C) to an ambulatory (ASIA D/E) status, occurred in four of nine (44.4%) surgically treated patients. However, only 2 of 10 (20.0%) patients treated conservatively showed cord level improvement, as assessed using the ASIA impairment scale., Conclusions: In their evaluation of paraplegic patients, spine surgeons should consider the many potential causes of late-onset neurological deficits in TB spondylitis to avoid performing unnecessary surgery. A simpler procedure may yield equivalent results.

Spinal tuberculosis leading to paraplegia is uncommon in pregnancy and is a diagnostic and therapeutic challenge. We report a case of tubercular paraplegia presenting at 35 weeks of gestation. She was managed with Anti-tubercular drugs and did not require surgical intervention. Her neurological status improved and she was allowed to go in labour. She delivered a healthy term infant by cesarean. At three months follow-up, both mother and child are doing well.

Background: Paraplegia associated with epidural anesthesia or caused by intramedullary spinal tuberculoma is rare but catastrophic. We present a case of paraplegia following epidural anesthesia in a patient with an undiagnosed intramedullary spinal tuberculoma., Case Presentation: A 42-year-old man developed paraplegia after an open cholecystectomy under epidural anesthesia. Spinal cord infarction, acute transverse myelitis, and intramedullary neoplasms were ruled out by histopathologic examination, and intramedullary spinal tuberculoma at the T6-T7 level was identified. Despite surgical treatment and subsequent antituberculous therapy, the patient retained some disability attributable to the delay in diagnosis., Conclusion: Physicians should be aware of coexisting disease as a cause of paraplegia following procedures using epidural anesthesia. Magnetic resonance imaging is the most sensitive diagnostic test, although it is still difficult to differentiate spinal cord infarction, myelitis, intramedullary spinal tuberculoma, and neoplasms from imaging features alone.

Background: Tuberculosis of the musculoskeletal system is not a common clinical condition; however, multifocal bone involvement is even rarer and difficult to recognize., Case: In this paper, we presented a patient who developed paraplegia 15 days before his hospital admission. He was operated by neurosurgeons due to spinal mass, but postoperative examination revealed vertebral and multifocal skeletal tuberculosis. It is difficult to diagnose this condition by conventional imaging methods. The importance of positron emission tomography (PET) in the diagnosis of skeletal tuberculosis was emphasized., Result: The importance of rehabilitation program in restoring functionality was overviewed in the light of current literature. Vertebral and osteoarticular tuberculosis should be considered in patients with vertebral and thoracic mass presenting with neurological deficits.

The most dreaded neurological complications in TB spine occur in active stage of disease by mechanical compression, instability and inflammation changes, while in healed disease, these occur due to intrinsic changes in spinal cord secondary to internal salient in long standing kyphotic deformity. A judicious combination of conservative therapy and operative decompression when needed should form a comprehensive integrated course of treatment for TB spine with neurological complications. The patients showing relatively preserved cord with evidence of edema/myelitis with predominantly fluid collection in extradural space on MRI resolve on non-operative treatment, while the patients with extradural compression of mixed or granulomatous nature showing entrapment of spinal cord should be undertaken for early surgical decompression. The disease focus should be debrided with removal of pus caseous tissue and sequestra. The viable bone should only be removed to decompress the spinal cord and resultant gap should be bridged by bone graft. The preserved volume of spinal cord with edema/myelitis and wet lesion on MRI usually would show good neural recovery. The spinal cord showing myelomalacia with reduced cord volume and dry lesion likely to show a poor neural recovery. The internal kyphectomy is indicated for paraplegia with healed disease. These cases are bad risk for surgery and neural recovery. The best form of treatment of late onset paraplegia is the prevention of development of severe kyphosis in initial active stage of disease.

