Cases Of Spinal Tuberculosis Research Articles

Tuberculous Spondylitis: Clinical Features of 36 Patients

We report 36 cases of spinal tuberculosis who were evaluated at the Internal Medicine Department of Istanbul University between January 1990 and March 2016. Twelve cases were accompanied by active pulmonary tuberculosis while ten patients had a previous history of tuberculosis. Eight patients had diabetes mellitus; six patients were on chronic steroid treatment with a mean dose of 24 mg/day while two patients used azathioprine and methotrexate. The dominant symptom was back pain that was present in 64% of the subjects followed by low grade fever (42%), and malaise (38%). Lytic and destructive lesions were noted in various vertebrae in all of the cases while four patients had spinal compression, and two patients had iliopsoas abscess. The preliminary diagnosis was myeloproliferative disease with vertebral metastasis in eight patients. Tuberculin test was over 15 mm in 20 patients (58.8%) while ERS and Creactive protein were highly elevated in 78%, and 84% of the patients. Diagnosis of tuberculosis was confirmed by culture of aspirated material from intervertebral disc space, collection under CT guidance, sputum or bronchial lavage, and by retrospective anti-tuberculous treatment response. MRI revealed compatible findings with spinal tuberculosis in 30 (80%) patients. In endemic countries, tuberculous spondilitis should be considered in immunosuppressed patients with back pain. Current or past tuberculosis infection is not a reliable indicator for Pott’s disease in these patients. Laboratory findings were not usually useful to support the diagnosis. The low sensitivity of the tuberculin test may lead to an erronous diagnosis. Sensitivity of vertebral radiography and CT was low. MRI was the most useful radiologic investigation for the diagnosis of spinal tuberculosis. Tuberculosis of the spine is a diagnostic impasse notably in immunodeficient patients for the clinician.

A case of atypical spinal tuberculosis mimicking metastatic tumor

A case of atypical spinal tuberculosis mimicking metastatic tumor

De la scoliose idiopathique au mal de Pott : présentation d’une observation et discussion diagnostique

Idiopathic scoliosis is the most common form of spinal deformity in adolescence. However, secondary causes of scoliosis should always be considered so as to provide appropriate treatment and avoid complications. Additional explorations, such as MRI, are required in the presence of atypical signs. We report a case of spinal tuberculosis, or Pott's disease, misdiagnosed as idiopathic scoliosis, and then present a discussion to help identify the warning signs during the evaluation of scoliosis that might indicate secondary scoliosis and suggest when to perform further radiologic exploration.

Analysis on 23 cases of spinal meningeal tuberculosis by magnetic resonance imaging

To explore the imaging features of spinal cord and spinal meningeal tuberculosis by magnetic resonance (MR). We analyzed retrospectively the features of MRI in 23 patients with spinal cord and spinal meningeal tuberculosis compared to 25 patients with spinal cord meningeal metastatic carcinoma. All patients were admitted in our hospital from Jun. 2011 to Oct. 2014. There were 12 males and 11 females with a median age of 26 (range 16-50) years in the spinal cord meningeal tuberculosis group, and 18 males and 7 females with a median age 56 (range 44-78) years in the spinal cord meningeal metastatic carcinoma group. All patients underwent MR plain and contrast-enhanced scanning. The enumeration data were compared with the χ² test and the measurement data were compared with t test. The difference was considered statistically significant when the P value was <0.05. Of the 23 cases, 16 were spinal meningeal tuberculosis and 7 were spinal cord tuberculosis. The MR imaging features were as follows: (1) Spinal meningeal tuberculosis: Irregular and linear strip and hummocky thickening (thickness <5 mm) of the meninges (dura, arachnoid and pia mater), with the average length of involvement of 7 vertebral segments. Enhancement was present in all cases by contrast-enhanced scanning, including clustering or moniliform enhancement in 5 cases. Subarachnoid irregular stenosis was seen in all cases, partial occlusion in 5, abnormal heterogeneous signal in 20, rough cerebrospinal fluid (CSF)-spinal interface in 10, and formation of secondary arachnoid cyst in 15. (2) Spinal cord meningeal tuberculosis: of the 7 cases, 4 showed ring enhancement and 3 showed small plaque with heterogeneous enhancement. (3) There were 20 cases of meningeal metastatic carcinoma and 5 cases of meningeal metastatic carcinoma with spinal cord metastasis. Nodular thickening was present in 8 cases, plaque thickening in 10, and nodular and plaque thickening in 7. Continuous thickening involving 3 vertebral bodies was seen in 19 cases. Multiple localized thickening was present in 6 cases, with obvious enhancement in the meninges and heterogeneous enhancement in the spinal cord. The MR imaging features of spinal cord meningeal tuberculosis include continuous meningeal thickening, secondary arachnoid cyst, rough and moniliform CSF-spinal cord interface. Diagnosis and differential diagnosis can be made based on these features combined with clinical data and disease history.

