Verettas D J, Ververidis A N, Boyiatzis C, Panagoutsos S, Galanis V, Passadakis P, Kazakos K, Vargemezis V
Department of Orthopedics and Trauma, Democritus University of Thrace, University General Hospital of Alexandroupolis, Alexandroupolis, Greece.
Clin Nephrol. 2006 Apr;65(4):299-302. doi: 10.5414/cnp65299.
Tuberculosis of the spine is not rare in immunocompromised patients and particularly in those with end-stage renal disease (ESRD). Furthermore, the possible vascular compromise of the spinal cord in patients with diabetic nephropathy may result in symptoms of neurological involvement that could lead to deterioration and paralysis. We report a series of 4 patients with ESRD undergoing dialysis that developed tuberculous spondylitis of the thoracic spine. Diabetic nephropathy was the primary cause for chronic kidney disease in 2 patients; 3 of these patients were treated conservatively with anti-tuberculous medication and orthotic splints and were cured. The fourth patient with diabetes mellitus and clinically evident signs and symptoms of severe vascular insufficiency has additionally developed incomplete paraplegia. A complete sensory recovery and partial recovery of the hip flexors and abductors within 3 months occurred, following decompression of the spine and drainage of the abscess, in combination with long-term anti-tuberculous treatment and spinal orthosis.
脊柱结核在免疫功能低下的患者中并不罕见，尤其是终末期肾病（ESRD）患者。此外，糖尿病肾病患者脊髓可能出现血管受压，进而导致神经受累症状，可能会致使病情恶化和瘫痪。我们报告了4例接受透析的ESRD患者，他们均发生了胸椎结核性脊柱炎。2例患者的糖尿病肾病是慢性肾病的主要病因；其中3例患者采用抗结核药物和矫形支具进行保守治疗并治愈。第四例患有糖尿病且有严重血管功能不全的明显临床体征和症状的患者还出现了不完全性截瘫。在进行脊柱减压和脓肿引流后，结合长期抗结核治疗和脊柱矫形器，该患者在3个月内实现了完全感觉恢复，髋部屈肌和外展肌部分恢复。