Objective: The objective is to study the rehabilitation management and to assess autonomy in daily life activities as well as walking recovery in patients with complicated Pott's disease., Patients and Methods: Retrospective study in nine patients over a period of 8 years extending from 2000 to 2008, collated in the Department of Physical Medicine and Functional Rehabilitation, CHU Sahloul, Sousse, Tunisia., Results: The mean age of our patients was 43.8 years; sex ratio was 5/4. The spine involvement of tuberculosis was dorsal in seven cases, dorso-lumbar in one patient, and multiple (cervical, dorsal and lumbar) in one case. All patients were paraplegic with a neurological involvement of the bladder. They had prior antituberculosis chemotherapy for at least 8 months. Decompression surgery was performed in six cases. Two female patients presented disorders of spinal posture during treatment requiring surgical revision with osteosynthesis. All patients received additional rehabilitation care. Following a mean duration of hospitalisation in the Rehabilitation department of 47 days with twice-daily sessions of tailored physiotherapy, three patients remained in complete paraplegia, autonomous in wheel-chair and with vesical and sphincter incontinence. The measure of functional independence (MFI) was at admission/discharge 71/92., Conclusion: Rehabilitation takes an important place in the medico-surgical management in Pott's disease, to limite or compensate the disabilities and handicap related to this pathology., (Copyright © 2012 Elsevier Masson SAS. All rights reserved.)

Purpose: The purpose of this study was to determine the clinical results of patients with late onset upper thoracic sharp Pott's kyphosis and to predict the prognosis for Pott's paraplegics., Method: The study included five patients who developed late onset upper thoracic (T1-T4) sharp Pott's kyphosis/kyphoscoliosis within a period from 19 to 37 years after the active disease was healed. The kyphosis angle of the patients ranged from 95° to 105°. Among them, three patients suffered onset of paraplegia ranging from 26 to 31 years after spinal tuberculosis was healed. The duration of neurological deterioration before surgery ranged from four to five years. All patients underwent decompressive surgery with an attempt to correct the curve. Neurological status was evaluated using the ASIA impairment classification and the motor score., Results: Postoperatively, kyphosis correction ranged from 20° to 30° for five patients. No neurological deficit occurred in two patients with normal neurological status. Two ASIA D paraplegics remained unchanged after surgery and no further improvement was found at one year follow-up. One ASIA C paralysis deteriorated neurologically to ASIA B after surgery and persisted to a deterioration of neurological status at one year follow-up., Conclusion: Upper thoracic sharp Pott's kyphosis and neurological deficits occur progressively. The neurological recovery or improvement of Pott's paraplegics with upper thoracic severe sharp kyphosis results in poor prognosis after decompressive surgery.

Aim: This study was aimed to identify the clinical and radiological profile of non-traumatic paraplegia and the various etiologies associated with the condition., Materials and Methods: A review of the clinical and radiological presentations of adult patients presenting with non-traumatic paraplegia managed at the Aminu Kano Teaching Hospital (AKTH) and Murtala Specialist Hospital (MMSH), Kano, from June 2006 to November 2009 was carried out. Patients underwent a detailed clinical evaluation followed by laboratory investigation and neuroimaging studies and were followed up for 9 months to asses outcome and complications., Results: 98 patients with non-traumatic paraplegia consisting of 71 males and 27 females (M:F: 5:2) were seen. The age range of the patients was between 16 and 76 years, with a mean age of 40 years (SD = 15.3) years; 54 (55%) of the patients presented after 2 months of the onset of paraplegia. The commonest symptoms were weakness of the lower limbs (100%), loss of sensation (55%), sphincteric disturbance (50%) radicular pain and paresthesia (38.4%), back pain (21.4%) and erectile dysfunction (40%). All the patients had X-ray of the spine; 26.3% had Magnetic Resonance Imaging (MRI) spine. The commonest etiological factors were tuberculosis (TB) (44.4%), transverse myelitis (13.1%), Guillain-Barre syndrome (9.1%), metastatic spinal disease (4%), and HIV myelopathy (4%). However, the cause could not be identified in 14 (14%) of the patients. The commonest site of affectation in those with TB spine was lower thoracic (53.8%) and upper lumbar (23.1%) vertebrae., Conclusion: Clinical profile of non-traumatic paraplegia in Kano, northwestern Nigeria, is similar to that reported elsewhere in Africa, with spinal tuberculosis and transverse myelitis accounting for over half the cases.

Tuberculosis is a rare disease in economically developed countries. Paraplegia is one of its severe complications, occurring in cases of spondylodiscitis with compressive epiduritis and/or pathological fracture of vertebral bodies with subacute kyphosis. Six patients aged 15-75 years were treated in our department from May 2005 to April 2006 by the same operator (L.N.) for paraplegia complicating Pott's disease. Patients' neurologic function at admission and their outcomes three and 12 months after surgery were graded using the Frankel classification. MRI showed a single lesion in five cases and skip lesions in one case. Standard antituberculosis chemotherapy was started immediately within the first week of admission in five patients following a 12-month regimen. Principles of surgical treatment were ventral spinal cord decompression (with or without dorsal stage procedure), immediate grafting, correction of subacute spinal deformity and instrumentation in all cases. The diagnosis of Mycobacterium tuberculosis was confirmed by laboratory investigations in four cases and by histopathological examination in all cases. One patient who had undergone prior isolated laminectomy performed by an on call team presented neurological deterioration and progressive kyphosis. Neurological outcome improved in five patients. Four of them were able to walk unaided within the first three months after surgery. No perioperative complication occurred. In paraplegia complicating vertebral tuberculosis, overall neurological outcome appeared to be good in case of delayed emergency surgical management combined with antituberculosis chemotherapy.