Spinal tuberculosis: Our experience and a review of imaging methods.

We share our experience of 2000 spinal tuberculosis (TB) cases, including both typical and atypical presentations. The aim of the study is to estimate the incidence and types of spinal TB referred to our department for diagnosis. 2000 patients were selected by convenience sampling from January 2006 to September 2010. Study design was descriptive and among 2000 mostly unknown cases without evidence of symptoms of systemic TB (1080 males and 920 females). MRI without and with IV contrast, CECT with MPR, and in some cases not fit for MRI, CT myelography, were performed. Out of 2000 cases of tuberculous spine, 1080 (54%) were male and 920 (46%) were female. Their age ranged from 8-60 years. About 90% of patients were below the age of 40 years. Peak age among the males and females was 20-29 years and 14-35 years, respectively. The most common site of involvement was dorsal spine (45%) followed by lumbo-sacral spine (33%), cervical spine (10%) and at multiple levels (12%). Biopsies were done in 240 (12%) cases. Spinal TB should always be suspected when radiographs demonstrate a destructive spinal process. Awareness and prompt management of TB spine will help in reducing the continuing morbidity of this disease.

English

The authors reviewed 15 cases of spinal tuberculosis from 2013 to 2014 attending NH Mallareddy hospital, Suraram, Qutbullapur, Hyderabad. A real control of tuberculou disease requires a serious and sustained global effort to eliminate immune-compromised states, poverty, malnutrition and overcrowding. Tuberculosis of the spine is one of the most common spine pathology in India. Over last four decades a lot has changed in the diagnosis, medical treatment and surgical procedures to treat this disorder. More common in poorly nourished, over crowed and in subnormal social conditions. Early diagnosis and management of spinal tuberculosis has special importance in preventing the serious complications like kyphosis, paraperesis, paraplegia etc.

Response to: Surgery-Related Complications and Sequelae in Management of Tuberculosis of Spine.

Dear Editor, We read the published article by Moon et al. [1] entitled Surgery-Related Complications and Sequelae in Management of Tuberculosis of Spine with great interest. The authors said should be reserved only for the complicated cases of spinal tuberculosis in patients for whom surgery is definitely indicated [1]. However, we think that some more points should be discussed regarding therapy planning. Spinal tuberculosis is the most common and the worst form of tuberculosis lesions in the skeleton [2,3,4]. If the lesion is limited within the vertebrae, and if there are no complications, triple-drug anti-tuberculous chemotherapy can be the main therapy to treat tuberculosis [5]. However, with proper indications, surgical procedures are superior in the prevention of neurological deterioration, maintenance of stability, and early recovery [3,4,5,6]. Oguz et al. [4] reported 76 cases with spinal tuberculosis resulted in excellent recoveries without any neurological deterioration. As a result, they developed an effective classification system named GATA. We believe that this new classification system should be considered as a practical guide for spinal tuberculosis treatment planning in all countries.

A case of multifocal spinal tuberculosis from Medieval Rhodes

A case of multifocal spinal tuberculosis from Medieval Rhodes

Video-Assisted Thoracoscopic Anterior Surgery Combined Posterior Instrumentation for Children with Spinal Tuberculosis

