Hello doctor. My name is sonia saha banerjee. I am staying at America. Today I am here to consult about my mother. She is in India (kolkata). Her age is 54. In the year 2008 from CMC-Vellor it was diagonised that my mother had Adinocarcinoma in her lungs(advanced lung cancer) and the primary cell growth was in lungs. The doctors of Vellor suggested chemotherapy but that too they said it might not work. So we became hopeless and decided not to tell my mother regarding her dicease and started searching for some other optional treatment. Then we moved for Ayurvedic treatment from “Baba-Ramdev Yogpith” and for last 2years she is under their treatment. But for past few months she is having severe back spinal cord pain and for past one month she is bed ridden, I mean she cannot walk (lower portion paralasied). We then consulted orthopedic of Apollo Geneagles at Kolkata. He took many test of her including MRI and Bone Marrow test. And from that report they told us that

1) Specimen – Ct Guided FNAC from pre & paraspinal soft tissue in dorsal region.

Microscopic examination- Smears show caseous necrotic material and inflammatory cells . Epitheloid cell granulomata are not seen. No malignant cells seen . Cell block is corroborative . ZN stain for AFB is negative.

Diagnosis – CT guided FNAC from pre & paraspinal soft tissue in dorsal region – Suggestive of tuberculosis.

2


Specimen – Small biopsy from D7-8 vertebrae.

Macroscopic examination – Received multiple pieces of bony tissue measuring 1.5*0.2 cm to 0.2*0.2 cm –all.

Microscopic examination – Section shows vertebral bony tissue & normal marrow elements. No GRANULOMA/ MALIGNANCY seen .

Diagnosis – Small biopsy from D7-8 vertebrae :
Descriptive as above.
3


Specimen – PUS from paravertebral region.

Observationm – AFB present in smear.


TB MEDICINE- (1) AKT4 TAB , (2) ZENOCIN DS TAB , (3) BENADON 100 MG TAB , (4) ULTRACET TAB , (5) CAP BECOSULES 2 .

MRI scan reveals destruction of adjoining parts of D5/6 and D7/8 vertebral bodies including intervening discs with partial collapse of D5/6 and D7/8 vertebral bodies . The D6-7 discs is spared. These involved vertebrae also has heterogenous marrow signal alteration appearing pre dominantly hyperintense in T2W and STIR sequences and hypointense in T1W1.

There is associated prevertebral , bilateral paravertebral and anterior epidural abscess at D5/6 and D7/8 levels appearing hyperintense in T2WI and hypointense in T1WI showing peripheral enhancement . The spinal canal is also compromised at these levels with resultant thecal and cord compression . The compressed spinal cord at D7/8 level also has mild hyperintense signal in T2WI suggesting myelopathic change.

The effective mid saggital diameter of spinal canal at D5/6 and D7/8 levels are about 6mm and 5mm respectively .

The involved vertebrae also show heterogenous enhancement in contrast study. There is mild bilateral pleural thickening in mid zones with minimal pleural effusion . The rest of dorsal spinal cord has normal signal intensity.

The rest of dorsal and lumbar vertebrae are normal in height showing early degenerative end plate changes.

There is grade I anterolisthesis of L4 over L5 with defect in bilateral pars interarticularis of L4. The L4-5 neural foramina are narrowed bilaterally (right more than left) but no central stenosis is seen . The rest of dorosolumbar spine has normal marrow signal .

The rest of the dorso lumbar discs are dessicated with reduced height of L4-5 disc . There is no remarkable posterior disc herniation at any level.


IMPRESSION

1) Inflammatory (likely tubercular) spondylodiskitis involving D5/6 AND D6/7 vertebrae and intervening discs with associated periveretebral and anterior epidural abscess causing spinal stenosis ,thecal and mild cord compression as well as compressive myelopathic change in spinal cord.

2) Grade I isthmic spondylolisthesis of L4 over L5 with narrowing of bilateral (right more than left) L4-5 neural foramina.

DORSAL SPINE WITH CONTRAST AND SCREENING OF LUMBO SACRAL SPINE

SCAN PROTOCOL: NON CONTRAST - T1 AND T2W SPIN ECHO SEQUENCES IN SAGITTAL , AXIAL AND CORONAL PLANE WITH STIR SEQUENCES IN SAGITTAL PLANE.

POST CONTRAST : T1 WEIGHTED SPIN ECHO SEQUENCE IN AXIAL,SAGITTAL AND CORONAL PLANES.