Syphilis of the spine.

The manifestations of late syphilis are rarely seen nowadays. In the Oslo study, benign tertiary syphilis occurred in 15-8 per cent. of 1,147 patients with untreated syphilis. The commonest sites of 'benign' tertiary syphilis were the skin, the mucous membranes, and the bones (70 0, 10-3, and 9-6 per cent. of all cases, respectively) (Gjestland, 1955). Thus, syphilis affecting the bones can be expected in about 1-5 per cent. of patients with untreated syphilis. Nielsen (1950) found manifestations of tertiary syphilis in 1 1 per cent. of his cases of partially treated syphilis. Gumma formation in the bone tissue leads to destruction of the bone. The tibia, skull, and sternum are affected more often than other bones, and gumma of the spine is extremely rare. The precise frequency of spinal manifestations has not been analysed, but some case reports of this complication have been published in the last few years (Johns, 1970). Syphilis can simulate other granulomatous diseases, e.g. tuberculosis. It is very difficult to establish the correct diagnosis from radiographs and histological examination alone. Positive serological tests for syphilis (STS) and, especially, positive treponemal tests are highly suggestive of syphilis in questionable cases. The frequency of early syphilis has slowly increased in most European countries in the last 10 years. Obviously, some of these patients are treated inadequately or not at all, and will later suffer from syphilitic complications. This paper presents the case history of a 38-year-old man with probable syphilis of the spine.