The use of thoracoscopy for the treatment of spinal disorders has been applied mostly in adults. However, thoracoscopic decompression of spinal tuberculosis in children has probably been rarely documented. To assess the efficacy of video-assisted thoracoscopic anterior surgery (VATS) combined with posterior instrumentation for children with spinal tuberculosis. Total 15 consecutive children with spinal tuberculosis with VATS combined with posterior instrumentation were included. Overall 15 cases of spinal tuberculosis were treated with the procedure of posterior internal fixation and anterior debridement by VATS combined with posterior instrumentation between January 2002 and December 2006.There were nine males and six females with an average age of 11.6 years (8-15 y). All patients were given appropriate chemotherapy for 4 to 12 weeks preoperatively and 12 to 15 months postoperatively. All patients were followed up with evaluation of the changes of kyphotic deformity noted. All the cases were followed up over an average of 37.3 months (range, 12-48 mo).The wounds were healed without chronic infection or sinus formation. Four patients improved three grades, two patients improved two grades, and seven patients improved one grade. The average neurological recovery in the patients was 1.44 grades on the scale by Frankel et al. The average preoperative kyphosis was 37 degrees (range, 23-59 degrees) and the average postoperative kyphosis was 25 degrees (range, 18-35 degrees) at final follow-up. Also, minimal progression of kyphosis was seen at final follow-up with an average kyphosis of 28 degrees (range, 20-40 degrees); and average loss of correction of 3 degree was seen at final follow-up. VATS combined with posterior instrumentation achieve satisfactory results for children with spinal tuberculosis.

Four Cases of Spinal Tuberculosis Within 7 Months at a Community-Based Hospital

Four Cases of Spinal Tuberculosis Within 7 Months at a Community-Based Hospital

Spinal Tuberculosis

Spinal tuberculosis (TB), a destructive form of extrapulmonary TB, is uncommon in the United States. It is more common among immigrants from TB-endemic countries. Typically, the infection spreads to the vertebrae from a primary site elsewhere. Spinal TB commonly presents with an insidious onset of nonspecific back pain and can be the first presenting symptom of underlying TB. Because it presents in a similar fashion to a metastatic disease, which is more common in the United States, a diagnosis of spinal TB is often delayed, resulting in long-term disability. A high clinical suspicion coupled with appropriate imaging studies helps in prompt diagnosis and the rapid institution of treatment. Anti-TB drugs are effective to treat spinal TB, but surgery is required in refractory disease, abscess formation, vertebral collapse, and/or nerve compression. We present 2 cases of spinal TB: one responded very well to medical treatment; the other required adjunct surgery.

Drug Susceptibility Testing Guided Treatment for Drug-Resistant Spinal Tuberculosis: A Retrospective Analysis of 19 Patients

Spinal tuberculosis is the most common manifestation of extrapulmonary tuberculosis. However, there have been few reports on the topic of drug-resistant spinal tuberculosis. The aim of this study was to investigate the efficacy and safety of treatment with a combination of surgery and individual chemotherapy guided by drug susceptibility testing for drug-resistant spinal tuberculosis. We retrospectively analyzed 19 patients with drug-resistant spinal tuberculosis. After surgery, individual chemotherapy was tailored for each patient according to his or her drug resistance profile and previous history of chemotherapy. The patients were followed up clinically and radiologically for an average period of 36 months. Among 19 drug-resistant spinal tuberculosis cases, 16 were multidrug-resistant tuberculosis (MDR-TB), and 3 were non-MDR-TB. The patients with MDR-TB and non-MDR-TB had undergone previous chemotherapy for an average of 12.50 ± 2.00 months (0-55 months) and 5.50 ± 1.20 months (0-60 months), respectively. A total of 16 patients underwent open operations, and the other 3 had percutaneous drainage and local chemotherapy. Patients received individual chemotherapy for an average of 24 months postoperatively. All patients had been cured at the final follow-up. Drug-resistant spinal tuberculosis is mainly acquired through previous irregular chemotherapy and the spread of drug-resistant strains. Treatment with a combination of surgery and individual chemotherapy is feasible in the treatment of severe complications and the prevention of acquired drug resistance.

Spinal TB

Spine is the most commonest site of skeletal system accounting for about 50% skeletal tuberculosis cases. This article describes the role of CT and MRI in evaluating a case of spinal tuberculosis.

