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Spinal tuberculosis in a developed country. A review of 26 cases with special emphasis on abscesses and neurologic complications.

A retrospective study of 26 cases was analyzed to review the sometimes unfamiliar clinical appearance and outcome of Pott's disease. Swiss nationals (46%) were older than patients from Mediterranean or developing countries (mean age, 69 versus 29 years). The number of vertebrae initially involved was 2.2. Localization was lumbar in ten cases, thoracic and lumbar in two, and thoracic or cervical in 14. Abscesses were present in 15 (57%) subjects and appeared during treatment in 20% of these cases. They were twice as frequent in non-Swiss patients. Three patients had surgery because of progression of the abscess under treatment. Ten cases needed single or multiple aspirations. Three of six lumbar abscesses were initially visualized only by computed tomography. Neurologic complications occurred in 12 (46%) patients, 11 of whom had cervical or thoracic vertebrae involved. In four cases (33%), the neurologic deficit developed during the first two months of treatment. Three patients had laminectomies, two without any benefit. Outcome was favorable for 11 of 12 patients without any difference between conservative treatment and surgery. Neurologic symptoms are in most cases related to radicular and medullary inflammation, with arachnoiditis and without compression. The possible benefit of steroids seems promising enough to warrant further investigation.