Twenty-three patients with atypical forms of spinal tuberculosis treated between 1975 and 1985, are described. All presented with signs and symptoms of compression of the spinal cord or cauda equina, ranging from paraesthesiae and increasing weakness of extremities to paraplegia and loss of sphincter control. None of them showed visible or palpable spinal deformity nor the typical radiographic appearance of destruction of the intervertebral disc and the two adjoining vertebral bodies. These atypical forms constituted about 12 percent of all the cases of spinal tuberculosis seen (a total of 190 cases); and fell into three well-defined groups: those with the involvement of neural arch only; those with the involvement of a single vertebral body; and, those without bony involvement. The correct surgical approach in these groups was found to be different: spinal cord compression caused by the tuberculous disease of the neural arch was best treated by laminectomy; whereas single vertebral body disease required an anterior or anterolateral approach. Spinal computerized tomography was helpful in defining the extent of disease and planning the surgical approach. Histological confirmation of tuberculosis was obtained in all the cases and acid fast bacilli (A.F.B.) were found in, and cultured from, the biopsy specimens of 18 cases.

We report on 14 patients with tuberculosis of the spine treated by operation. All had disease of three or more vertebrae with involvement of both the anterior and posterior columns and a progressive kyphotic deformity in spite of conservative treatment. We consider such spines to be 'unstable' and have found that anterior as well as posterior fusion with instrumentation is necessary.Résumé Nous rapportons 14 cas de patients atteints de tuberculose rachidienne traitée chirurgicalement. Tous avaient une affection de trois vertèbres ou plus, avec une atteinte de la colonne antérieure et de la colonne posté-rieure et une cyphose progressive malgré le traitement conservateur. Nous avons considéré de telles colonnes vertébrales 'instables' et avons trouvé qu'une double instrumentation, antérieure et postérieure était nécessaire.

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A review of twenty-two children with a mean age of 1.9 +/- 0.3 years who sustained injuries to the fingers and hand by domestic mincer machine. In each case the child inserted his hand in the machine while in motion. The pattern of injury is discussed and recommendations to avoid these mutilating injuries are made.