THE IMPORTANCE OF DIRECT SURGICAL ATTACK UPON LESIONS OF THE VERTEBRAL BODIES, PARTICULARLY IN POTT'S DISEASE

¹ Department of Surgery, Division of Orthopaedic Surgery, The Johns Hopkins Hospital and The Johns Hopkins School of Medicine, Baltimore

From a study of 407 patients admitted to The Johns Hopkins Hospital either with the diagnosis of tuberculosis of the spine or with some other diagnosis which was changed to tuberculosis of the spine during the years 1926 to 1951, it has been observed:

1. Proved diagnosis was obtained by non-operative means in an average of 30 percent of the entire series (407 cases). Direct vertebral biopsy has been responsible for an increase to 52 per cent of proved diagnosis in the eighty-seven cases which occurred during the past five years.

2. Erroneous diagnosis was found in 12 per cent of the 320 cases occurring during first twenty years. Direct vertebral biopsy has reversed the initial diagnosis in twenty-six out of eighty-seven cases occurring during the past five years.

3. The difficulty of making exact diagnosis of lesions of the vertebral bodies by clinical roentgenographic study alone is demonstrated by the sixty-eight cases in which therean initial diagnostic error. Fifty-two of the sixty-eight errors arose from failure to recognize tuberculous spondylitis; sixteen of the sixty-eight errors arose from making the diagnosis of tuberculous spondylitis without laboratory or biopsy confirmation.

4. In twenty-four consecutive cases, direct operation into tuberculous lesions of the spine, combined with local and parenteral administration of streptomycin, has proved a safe and satisfactory diagnostic procedure.

5. Direct operative approach and evacuation of the paravertebral abscess appears to be the treatment of choice in tuberculous paraplegia.

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