A Case of Intradural Extramedullary Spinal Tuberculosis Diagnosed 8 Years After Treatment of the Primary Infection

Tuberculosis (TB), the disease caused by Mycobacterium tuberculosis, is the second leading killer worldwide from a single infectious agent. Spinal TB is associated with pulmonary disease and may originate from (1) hematogenous spread outside the central nervous system (CNS), (2) sites located within the cranium (meningitis), or (3) secondary extension from vertebral bodies or discs (Pott’s disease).1

Analysis and therapeutic schedule of the postoperative recurrence of bone tuberculosis

ObjectiveThe present study aims to analyze the main reasons that lead to the failure of bone tuberculosis (TB) surgery and the efficacy of reoperation.MethodsA total of 3,000 cases of bone TB patients were examined retrospectively. Of these, 180 cases had recurrence, including 135 cases of spinal TB and 45 cases of limb TB. Preoperative indicators of duration of anti-TB chemotherapy, nutritional conditions, temperature conditions and erythrocyte sedimentation rate, and medication time of postoperative and recurrence were statistically analyzed.ResultsOf all 180 cases with reoperation, 176 cases were cured, and four paralyzed patients were symptomatically improved. The causes of postoperative recurrence of bone TB were relatively complex. Efficacy of reoperation was evaluated. Shorter chemotherapy duration, long-term illness, poor health, a higher body temperature, and an accelerated ESR are likely to increase the risk of recurrence.ConclusionsGiven the operation failure, careful analysis of the failure reasons and the targeted reoperation can obtain satisfactory results, thereby avoiding the failure of the initial surgery.

Pediatric cranio-vertebral junction tuberculosis: management and outcome

Tuberculosis (TB) of the cranio-vertebral junction (CVJ) is a rare condition, accounting for 0.3% to 1% of all cases of spinal TB. Early diagnosis and treatment are important in preventing long-term neurological sequelae. Management protocol of this rare site of TB is yet to be conclusively established. This holds particularly true for pediatric age group in which this condition is infrequently encountered. A total of 29 consecutive pediatric patients presented to the Department of Neurosurgery at Sanjay Gandhi Post-Graduate Institute of Medical Sciences, Lucknow, from January 1997 to October2011 with clinical and/or radiological features suggestive of CVJ TB. A clinical grading system to evaluate the neurological status was developed, and all patients were evaluated using this scoring system. Patients were radiologically evaluated with computed tomography (CT) of CVJ and magnetic resonance imaging (MRI) with gadolinium enhancement. These cases were managed according to their grade and followed up. Out of a total of 29 cases, 18 were females and 11 males. Age range was 4 to 18years with mean age 9 ± 3.8years. The follow-up period ranged from 2months to 7.5years with mean follow-up of 2.7years. Eleven cases were of grades 1 and 2, and 18 cases were of higher grade (grades 3 and 4). Predominantly conservative approach was utilized in cases with better clinical status, and grade (grades 1 and 2) and surgical intervention was needed in the more severe grades. All cases had significant improvement at the last follow-up. One needs to have a high index of suspicion of CVJ TB if one encounters a case with neck pain, neck restriction, and raised erythrocyte sedimentation rate. CT CVJ and MRI with gadolinium contrast enhancement are the investigations of choice for both establishing a diagnosis and planning the management. For cases with mild neurological deficit, conservative approach would work for majority of cases, and for severe cases, initial conservative approach may be tried, failing which surgical intervention would be needed.

Late Diagnosed Cervical Spine TBC Spondylitis: Case Report

SUMMARY Cervical tuberculosis is a rare disease with a high complication rate. Tuberculosis of the cervical spine is reported in about 6-9% of all cases of spinal tuberculosis. Early diagnosis and treatment of spinal tuberculosis is essential in order to prevent neural deficit. Management strategies for spinal tuberculosis range from ambulatory chemotherapy to radical surgical debridement with fusion. The paper presents a case of an 18-year-old patient with TBC spondylitis C3- C5. Eleven months passed from the onset of the disease until surgery and final diagnosis. When hospitalized, the patient suffered from the overall weakness, a 15- kg weight loss, dysphagia, neck pain, neck rigidity, febrility, cervical radiculopathy and paresthesia of both upper extremities. MR image showed a complete destruction of C3, abscess perforation in the anterior epidural space with the spinal cord compression and abscess extension to prevertebral space from C2 to C5. After the radical surgical debridement of C3-C5 and anterior decompression, a tricorticate autologous bone graft obtained from the iliac crest was placed and a plate fixation was done. Tuberculostatics were included for 12 months after surgery. Complete recovery occurred six months after surgery. Anterior decompression with autologous iliac bone graft led to a good clinical and radiological outcome in patients with cervical spine tuberculosis.