Background: In developing countries, a recognized etiology of paraplegia can be tuberculous radiculomyelitis or tuberculomas, especially in patients with evidence of either active or latent tuberculosis. These entities should also be considered in high-risk patients or in patients who have emigrated from regions with a high prevalence of tuberculosis (TB). Both arachnoiditis and intradural tuberculomas are uncommon forms of spinal TB., Case Reports: We report three cases of TB of the spinal cord in young males with paraplegia or paraparesis who were hospitalized over a one-year period. The clinical presentation and clinical course differed among the three patients: radiculomyelitis complicating tuberculous meningitis for the first patient and spinal tuberculomas in the other two. Neuroimaging with magnetic resonance imaging (MRI) was critical for diagnosis., Conclusions: The therapy for spinal TB should be conservative since the neurologic deficits are mainly secondary to the inflammatory process. Usually these lesions respond to medical therapy alone, and with early diagnosis one can avoid unnecessary surgical intervention. In our limited clinical experience, corticosteroids (IV, intrathecal, or both) appear to have a beneficial effect.

Objective: To discuss the failure reasons of operation for spinal tuberculosis complicated with paraplegia and methods of the second operation., Methods: Spinal tuberculosis paraplegic patients (18 males, 14 females) were reviewed retrospectively. They have been treated with failing decompressive surgery from January 2001 to December 2006. Seventeen patients received anterior debridement surgery via transpleural approach while the other 15 patients received posterolateral decompression surgery via costotransverse approach. Twenty-two patients got chemotherapy after the surgery., Results: Twenty-three patients were treated by anterior debridement, decompression and graft placement via transpleural approach (9 received the single-stage posterior instrumentation). Five patients received posterolateral debridement and decompression via extrapleural approach. Two patients, recur focus be eliminated. Two patients were given sinus debridement surgery alone. All patients were given anti-tuberculosis chemotherapy. The paraplegia was recovered completely in 26 patients, and partly in 5 patients., Conclusions: Inadequate treatment results in defeated operative. The proper selection of operative modalities and timing on the basis of systematically anti-tuberculosis chemotherapy remains the best mode of therapy for spinal tuberculosis complicated with paraplegia. And it is also essential to choose a radical debridement surgery to decompress the spinal cord and to reconstruct the stability of spine.

Object: Significant numbers of patients with spinal tuberculosis (TB), especially in developing countries, still present late after disease onset with severe neurological deficits. The authors conducted a study to assess the outcome in these patients., Methods: Fifty-nine patients with spinal TB and severe motor deficits underwent surgery at the authors' center during the past 10 years. Data obtained in 48 patients with a minimum of 3 months of follow up (mean follow-up period 12.8 months) were analyzed. The disease in 34 patients was characterized by Frankel Grade A/B (Medical Research Council Grade 0/5) and in 14 patients by Frankel Grade C (unable to walk even with support) at admission. Thirty (88%) of the 34 patients with Frankel Grade A/B status and 13 (92.8%) of the 14 patients with Frankel Grade C status at admission experienced improvement to Frankel Grade D/E (walking with or without support) at the last follow-up examination 3 or more months after surgery. The degree of improvement exhibited by patients with a Frankel Grade A/B spinal cord injury was comparable to that shown by patients with Frankel Grade C status. Even patients with flaccid paraplegia, gross sensory deficit, prolonged weakness, spinal cord signal changes demonstrated on magnetic resonance imaging, and bladder involvement have experienced dramatic improvement in motor function since surgery. A significant number of the patients have shown remarkable improvement in other symptoms such as pain (91.6%), spasticity (88%), and bladder symptoms (88%)., Conclusions: A significant proportion of patients with spinal TB and severe motor deficits experience remarkable improvement after surgical decompression and hence should undergo surgery even though they may be suffering from paraplegia of considerable duration.

