Search

Introduction. The spine is involved in less than 1% of all tuberculosis (TB) cases, and it is a very dangerous type of skeletal TB as it can be associated with neurologic deficit and even paraplegia due to compression of adjacent neural structures and significant spinal deformity. The spine TB is one of the most common causes for an angular kyphotic deformity of spine. Patients with kyphosis angle ≥ 60° at dorsolumbar spine are at great risk to develop late onset neurological deficit and paraplegia due to chronic compression and stretching of the spinal cord over bonny ridges. In a small number of cases, other conditions may lead to neurological deficit in patients with long standing angular kyphosis which also alters the treatment strategy that otherwise involves prolonged and mutilant surgery. Case outline. We present a case of a 61-year-old male patient with concomitant 90° dorsolumbar spine kyphosis due to spinal TB and ligamentum flavum hypertrophy which led to spinal canal stenosis with myelopathy, and consequent paraplegia. The patient underwent dorsal decompression with hypertrophic yellow ligament removal after which he recovered to the level of walking. Conclusion. Many authors propose guidelines for treatment of spinal TB, taking into account the stage of the disease, the age of the patient, the angle of kyphosis, and other factors. We find that personalized medical approach is the best approach for each patient.

Introduction/Objective. Pseudoprogression represents an enlarging contrast-enhancing lesion that occurs after chemoradiation and stabilizes with time without any changes in the therapeutic procedure. This phenomenon is highly significant, because it can have influence on further therapeutic procedures; however, precise criteria for pseudoprogression diagnosis have not yet been defined. The main goal of this study is to examine the endothelial hyperplasia influence on pseudoprogression. Methods. We analyzed a group of 106 patients with glioblastoma who had undergone surgical treatment from 2010–2012, at the Clinic of Neurosurgery, Clinical Center of Serbia, who received Stupp protocol. Pre- and post-treatment imaging was evaluated using RANO criteria. Lesions that improved or stabilized were defined as pseudoprogression, and lesions that progressed were defined as true progression. Endothelial hyperplasia was identified based on the hematoxylin and eosin pathohistological examination. Results. Thirty-two (30.2%) of the patients were diagnosed with pseudoprogression. Endothelial hyperplasia was observed in 51 (48.1%) of glioblastoma tissue samples, and 28 (87.5%) of all the patients with pseudoprogression were found to have endothelial hyperplasia. The group of 51 (68.9%) patients without pseudoprogression did not show the presence of endothelial hyperplasia. Statistical analysis showed significantly higher incidence of pseudoprogression in patients with endothelial hyperplasia. (χ2 = 26.269, p < 0.01) Conclusion. Taking into account that there are no precise diagnostic methods that could determine the presence of endothelial hyperplasia with certainty, it could be an indicator, as a pathohistological entity, of a higher likelihood of pseudoprogression, which could be used in everyday clinical practice. In order to reach definite conclusions, we believe it is necessary to conduct prospective controlled studies with larger sample sizes.