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1、MarissaHeller,HMSIVGillianLieberman,MDJanuary2003TuberculousSpondylitis(a.k.a.Pott’sDisease)MarissaHeller,HarvardMedicalSchoolYearIVGillianLieberman,MDMarissaHeller,HMSIVGillianLieberman,MDOurPatientS.T.•82yearoldmalefromChina•PMH:–s/pbrachytherapyforprostatecancerin1997–
2、h/opulmonaryTBasateenager,treatedwithChinesemedicine•HPI:–3monthhistoryofprogressivelowerbackpain–Outsidelumbo-sacralspinefilmsreveal:•“milddegenerativechanges&stableL2compressionfracture”•A/P:lumbarspondylosis&stableL2compressionfx–Daypro600mgPRN–Exercise–Bracing2Marissa
3、Heller,HMSIVGillianLieberman,MDAnatomyofSpineCervicalvertebrae(7)Thoracicvertebrae(12)Lumbarvertebrae(5)Sacrum3FromNetter,Frank.AtlasofHumanAnatomy.2ndedition.Novartis,1997.MarissaHeller,HMSIVGillianLieberman,MDAnatomyofLumbarVertebraVertebralbodyPedicleTransverseProcessL
4、aminaSpinousProcess4FromNetter,Frank.AtlasofHumanAnatomy.2ndedition.Novartis,1997.MarissaHeller,HMSIVGillianLieberman,MDAnatomyofParaspinalMusclesVertebralBodyofL2PsoasmuscleTransverseprocessSpinousprocessofL1Erectorspinaemuscle5FromNetter,Frank.AtlasofHumanAnatomy.2ndedi
5、tion.Novartis,1997.MarissaHeller,HMSIVGillianLieberman,MDDDxforLowBackPaininS.T.•MetastaticProstateCancer•LumbarSpondylosis(degenerativechanges)•MusculoskeletalTuberculosis•Other:6FromLehrichJR,KatzJN,SheonRP.ApproachtotheDiagnosisandEvaluationofLowBackPaininAdults.UpToDa
6、te,online10.1.2002.MarissaHeller,HMSIVGillianLieberman,MDLumbo-sacralfilmsforS.T.L1L1L2L2CalcifiedAortaDiverticulaewithbariumBothImagesFromBIDMC,Boston,MA7SeedimplantsMarissaHeller,HMSIVGillianLieberman,MDDiagnosisofS.T.•FirstDiagnosis:LumbarspondylosiswithastableL2compre
7、ssionfracture•However,duetohistoryofprostatecancer,bonescanandCTwereperformedtoruleoutmets…•BonescanrevealedincreasedtraceractivityattheL1/L2discspaceinvolvingtheinferiorL1endplateandsuperiorL2endplate•CTrevealednoevidenceofrecurrentprostatecancer,butsomeunexpectedfinding
8、s…8MarissaHeller,HMSIVGillianLieberman,MDCTforS.T.PsoasabcessAcutedestructivechangesinL1-L2Mothe