Background: Pott's disease refers to spinal tuberculosis, which commonly leads to a gradual onset of neurological deficit that are difficult to diagnose at the early stage., Method: The study was a combination of retrospective and prospective study. Information was obtained using a predesigned protocol. Diagnosis was based on clinical features and plain spinal x-ray. Anti-tuberculous therapy was instituted in all patients for a minimum of 18 months. Monitoring of neurological status was done weekly., Results: There were 92 patients made up of 71 males (77.2%) and 21 females (22.8%) with a male: female ratios of 3.4:1. 53.3% were paraplegic while 46.7% were paraparetic. The age group 31-40 years was the most affected. 43.5% of the patients were farmers who formed the majority. Back pain, weight loss, paraplegia and paraparesis in that order were the common clinical features. 25% of the patients recovered full use of their lower limbs at the end of the study. Thoracic spine and lumbar spine were equally involved (41.5% respectively) while thoraco-lumbar spine was involved in 15.1% of patients. Cervical spine was only involved in 1.9% of the patients., Conclusion: Effective management of spinal tuberculosis should be a teamwork involving the physician, orthopedic surgeon, neurosurgeon as well as the radiologist. The rural populace needs to be educated to prevent late complications and ensure better prognosis.

A review of the presentation, management and outcome in all children presenting with non-traumatic paraplegia managed by the paediatric neurology team at the University College Hospital Ibadan, Nigeria from June 1989 to May 2004 is presented. Of the 110 patients, there were 54 males and 56 females giving a M:F ratio of 1:1. The mean age of the group was 5.3 (SD = 3.1) years, with a range from 9 months to 11 years. Infections and infectious processes caused the paraplegia in 102 (92.7%) of the cases with poliomyelitis and tuberculosis (TB) of the spine accounting for 88 (80%) of cases. The study period was divided into three 5 year periods. While poliomyelitis was the commonest cause of paraplegia (60%) in the first 5 years: TB spine was responsible for most cases (40%) in the last 5-year period of the study. There was a significant reduction in the total number of cases seen when the initial 5-year period was compared with the last (45 and 26 respectively, P = 0.001). Overall mortality among the 110 admitted patients was 7.2% being highest (50%) in malignant disorders and none was recorded in TB spine. Prognosis for eventual ability to walk was best in cases of TB spine where 37 of the 39 patients (95%) were ambulant by discharge after 60 days of anti-TB treatment. The 2 non-ambulant patients eventually walked within 3 months of discharge while on maintenance treatment for TB. Only 2 of the 51 non-ambulant patients obtained wheelchairs at discharge. The implications of inadequate facilities for investigation and treatment as well as the lack of financial and social support for the families of affected children are discussed.

Study Design: Case report., Objectives: To report on a patient with Pott disease, progressive neurologic deficit, and severe kyphotic deformity, who had medical treatment fail and required posterior/anterior decompression with instrumented fusion. Treatment options will be discussed., Summary of Background Data: Tuberculous spondylitis is an increasingly common disease worldwide, with an estimated prevalence of 800,000 cases., Methods: Surgical treatment consisting of extensive posterior decompression/instrumented fusion and 3-level posterior vertebral column resection, followed by anterior debridement/fusion with cage reconstruction., Results: Neurologic improvement at 6-month follow-up (Frankel B to Frankel D), with evidence of radiographic fusion., Conclusions: A 70-year-old patient with progressive Pott paraplegia and severe kyphotic deformity, for whom medical treatment failed is presented. A posterior vertebral column resection, multiple level posterior decompression, and instrumented fusion, followed by an anterior interbody fusion with cage was used to decompress the spinal cord, restore sagittal alignment, and debride the infection. At 6-month follow-up, the patient obtained excellent pain relief, correction of deformity, elimination of the tuberculous foci, and significant recovery of neurologic function.

This is a case report of Mr S, a 43-year-old man with a spinal cord lesion caused by tuberculosis resulting in incomplete paraplegia. He was discharged from hospital with significant residual disability. He received a major part of his rehabilitation in the community from an interdisciplinary neuro rehabilitation team with good results. Because Mr S was overweight, over 20 stones, the therapists had to use considerable creativity and imagination to facilitate his rehabilitation. Mr S's high level of motivation and courage was essential to the success achieved. The purpose of the case report is to demonstrate that a positive outcome can be achieved despite the many difficulties faced in the rehabilitation of an overweight patient with an incomplete spinal cord lesion in a community setting.

