XXXX : a diagnostic and management challenge.

@entity1 @entity6551 @entity132 @entity1494 @entity66 @entity146 @entity1513 @entity4034 @entity3083 @entity1746 @entity177 @entity51 @entity79 @entity158 @entity221
The authors reviewed 29 cases of @entity3083 treated from 1973 to 1993 with an average follow-up time of 7.4 years. Clinical findings included back @entity158 , @entity1746 , @entity1513 , @entity221 , @entity132 , and bowel and @entity1494 . Twenty-two @entity1 (76%) presented with @entity51 ; 12 (41%) were initially misdiagnosed. Sixteen @entity1 (55%) had predominant vertebral body involvement; nine had marked @entity79 with neurological compromise. Eleven individuals (39%) had intraspinal granulomatous tissue causing @entity51 in the absence of @entity79 , and two (7%) had intramedullary @entity6551 . All patients received antituberculous medications: 13 were initially treated with bracing alone, eight underwent laminectomy and debridement of extra- or intradural granulomatous tissue, and eight underwent anterior, posterior, or combined fusion procedures. No @entity1 with @entity51 recovered or stabilized with nonoperative management. Thirteen @entity1 were readmitted with progression of inadequately treated @entity4034 ; 12 (92%) of these required new or more radical fusion procedures. @entity177 was associated with marked @entity1513 and @entity66 requiring a graft that spanned more than two disc spaces. Courses of antibiotic medications shorter than 6 months were invariably associated with disease recurrence. It was concluded that 1) @entity1 should receive at least 12 months of appropriate antituberculous therapy; 2) individuals with @entity51 should undergo surgical decompression; 3) laminectomy and debridement are adequate for intraspinal granulomatous tissue in the absence of significant @entity79 ; 4) when vertebral body involvement has produced wedging and @entity1513 , @entity146 debridement and fusion are indicated to prevent delayed instability and progression of disease.
