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Pott's disease in Senegal

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European Journal of Orthopaedic Surgery & Traumatology Aims and scope Submit manuscript

Abstract

Objectives

The purpose of this study is to report our experience on Pott's disease in Senegal, which belongs to the group of least-developed countries .In these countries, tuberculosis is still a public health issue. Regarding spine tuberculosis, we attempted to implement a diagnostic and therapeutic approach appropriate for our conditions of medical practice.

Patients and methods

The authors reported a retrospective epidemiological and clinical study of 255 patients suffering from tuberculosis of the spine. Theses patients were hospitalized at the University Hospital of Fann in Dakar from January 1986 to July 1998.

Results

Sixty percent came from the capital, the mean age was 34.9 years, there were 136 males for 119 females, and antituberculosis immunization were not done every time. Associated extra-spinal tuberculosis, predominantly tuberculosis of the lung, was observed in 28.2 patients (59%). Of 37 patients tested for human immunodeficiency virus (HIV) infection, only one was positive. Patients came late to the hospital, leading to a high percentage of neurological complications (79.2%). Our diagnostic strategy was based on epidemiological and clinical criteria already defined by Martini. Thoracic spine (53.8%) and lumbar sacral spine (21.7%) were the column vertebral segments most frequently involved. All patients received antituberculosis chemotherapy, and only 39 patients underwent surgery with laminectomy without posterior instrumentation. Functional outcome study was done for 89 paraplegic patients: 26 (29%) went to Frankel grade D or E and, among 27 operated patients, nine entered theses grades. Seventeen patients (11.5%) died.

Conclusion

We developed the concept of "spinal-cord rescue," which focuses more on neurological rather than biomechanical issues.

Résumé

Objectifs

Notre pays qui appartient au groupe des pays les moins avancés est toujours confronté à l'endémie de la tuberculose qui en fait constitue un véritable problème de santé publique. L'objet de cette étude est de rapporter notre expérience sur le mal de Pott au Sénégal et surtout d'asseoir une stratégie diagnostique et thérapeutique adaptée á nos moyens limités.

Patients et méthodes

Nous rapportons une étude rétrospective allant de Janvier 1986 à Juillet 1998 et concernant une population de 255 patients présentant une tuberculose vertébrale. Tous ces patients ont été hospitalisés à la clinique neurologique et neurochirurgicale du C.H.U. de Fann Dakar.

Résultats

Nous constatons, si on étudie la provenance géographique, que 6% viennent de la capitale Dakar. Concernant le sexe nous notons 136 de sexe masculin pour 119 de sexe féminin. Dans les antécédents une notion de vaccination B.C.G n'est pas la règle. Chez 28,2% des patients il existait une association avec une tuberculose extra-rachidienne avec une prédominance d'une tuberculose pulmonaire concomitante (59%). Parmi les 37 patients qui ont été testés à l'HIV 1 et 2 seul un avait une sérologie positive. La consultation tardive des patients explique le taux élevé de complications neurologiques (79%). Notre approche diagnostique est basée sur les arguments épidémiologiques et les critères cliniques définis par Martini. A propos de la fréquence selon le siège sur l'axe vertébral, le rachis dorsal est le plus touché (53.8%) suivi du rachis lombo-sacré (21.7%). Tous nos patients ont bénéficié d'une chimiothérapie antituberculeuse ; une laminectomie décompressive sans instrumentation postérieure n'a été pratiquée que chez 39 d'entre eux. Le suivi fonctionnel n'a été effectué que chez 89 patients paraplégiques ; nous constatons que 26 (29%) se sont améliorés pour atteindre le grade D ou E de Frankel.17 patients (11.5%) sont décédés.

Conclusion

Nous avons développé le concept de " sauvetage médullaire " qui se fonde tant sur une indication opératoire à base neurologique que sur une base mécanique.

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References

  1. Alamé T, Dierckx P, Nimane V, Sergysels R. (1996) Spinal tuberculosis: a report of five cases and a review. Monaldi Arch Chest Dis. 51(5):362–368

    Google Scholar 

  2. Altman GT, Altman OT, Frankovich KE (1996) Anterior and posterior fusion for children with tuberculosis of the spine. Clin Orthop 325:225–231

    PubMed  Google Scholar 

  3. Chen WI, Chen C, Shih C (1995) Surgical treatment of tuberculous spondylitis: 50 patients followed for 28 years. Acta Orthop Scand 66(2):137–142

    Google Scholar 

  4. Emery E, Redondo A, Rey A. (1996) Mal de Pott: actualités en neurochirurgie. Sem Hop Paris 72(56):146–151

    Google Scholar 

  5. Fam G, Rubenstein J (1993) Another look at spinal tuberculosis. J Rheumatol 20(10):1731–1740

    CAS  PubMed  Google Scholar 

  6. Frankel HL (1969) The value of postural reduction in the initial management of closed injuries of the spine with paraplegies and tetraplegies. Paraplegia, 7(3):179–192

    Google Scholar 

  7. Ghadouane M, El Mansari O, Bousalmane N, Lezrek K, Aociam U, Moulay I (1996) Place de la chirurgie dans le traitement du Mal de Pott de l'adulte. A propos de 29 cas. Revue de chirurgie orthopédique. 82(7):620–628

  8. Güven O, Chen WJ (1996) Surgical treatment of tuberculous spondylitis (Letter to the editor). Acta Orthop Scand 67(2):204–210

