DIAGNOSTIC AND THERAPEUTIC DIFFICULTIES IN THE NEUROSURGICAL MANAGEMENT OF POTT’S DISEASE IN MADAGASCAR
DOI:
https://doi.org/10.53555/eijmhs.v5i4.128Keywords:
Madagascar, Neurosurgery, Pott’s diseaseAbstract
Introduction: Pott’s disease or spinal tuberculosis is feared by its neurological damages. The study aimed to indicate and solve the diagnostic and therapeutic problems met in its neurosurgical management.
Methods: It was a retrospective study conducted during 3 and half years (2015-2018) about
36 patients from three neurosurgical centers in Madagascar: CHUJRA, CENHOSOA and CHU FIANARANTSOA.
Results: Pott’s disease had an incidence of 10 cases/year. The mean age was 37 years and the sex ratio was 0.9. Most of the patients came from rural regions (65%). The average of consultation delay was about 16 months. Neurological deficits were observed at 69.4 % and complete paraplegic at 47.2 % at the beginning of hospitalization. The delay of consultation upper to 6 months was significantly correlated in the paraplegia (p-value = 0,002). Spinal injuries had shown by MRI only in 19.4 % and by a spinal CT in 69.4 %. Over 83.3 % of patients needed a neurosurgical intervention while only 52.8 % were able to be operated. Anterior approach offered best results with 83.3 % of neurological recuperation in 3 months. Conclusion: The insidious installation of the disease, the diagnostic delay, the pecuniary insufficiency, the expensive cost of MRI and surgical implants are the main difficulties met in neurosurgical management of Pott’s disease. Anterior approach is the surgical technique the most adapted to the advanced Pott’s disease.
References
. World Health Organization. Journée mondiale de lutte contre la tuberculose 2017. www.who.int/tb/data/WHO_HQ_Reports-G2-PROD-EXT-TBCountryProfile. 23/02/2018.
. Rakotoson J, Rajaoarifetra J, Raherimandimby H, Raharimbohitra L, Raholiarisoa L, Zafimahita A, et al. Issues du traitement de la tuberculose dans le service de Pneumophtisiologie du Centre Hospitalier Universitaire de Fianarantsoa, Madagascar. Rev. méd.
. Madag. 2013; 3(1): 230-4.
. Hamza M. Tuberculose articulaire et vertébrale. Rev Rhum 1993; 60 (2): 115-8.
. Cohen A, Fllipo R, Drouat, et Al. Tuberculose vertébrale - Etude des aspects cliniques et radiologiques à partir d’une série de 82 cas. J Radiol. 1996; 77: 419-26.
. Brochard H. La tuberculose des noirs transplantés. Rev Prat. 1965; 15(2): 221-7.
. Badr F, Khalid, Mohamed El Faiz C. Le mal de Pott: à propos de 82 cas. Pan African Medical Journal. 2011; 8: 22.
. Beytout, Petit M, Farret, et al. Place actuelle de la tuberculose extrapulmonaire en pathologie hospitalière. Sem Hop Paris 1988; 64:1899-906.
. Maftah M, Lmejjati M, Monssouri A, Abbadi N, Bellakkadar F. Mal de Pott: à propos de 320 cas. Médecine du Maghreb. 2001; n°90.
. Ghadouane M, Mansouri O, et al. Place de la chirurgie dans le traitement du mal de Pott de l’adulte à propos de 29 cas. Revue de chirurgie orthopédique. 1996; 82: 620-8.
. Loembe P, Choteau Y. Reste-t-il une place pour la chirurgie dans le mal de Pott de l’adulte. Neuro chirurgie. 1994; 14: 247-25.
. Remili S, Baba A, Mardini A, Lambert F. La tuberculose vertébrale. À propos de 41 cas.
. La Lettre du Pneumologue. 2003; 6 (2) : 53.
. Ousehal A, Gharbi A, Zamiati W, Saidi A, Kadiri R. Imaging findings in 122 cases of Pott's disease. Neurochirurgie. 2002 Nov; 48(5): 409-18.
. Frocrain L, Duvauferrier R, Chalès G, Martin A, Moisan A, Ramée A, et al. Une nouvelle méthode diagnostic de la spondylodiscite: L’imagerie par résonance magnétique. J Radiol. 1987 May;68(5):373-80.
. Debeyre J. Mal de Pott, traitement médical ou médico chirurgical - Table ronde 49è réunion annuelle SOFCOT. Rev Chir Orthop. 1975; 61(1): 133-340.
. Martini M, Ouhaes M. La tuberculose osseuse et ostéo-articulaire dans les pays à forte prévalence de tuberculose. Encycl Med chir Paris, Appareil locomoteur, 1984 ; 14185-B : 10-3.
. Louis R, Conty C, Pouve I. Chirurgie du mal de Pott avec correction des gibbosités. J Chir (Paris). 1970 Apr;99(4):401-16.
. Zlitini M, Kassab M. Spondylodiscite tuberculeuse (Mal de Pott). Encyclo Med-Chir App Locomoteur. 1988; 15852-A : 10-4.
. Pertuiset E. Tuberculose vertébrale de l’adulte. Encyclo Med Chir (Elsevier; Paris), Appareil locomoteur. 1998; 8P: 15852-10.
Downloads
Published
Issue
Section
License
Copyright (c) 2019 EPH - International Journal of Medical and Health Science (ISSN: 2456 - 6063)
![Creative Commons License](http://i.creativecommons.org/l/by-nc-nd/4.0/88x31.png)
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.