Rezai A R, Lee M, Cooper P R, Errico T J, Koslow M
Department of Neurosurgery, New York University Medical Center, New York.
Neurosurgery. 1995 Jan;36(1):87-97; discussion 97-8. doi: 10.1227/00006123-199501000-00011.
The resurgence of pulmonary tuberculosis in the United States has been paralleled by a concomitant rise in tuberculosis of the spine (Pott's disease). The appearance of drug-resistant strains of tuberculosis, infection in large numbers of immunocompromised hosts, newer imaging modalities, and the development of more effective spinal reconstruction techniques have raised important issues regarding the management of Pott's disease. In spite of this, there has been little published recently on the modern management of Pott's disease in developed countries. We report our experience with the management of 20 patients with Pott's disease in the past 5 years, 16 of whom were admitted during the last 18 months of this retrospective study. The mean patient age was 49 years. Sixteen (80%) were men. Nineteen (95%) had a positive tuberculin skin test, and 13 (65%) had pulmonary tuberculosis. Symptoms consisted of spinal pain, weakness, sensory complaints, and flank mass in order of decreasing frequency. Ten patients were neurologically intact; the remainder had motor deficits of variable severity. The thoracic spine was involved in 13 patients, the lumbar spine was involved in 4, the cervical spine was involved in 2, and the thoracolumbar spine was involved in 1. Spinal deformity was present in 11 patients, spinal epidural compression was present in 13, and a paraspinal mass was present in 18. Operative indications included motor deficits, spinal deformity, nondiagnostic computer tomographic-guided needle biopsy, and noncompliance with, or lack of, response to medical therapy. Eleven patients underwent operations. Six patients had vertebrectomy and bone grafting with posterior instrumentation when indicated; three had laminectomy, debridement, and abscess drainage; one had laminectomy and posterior instrumentation; and one had paraspinal abscess drainage. Two patients have died; the remainder have been monitored for at least 1 year and are neurologically improved or normal without residual infection. The average angulation decreased from 31 to 24 degrees by the follow-up examination. In selected patients, early operative treatment with instrumentation, when indicated, minimizes neurological deterioration and spinal deformity, allows early ambulation, and results in excellent neurological outcome.
在美国，肺结核的再度流行伴随着脊柱结核（波特氏病）的相应增加。耐药结核菌株的出现、大量免疫功能低下宿主的感染、更新的成像方式以及更有效的脊柱重建技术的发展，引发了关于波特氏病治疗的重要问题。尽管如此，最近发达国家关于波特氏病现代治疗的文献报道很少。我们报告过去5年中20例波特氏病患者的治疗经验，其中16例在这项回顾性研究的最后18个月入院。患者平均年龄为49岁。16例（80%）为男性。19例（95%）结核菌素皮肤试验呈阳性，13例（65%）患有肺结核。症状依次为脊柱疼痛、无力、感觉异常和侧腹肿块，出现频率逐渐降低。10例患者神经功能正常；其余患者有不同程度的运动功能障碍。13例患者胸椎受累，4例腰椎受累，2例颈椎受累，1例胸腰椎受累。11例患者存在脊柱畸形，13例存在脊髓硬膜外压迫，18例存在椎旁肿块。手术指征包括运动功能障碍、脊柱畸形、计算机断层扫描引导下针吸活检无法明确诊断以及对药物治疗不依从或无反应。11例患者接受了手术。6例患者在有指征时接受了椎体切除、植骨并后路内固定；3例接受了椎板切除、清创和脓肿引流；1例接受了椎板切除和后路内固定；1例接受了椎旁脓肿引流。2例患者死亡；其余患者至少接受了1年的监测，神经功能得到改善或恢复正常，无残留感染。随访检查时平均成角从31度降至24度。对于选定的患者，在有指征时早期进行内固定手术治疗可将神经功能恶化和脊柱畸形降至最低，使患者能够早期活动，并取得良好的神经功能结果。