    PubMed  Google Scholar 

  9. Güven O, Moon MS (1996) Surgical treatment of tuberculous spondylitis (Letter to the editor). Spine 121(15):1840–1841

    Google Scholar 

  10. Güven O,Kumano K,Yalcin S,Karahan M,Tsuji S. (1994) A single stage posterior approach and rigid fixation for preventing kyphosis in the treatment of spinal tuberculosis. Spine 19(9):1039–1043

    Google Scholar 

  11. Hodgson AR, Stock FE (1996) The classic anterior spinal fusion. Clin Orthop 300:16–22

    Google Scholar 

  12. Hoffman EB, Crosier JH, Cremin BJ (1993) Imaging in children with spinal tuberculosis. J Bone Joint Surg [Br] 75(2):233–239

    Google Scholar 

  13. Jelinek JS, Kransdorf MJ, Gray R, Aboulafia AJ, Malawer MM (1996) Percutaneous transpedicular biopsy of vertebral body lesions. Spine 21, 34(17):2035–2040

    Google Scholar 

  14. Juffermans NP, Verbon A, Danner SA, Kuijper EJ, Speelman P (1998) Mycobacterium xenopi in HIV infected patients: an emerging pathogen. AIDS 12(13):1661–1666

    CAS  PubMed  Google Scholar 

  15. Korkusuz F, Islam C, Korkusuz Z. (1997) Prevention of post operative late kyphosis in Pott's disease by anterior decompression and intervertebral grafting. World J Surg 21(5):524–528

    CAS  PubMed  Google Scholar 

  16. Laredo JD, Chevrot A, Codefroy D, Auberge Th, Leblanc G, Bard M, Pallardy G. La ponction biopsie disco-vertébrale radioguidée. Encycl. Med. Chir,(Paris, France) Radiodiagnostic I, 30660 A10, 4.10.03, p 10

  17. Loembe PM (1995) Medical surgical treatment of progressive tuberculous (Pott's) paraplegia in Gabon paraplegia, 33:579–584

  18. Loembe PM, Chouteau Y (1994) Reste t-il une place pour la chirurgie dans le Mal de Pott de l'adulte? Notre expérience au Gabon. Neurochirurgie 14(4):247–255

    Google Scholar 

  19. Loembe PM, Assengoné ZY, Guerch M, Mbumb KA (1998) La tuberculose vertébrale au Gabon: aspects anatomo-cliniques, problèmes diagnostiques et thérapeutiques, 107 cas de 1976 à 1988. Neurochirurgie, 134(6):420–427

    Google Scholar 

  20. Louis R (1982) Surgery of the spine. Surgical anatomy an operative approaches. Spinger-Verlag, Berlin Heidelberg New York, p 345

  21. Martini M et Coll (1998) La tuberculose ostéo-articulaire. Springer-Verlag, Berlin Heidelberg New York, p 215

  22. Moon MS, Ha K, Sun D, Moon J, Moon Y, Chung J. (1996) Pott's paraplegia: 67 cases. 323:122–128

  23. Ouahes M, Martini M (1988) Résultat du traitement conservateur de 171 maux de Pott sans atteinte neurologique. Revue de chirurgie orthopédique, 74(6):563–568

    Google Scholar 

  24. Rath SA, Neff U, Schneider O, Richter H (1996) Neurosurgical management of thoracic and lumbar vertebral osteomyelitis and discitis in adults: A review of 43 consecutive surgical treated patients. Neurosurgery 38(5):926–933

    CAS  PubMed  Google Scholar 

  25. Rezai AR, Lee M, Raul R, Enrico T (1995) Modern management of tuberculosis of the spine. Neurosurgery 36:87–98

    CAS  PubMed  Google Scholar 

  26. Sakho Y, Ndiaye M, Gueye M, Ndiaye IP (1983) Les névralgies sciatiques par spondylodiscite tuberculeuse. Dakar Médical, 28(4):663–671

    Google Scholar 

  27. Schulzer M, Fitzgerald JM, Enarson DA, Grzybowski S (1992) An estimate of the future size of the tuberculosis problem in Sub-Saharan Africa resulting from HIV infection. Tuber Lung Dis 73(52):58

    Google Scholar 

  28. Vidyasagar C, Murthy MKRS (1994) Management of tuberculosis of the spine with neurological complications. Ann R Coll Surg Engl 76:80–84

    CAS  PubMed  Google Scholar 

  29. Wimmer C, Ogon M, Sterzinger W, Landauer F, Stöckl B (1997) Conservative treatment of tuberculous spondylitis: A long-term follow-up study. J Spinal Disord 10(5):417–419

    CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Neurosurgery Department, School of Medicine, Universite Cheikh Anta Diop, C.H.U. Fann, B.P. 5035, Dakar, Senegal

    Youssoupha Sakho, Seydou B. Badiane, Alimatou N'Diaye, Mamadou Gueye & Ibrahima Pierre N'Diaye

  2. Neurology Physical Therapy, School of Medicine, Universite Cheikh Anta Diop, Dakar, Senegal

    Amadou K. N'Dao

Authors
  1. Youssoupha Sakho
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  2. Seydou B. Badiane
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  3. Amadou K. N'Dao
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  4. Alimatou N'Diaye
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  5. Mamadou Gueye
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  6. Ibrahima Pierre N'Diaye
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Corresponding author

Correspondence to Youssoupha Sakho.

Additional information

This work has been supported with a grant from Aupelf/Uref, the international association of French-speaking universities, 2000/PAS/06.

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Sakho, Y., Badiane, S.B., N'Dao, A.K. et al. Pott's disease in Senegal. Eur J Orthop Surg Traumatol 13, 13–20 (2003). https://doi.org/10.1007/s00590-002-0057-y

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  • DOI: https://doi.org/10.1007/s00590-002-0057-y

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