Pott's paraplegia associated with pregnancy is a serious problem and is difficult to treat, as not much literature is available regarding its management. Such a case, where the multidisciplinary team approach gave good neonatal and maternal outcome, is reported here.

Tuberculous paraplegia in pregnancy is reported to be rare. Paraplegia due to tuberculosis has a good prognosis if surgical decompression and stabilisation are done early together with chemotherapy. Vaginal delivery is not contraindicated in pregnancy complicated by paraplegia, but is associated with problems related to the initiation and progression of labour. Performing spinal nursing on an unstable spine with a rapidly enlarging gravid uterus in the third trimester of pregnancy poses a significant challenge. We report successful simultaneous Caesarean section and surgical treatment of a paraplegic spine due to tuberculosis.

Neurologic complications are the most dreaded complication of spinal tuberculosis. The patients who have paraplegia develop in the active stage of tuberculosis of the spine require active treatment for spinal tuberculosis and have a better prognosis than the patients who have paraplegia develop many years after the initial disease has healed. Neurologic dysfunctions in association with active tuberculosis of the spine can be prevented by early diagnosis and prompt treatment. Prompt treatment can reverse paralysis and minimize the potential disability resulting from Pott's paraplegia. When needed, a combination of conservative therapy and surgical decompression yields successful results in most patients with tuberculosis of the spine who have neurologic complications. The vertebral body primarily is affected in tuberculosis; therefore, decompression has to be anterior. Laminectomy is advocated in patients with posterior complex disease and spinal tumor syndrome. Late onset paraplegia is best avoided by prevention of the development of severe kyphosis. Patients with tuberculosis of the spine who are likely to have severe kyphosis develop (< 60 degrees) on completion of treatment should have surgery in the active stage of disease to improve kyphus.

This study was conducted to determine the factors involved in predicting the onset of paraplegia in tuberculosis of the spine. A cross-sectional, case control review of 85 cases of spinal tuberculosis was conducted at the National Tuberculosis Centre in Kuala Lumpur. Sixty-nine of these cases were normal neurologically, whilst 16 cases experienced neural deficit. The data was analysed using backward logistic regression and Fishers exact probability test. The factors studied included symptoms and signs of spinal tuberculosis, common investigations for tuberculosis, and physical factors of the disease. Only the erythrocyte sedimentation rate (ESR) showed a significant difference between the neural deficit and neurologically normal groups. This suggests that the ESR may be a factor in predicting evolution of paraplegia in spinal tuberculosis. In addition, it was noted that a low proportion of patients had positive sputum smear results and bacterial culture growth for mycobacterium tuberculosis suggesting these tests are of limited value for tuberculosis of the spine.

Sixteen patients had paraplegia due to tuberculosis of the cervicodorsal junction. Spinal decompression was performed through an extended lower cervical approach, and a humeral allograft was used to reconstruct the anterior column. All patients improved neurologically with satisfactory correction of the deformity and successful incorporation of the allograft.

Background: Pott's disease may cause late neurological involvement due to development of sharp kyphosis. Anterior decompression and fusion is the treatment of choice for this disorder., Objective: To determine the mid-term clinical results of patients with late onset Pott's paraplegia, who underwent anterior decompression and grafting after neurological deterioration., Setting: A university hospital in Istanbul, Turkey., Methods: Eight patients who developed late onset paraplegia with a mean period of 24.6 years (range, 9-46 years) after the active disease were treated with anterior decompression and grafting. The mean age at surgery was 36.1 years (range, 18-63 years) and the mean duration of neurological deterioration before surgery was 7.4 weeks (range, 2-13 weeks). The mean kyphosis angle of the patients was 105.63 degrees (range, 80 degrees- 135 degrees). No attempt to correct the curve was made in any operation. All but two patients' neurological status were evaluated according to the International Standards for Neurological and Functional Classification of Spinal Cord Injury determined by ASIA-IMSOP on admission., Results: Neurological status of all patients showed progression either in Frankel scale or in motor scores in the early postoperative period. One patient needed to be reoperated on because of a deterioration of neurological status 26 months after surgery. The mean length of time since the operations is 75.9 months (range, 48 173 months) and all the patients are carrying out their lives independently with a mean motor score of 97.5 and full pin-prick and light touch scores., Conclusions: Anterior decompression and grafting is an effective procedure for the treatment of late onset paraplegia in Pott's disease.

