Cauda Equina Syndrome Retention Type –Late Intervention Can also give Excellent Results

Introduction: Cauda Equina Syndrome (CES) is an acute stenosis of lumbar spinal canal leading to compression of neural elements below the level of L1 mostly due to disc herniation but other causes exist. Intervention within 48 hours prevent permanent sensorimotor, sphincter and sexual disturbances. We reporttwelvecases of Cauda Equina Syndrome with complete sensorimotor deficit, bladder, bowel dysfunction intervened at least 1 month after initiation of symptoms with complete recovery of functions. Till date a few literature support is there to substantiate this evidence. Methods: 22 patients between 2011 to 2015, 18 male and 4 female, attended with complete or retention type of cauda equina syndrome. Of the 8 men, 5 had acute discherniations, 2 had caries spine, 1 had trauma. Of the 4 women,3 had acute disc herniation,1 had caries spine. 4 attended 35- 39 days, 4 between 45- 45 days,4 between 45- 60 days. They were urgently decompressed within 72 hours of attendance. 4 were lost in follow- up within 1 year. Rest were followed up3- 5 years. Results: 3 patients improved by 14 to 28 days, their neurological status improved from ASIA A to ASIA D, 4 patients by 30 to 90 days from ASIA A to ASIA E. 1 male patient improved from ASIA A to ASIA C in 3 years. All the above neurological status maintained. 2 men and 2 women were lost to follow up within 1 year when their improvement were by only one grade in ASIA impairment scale. 7 out of 8 patients had excellent results. Conclusion: Though early intervention is the golden rule, in late presentations of complete cauda equine syndrome, thorough decompression improves the neurological status of the patient

Caries Spine: A Comparative Study between Medical Management Alone with Combined Medical and Surgical Management

Objective: To compare short term outcome of combined surgical and medical management versus medical management alone in caries spine.Material and Methods: This study was conducted from August 2015 to August 2018, on 68 patients randomly divided into two groups of 34 each. All were diagnosed cases of Caries spine based on history, clinical examination, ESR and imaging appearances. Group A underwent surgical intervention along with Anti-Tuberculous Treatment (ATT) while Group B received medical treatment (ATT) alone. Results: There were 37 (54.41%) males and 31 (45.59%) females with mean age of 34.84 ± 10.6 years. The thoracic spine was the commonest site in 33 (48.5%) patients, followed by lumbar in 20 (20.8%), dorso-lumbar in seven (10.3%) and cervical in four (5.88%) patients. The ESR fell from 85mm/hr to 24.46mm/hr in Group A and to 41.92mm/hr in Group B (p = 0.0124). Overall improvement in Frankel grade was seen in 25 (73.5%) patients in Group A and 12 (35.3%) in group B. In group A, improvement seen from grade A in two (8%), grade B in three (12%), grade C in 12(48%), Grade D in seven (28%) patients, (p = 0.000) while eight (23.5%) patients remained same and only one (2.5%) deteriorated from baseline neurological status. In Group B, 16 (47%) patients remained same and six (17.6%) deteriorated. Conclusion: Surgery combined with antituberculous therapy was found to be beneficial in patients suffering from caries spine and to be recommended to patients desiring rapid recovery

Congenital Tuberculosis

2 month old baby presented with huge hepato-splenomegaly, ascites & pallor, , born to a mother suffering from fever and backache since last 4 months. Hypo-echoic shadows in liver, spleen and abdominal lymph nodes on USG & CT-scan and acute-on-chronic inflammation of liver by FNAC suggested Congenital Tuberculosis. Investigations in mother revealed Pulmonary Tuberculosis & Caries Spine, confirming the diagnosis of Congenital Tuberculosis in the baby. DOI: http://dx.doi.org/10.3126/jnps.v34i2.10910 J Nepal Paediatr Soc 2014;34(2):144-146

OUTCOME OF CONSERVATIVE TREATMENT IN CARIES SPINE

Tuberculosis remains endemic and major public-health problem in most part of the world. Despite the reduction in the prevalence of the tuberculosis and the advent of new drugs for tuberculosis, the incidence of extra pulmonary tuberculosis continues to increase at world level.

Gluteal Abscess: Diagnostic challenges and management

Gluteal abscess is a well-documented presentation of a caries spine and other local bony foci of tuberculosis. Still, during a PUBMED data search, only one report of vertebral tuberculosis presenting only as a gluteal abscess in adults was found in English medical literature. The current article describes a case of tuberculosis of the lumbar spine with gluteal abscess as the only clinical feature, in an immunocompetent young adult.