Outcome Of Surgical Treatment Of Tuberculosis Of The Spine In Patients With Motor Deficits

Bassam Mahmood Flamerz

doi:10.47723/kcmj.v13i1.124

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Publication Date

Wed Nov 13 2019

Journal Name

Al-kindy College Medical Journal

Volume

13

Issue Number

1

DOI

10.47723/kcmj.v13i1.124

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Outcome Of Surgical Treatment Of Tuberculosis Of The Spine In Patients With Motor Deficits

• tuberculosis • severe neurological deficits • Pott’s disease • spinal instrumentation

Bassam Mahmood Flamerz

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Background: Significant numbers of patients with spinal tuberculosis (TB), especially in developing countries, still present late after disease onset with severe neurological deficits.

Objective:This study was conducted to assess the outcome of surgery in patients with tuberculosis of the spine with motor deficits.

Type of the study: Retrospective study.

Methods: We retrospectively analyzed data obtained in all the patients with severe motor deficits due to spinal TB admitted to and surgically treated in four hospitals in Baghdad/Iraq during the period from January 2012 to January 2014. History, examination, imaging, histological, postoperative, and follow-up data were retrospectively culled from hospitals records and then analyzed. Data obtained in 48 patients with 6-24 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 and in 14 patients by Frankel Grade C at admission.

Results: 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 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

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Multivariate statistical

Techniques

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Introduction: Age

hypertension

and diabetes can cause significant alterations in arterial structure and function

including changes in lumen diameter (LD)

intimal-medial thickness (IMT)

flow velocities

and arterial compliance. These are also considered risk markers of atherosclerosis and cerebrovascular disease. A difference between right and left carotid artery blood flow and IMT has been reported by some researchers

and a difference in the incidence of nonlacunar stroke has been reported between the right and left brain hemispheres. The aim of this study was to determine whether there are differences between the right and left common carotid arteries and internal carotid arteries in patients with hypertension and diabetes for 2 age groups. Methods: We studied 250 patients with both diabetes and hypertension. Patients were divided into 2 age groups with the old age group being 56 to 75 years and the young age group 35 to 55 years. The bilateral common carotid and internal carotid arteries were evaluated with B-mode ultrasound and Doppler examinations. The LD and IMT were measured for both common carotid arteries

and spectral waveform parameters and indices were recorded for both internal carotid arteries. Results: The difference in LD between the left and right common carotid arteries for the old age group was 11.64% and for the young age group was 6.42%

with significant P values of <.05 for both age groups. The difference in IMT between the left and right common carotid arteries was 18.27% in the old age group compared with 15.38% in the young age group

with significant P values of <.05. There was a difference in peak systolic velocity between the left and right internal carotid arteries of 4.85% in the old age group which was not significant

compared with 14.28% in the young age group with a significant P value <.05

whereas the difference in end-diastolic velocity between the left and right internal carotid arteries was not significant for both age groups. Differences between the right and left internal carotid arteries for resistive index

pulsatility index

and pressure gradient were significant only in the young age group. Conclusion: We found significant differences between the right and left common carotid and internal carotid arteries in patients with diabetes and hypertension which were more prominent in the young age group. Values for common carotid IMT and LD were significantly higher in the left common carotid artery versus the right common carotid artery in both age groups. Differences between the 2 carotid sides may be attributed to anatomic variations in the common carotid artery origins which lead to differences in stress between the 2 sides

Ahmed Abduljabar

Samar I.

Anmar Z

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Introduction:

Age, hypertension, and diabetes can cause significant alterations in arterial structure and function, including changes in lumen diameter (LD), intimal-medial thickness (IMT), flow velocities, and arterial compliance. These are also considered risk markers of atherosclerosis and cerebrovascular disease. A difference between right and left carotid artery blood flow and IMT has been reported by some researchers, and a difference in the incidence of nonlacunar stroke has been reported between the right and left brain hemispheres. The aim of this study was to determine whether there are differences between the right and left common carotid arteries and internal carotid arteries in patient

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