A 38 year-old woman, without previous medical history, presented, since 1993, several paraplegic fits carrying herself progressively through to a severe paraplegia. Diagnoses successively proposed were spinal cord compressions by slipped discs, spinal cord infarct and multiple sclerosis. In November 1998, the patient presented back pain and fever. Spinal cord magnetic resonance imaging (MRI) revealed a mildly enlarged dorsal cord with signal abnormalities. The lesions were isointense on T1-weighted images, hyperintense on T2-weighted images and showed a ringlike contrast enhancement. A lumbar puncture showed a trouble cerebrospinal fluid (CSF) with leucocytes 600/mm(3) (85 p.100 polynuclear), protein 6.7 g/l, glucose 0.26 g/l, chloride 109 mmol/l. The patient was first treated with parenteral unspecific antibiotherapy. Microbiological studies of blood and CSF were negative. CSF examination with polymerase chain reaction (PCR) was positive for Mycobacterium tuberculosis. Clinical (pain and fever) symptoms and CSF abnormalities decreased after antituberculous treatment. However, paraparesis remain severe. Spinal tuberculous localizations often lead to diagnostic and therapeutic errors. Improvement of spinal cord MRI sequences and using of PCR technics in CSF would contribute to reduce these difficulties.

Purpose: We report a series of 6 Pott's disease paraplegias treated between 1982 and 1996., Materials and Method: Out of 15 children suffering from Pott's disease, 6 had paraplegia. Treatment consisted of anterior medullar decompression and anterior spine fusion with bone grafting. Two or three weeks later, posterior spine fusion was achieved systematically using a CD fixation device in 3 cases., Results: Neurological signs completely disappeared in 5 children. Vertebral fusion was correct in all patients and kyphosis was less than 50 degrees., Discussion: The posterior approach to the spine must be proscribed as a first step, except for spine dislocation. The anterior approach allowed us to drain the abscess, to correct the kyphosis, and to perform an anterior spine fusion. The posterior spine fusion was performed a few weeks later in order to avoid kyphosis aggravation., Conclusion: Prognosis of Pott's disease is good but at the present time, paraplegia remains too frequent. Adapted treatment must be performed without delay.

Objectives: To ascertain the aetiology of non-traumatic paraplegia in a Zimbabwean population and to compare findings with other studies from Africa., Design: Retrospective survey over a six year period., Setting: National Rehabilitation Centre, Ruwa, Zimbabwe., Subjects: 159 patients referred to the National Rehabilitation Centre with non-traumatic paraplegia., Results: The commonest causes of non-traumatic paraplegia were neoplasms (28% of cases) of which a third were metastatic, followed by tuberculosis (TB) (27%). Transverse myelopathy of unknown aetiology was diagnosed in 11% of cases and 6% had Guillain Barré syndrome. Miscellaneous conditions included: degenerative bone and joint conditions, degenerative cord disorders and infections. In 7% of cases no diagnosis was reached. On admission all patients were confined to wheelchairs. On discharge 49% had regained some degree of mobility. A year after discharge 48% were known to be alive and 18% had died. The fate of 34% was not known., Conclusions: The aetiology of non-traumatic paraplegia in a Zimbabwean population is similar to that reported from other African countries, with tumours and tuberculosis accounting for over half the cases. Survival appears to be related not only to the primary condition but also to the severity of the disability.

The proposed protocol for postoperative motor rehabilitation of children with tuberculous spondylitis complicated by severe neurological disorders is based on the procedures developed by the authors to induce spinal locomotor activity. The developed algorithm of motor rehabilitation of spinal patients involves separate restoration of gait components (rhythmic stereotypic walking (spinal locomotion), maintenance of a standing posture and voluntary control over the movements ensuring gait. The stages of motor rehabilitation were defined by taking into account these factors and a child's neurological status. The use of the algorithm in the treatment of 11 children with tuberculosis and 13 children with other spinal diseases resulted in the restoration of normal compensatory gait or in its formation in the vast majority of patients.

CT scans of fifteen patients with tuberculosis of the spine without neurological deficit were analysed for canal encroachment. We calculated that up to 76% encroachment of the spinal canal by tubercular pathological tissue is compatible with undisturbed neural status.

Neurological complications of thoracic and lumbar spinal tuberculosis were studied in 32 patients under the age of 16 years. The majority had lesions involving three or more vertebral bodies. Paraplegia occurred in 8 patients and was always associated with bladder and bowel dysfunction. Lesions located at T4/5 were most commonly accompanied by paraplegia. Deterioration of the neurological status was related to the degree of spinal stenosis, whereas the degree of kyphosis was of less importance. Radiculopathy is rare in children with Pott's disease.

Objective: To explore characteristics of thoracolumbar tuberculosis complicated with paraplegia, relationship between efficacy and approach of operation, and to discuss indication and applicability of conservative treatment., Method: Forty-eight cases with thoracolumbar tuberculosis complicated with paraplegia were classified into two groups. Thirty-two cases in the operational group were treated with extrapleural, extraperitoneal approach and transpleural, extraperitoneal approach. Sixteen cases in the nonoperational group were treated conservatively., Result: The recovered cases in the operational and the nonoperational groups respectively accounted for 75% and 88%., Conclusion: Thoracolumbar tuberculosis complicated with paraplegia can be cured by either operative or conservative treatment, and the efficacy of operation directly related with operational approach.

Late onset paraplegia is a neurological complication that develops after a variable period in a patient with healed tuberculous disease of the vertebrae. In this retrospective analysis clinical features, imaging in diagnosis and treatment of this condition are described among 5 cases seen over a period of 5 years. This complication occurred even after successful treatment of initial spinal lesions with rifampicin-containing regimens. Magnetic resonance imaging was useful in pinpointing the exact pathology; one case had syrinx and two cases had marked internal gibbus with cord atrophy. Of the two cases who accepted surgical treatment, one improved.

Study Design: This case report illustrates two patients with paraplegia of late onset resulting from cord compression in the hyperlordotic thoracic or thoracolumbar spine proximal to a healed tuberculous kyphosis., Objectives: The objective of this paper is to highlight that degenerative stenosis of the thoracic spine proximal to a healed stable kyphosis can be a cause of paraplegia of healed disease., Summary of Background Data: Paraplegia resulting from tuberculosis of the spine can be of early or late onset. Early onset paraplegia is usually a result of cord compression by active disease. Late onset paraplegia can be due to disease reactivation, bony ridge compression, or unstable kyphosis. To our knowledge, compression of the cord proximal to a healed, stable kyphosis giving rise to paraplegia has never been reported., Methods: Patient 1 presented with symptoms of spinal claudication and progressive paraparesis. He was found to have spinal stenosis in the hyperlordotic thoracolumbar spine proximal to a healed lumbosacral tuberculous kyphosis. Patient 2 presented with a 2-year history of progressive paraplegia. Imaging revealed cord compression at the hyperlordotic T10-11 segment by disc protrusion, and facet hypertrophy., Results: Laminectomy successfully relieved the first patient of all symptoms but the second patient had significant deterioration of the neurologic status after surgery., Conclusion: Compensatory hyperlordosis of the thoracic or thoracolumbar spine commonly occurs in patients with severe tuberculous thoracolumbar or lumbosacral kyphosis. Degenerative spinal stenosis and cord compression at such hyperlordotic segment can cause late onset paraplegia. The blood supply of these chronically compressed cords is precarious and the risk of surgery is high.

We report a case of massive chylothorax occurring postoperatively in a patient with Potts paraplegia who underwent transthoracic anterior debridement and fusion of the T7 and T8 vertebrae. This is an uncommon complication of anterior spinal surgery but has a significant morbidity and mortality. Diagnosis of the condition and the institution of the appropriate therapy will reduce this significantly. The treatment principles are continuous tube drainage, nutritional support and reduction of chyle production. In 50% of cases a surgical procedure will be required. There are a variety of techniques available. We describe a technique that uses a pedicled intercostal muscle flap, which to our knowledge, has not been described previously. Among the other techniques, video-assisted thoracoscopic surgery is the most promising because of its low morbidity.

Sixty-seven patients were treated for Pott's paraplegia: 58 were adults and 9 were children. Sixty-four patients had active disease, and 3 had healed disease. All patients had triple chemotherapy with or without decompression surgery. Thirteen patients, including 9 children, were treated conservatively, whereas 54 patients who met the selection criteria for surgery were treated surgically. Fifty-two patients had anterior radical decompression surgery, and for 14 of them, anterior surgery was preceded by posterior instrumental stabilization surgery. Two patients with healed disease had posterior decompressive corpectomy. There was functional recovery in 60 (89.6%) patients, including 13 who had active disease that was treated conservatively. In 47 of the 54 surgically treated patients there was neurologic recovery, and 2 of these recovered incompletely with some residual spasticity. In the remaining 7 patients, there was no recovery. It took 2 to 6 months for recovery for the patients with conservative treatment, whereas it took <2 months for the patients with anterior decompression. The patients who had the combined 2-stage procedure could be mobilized earlier after neurologic recovery than could the patients having the anterior radical surgery and the conservatively treated patients. It was proven that paraplegia of active disease can be treated successfully by conservative or surgical means and that paraplegia caused by healing of fibrosis in the severely deformed spine was difficult to treat successfully, even with radical surgery.

The present study deals with the results of the medical-surgical treatment of 22 patients with Pott's tetraplegia or paraplegia. Seventeen had progressive tetraplegia-paraplegia which failed to respond solely to medical treatment. On admission, four patients exhibited an acute onset tetraplegia-paraplegia, and one had a 'spinal tumour syndrome'. In addition to antituberculous therapy, seven patients had anterior spinal surgery, consisting of four corporectomies, two anterior debridments and grafting, and one debridment alone. Moreover, one patient had a posterior interbody fusion, four had laminotomies, and 10 had laminectomies. The causes of the spinal cord or cauda equina compression, as was determined at operation, were extradural abscess in eight patients, bony compressions in 11, arachnoiditis in two, and posterior neural arch tuberculosis in one patient. Neurological recovery began between 10 and 21 days postoperatively. The mean length of follow-up was 42.36 months (range 8-144 months). Fourteen patients were found to be functionally and neurologically normal at follow-up examinations (63%). Eighty-two percent recovered sufficiently to walk unaided. Two patients were left paralysed and unable to walk. Two patients were able to get about on crutches. The onset of objective improvement soon after surgical decompression suggests a causal effect. It was concluded that early neural decompression and spinal stabilisation provided the maximum potential for neurological recovery.

Admission analysis of adult non-traumatic paraplegia and paraparesis from 1981 to 1988 was carried out. Information was collected from charts of 223 consecutive admissions according to a pre-set protocol. Paraplegia or paraparesis was responsible for 164(13.4%) of all neurological admissions over the study period. The median age of the patients was 36 years with a male to female ratio of 1.7:1. Tuberculosis was the leading cause of paraplegia or paraparesis accounting for 47% of the cases. Tumours (20%), Landry-Guillain-Barre' syndrome (12.2%) and tropical spastic paraparesis (TSP) (9.8%) were important but less frequent causes in this series. Other causes like disc prolapse, transverse myelitis, spinal artery stroke and fluorosis were rarely encountered. Vertebral deformity (88.1%), vertebral tenderness (88.1%) and abnormal plain spinal X-ray (89%) were the most helpful findings in the diagnosis of tuberculous paraplegia. Nearly all cases of tuberculous paraplegia were treated medically alone. However, the outcome of treatment as judged by the treating physicians was good with a significant response recorded in 78%.

Experience in treating Pott's Paraplegia in a rural general hospital in Northern Kenya is reported. Five TB patients with severe neurological involvement of the spine were treated by orthopaedic reduction and antituberculous drugs. All were able to walk three months later.

Two hundred and twenty patients with active spinal tuberculosis were seen at the Orthopaedic Centre, Tunis, between 1965 and 1975. Fifty adults and 11 children were paraplegic, this being particularly associated with infection of the mid-thoracic spine and with marked kyphosis. The number of diseased vertebrae ranged up to 7, the average kyphosis measuring 53 degrees and the worst being 140 degrees. Patients had been paralysed for an average of 4 months before seeking treatment. Thirty seven patients were treated by chemotherapy alone and 26 with the addition of anterior decompression and grafting. The selection of treatment was arbitrary. The average follow up was nearly three years. Sixty eight percent of the medical group had complete neurological recovery and 19% partial recovery, against 38% and 31% respectively for the surgical group. Mortality in the medical group was 5% compared with 23% after surgery. Patients in either group who showed no sign of improvement within six months of the beginning of treatment failed to recover. The prognosis was better in children and in patients with partial paraplegia but was not influenced by the duration of paraplegia.

Experience gained in the management of 261 patients with tuberculous paraplegia and paraparesis seen over a 17-year period is presented. A plea is made for prompt spinal canal decompression in all cases of tuberculosis of the spine with evidence of neurological involvement.