Changes in the incidence and management of spinal tuberculosis in a French University Hospital Rheumatology Department from 1966 to 2010

IntroductionTwo previous single-center studies in a university hospital rheumatology department suggested an increase in the incidence of spinal tuberculosis in France in the 1990s. Our objective in this study was to obtain incidence data on spinal tuberculosis since 1995 in the same department and to describe changes over the entire study period from 1966 to 2010. We also compared patients seen between 1966 and 1995 to those seen between 1995 and 2010. MethodsWe conducted a retrospective review of all cases of spinal tuberculosis seen in our rheumatology department between 1966 and June 1995 and between July 1995 and 2010. We collected the annual incidence, clinical and radiological features, and diagnostic and therapeutic strategies. ResultsOne hundred and thirty patients were managed between 1966 and 2010. The number of cases declined in the 1970s and 1980s then increased over the next two decades. None of the patients had HIV infection. Over 70% of patients were from continental France. Compared to patients seen during the earlier period, those seen after June 1995 were older (62.8±17.2 vs. 53±14.3 years, P=0.0006), had more comorbidities, and more often exhibited severe radiological findings (including multilevel involvement, epidural involvement, and abscesses). No changes occurred in time to diagnosis or management strategies. ConclusionThe incidence of spinal tuberculosis in a university hospital rheumatology department has increased over the last two decades, chiefly as a result of reactivation of past tuberculosis, as opposed to origin from endemic countries or HIV infection.

Surgical management for thoracic spinal tuberculosis in the elderly: posterior only versus combined posterior and anterior approaches

To compare the clinical outcomes of surgical management by posterior only and combined posterior and anterior approaches for thoracic spinal tuberculosis in the elderly. This was a retrospective cohort study. Thirty-six cases of thoracic spinal tuberculosis treated by two different surgical procedures in our center from January 2004 to June 2009 were studied. All the cases were divided into two groups: 20 cases in Group A underwent single-stage posterior debridement, transforaminal fusion and instrumentation, and 16 cases in Group B underwent posterior instrumentation, anterior debridement and bone graft in a single- or two-stage procedure. The operation time, blood loss, correction rate, recovery of neurological function, fusion time and complications were, respectively, compared between Group A and Group B. All patients were followed up for an average of 35.1±5.8months (range 26-45months). It was obviously that the average operative duration, blood loss, hospitalization and complication rate of Group A was less than those of Group B. Spinal tuberculosis was completely cured and the grafted bones were fused in 10months in all patients. There was no persistence or recurrence of infection and no differences in the radiological results in both groups. The kyphosis was significantly corrected after surgical management. However, loss of correction also occurred in both groups. Our study showed that the posterior approach only procedure obtained better clinical outcomes than combined posterior and anterior surgeries. It might be a better surgical treatment for thoracic spinal tuberculosis in aged patients with poor health status, especially for cases in early phase of bone destruction and/or mild and moderate kyphosis.

Posterior-only Approach Surgery for Fixation and Decompression of Thoracolumbar Spinal Tuberculosis

A retrospective case study series. To evaluate the results of posterior decompression and transpedicular screw fixation in 18 cases of thoracolumbar spinal tuberculosis with neurological deficit. Spinal tuberculosis has been managed with various modalities of treatment ranging from only antitubercular drugs to radical procedures such as anterior or combined approach surgeries. However, although the former method of treatment sometimes is met with unacceptable kyphosis, the later is considered to be too drastic. In the present study, authors have shown the results of posterior decompression and pedicle screw fixation in selected cases of Pott paraplegia. The cases (12 males and 6 females) were operated with a posterior decompression and transpedicular screw fixation in a single stage along with antitubercular drug treatment. All of these patients had varying degrees of neurological deficit (4 with Frankel grade A, 8 Frankel B, 4 Frankel C, and 2 Frankel D) and single level involvement with <50% vertebral body destruction and mild kyphosis of 8-27 degrees. Short-segment pedicle screw fixation, posterior decompression, and correction of kyphosis were performed in single stage. Kyphosis improved from preoperative value of 17.7±5.8 degrees to 9.4±4.6 degrees postoperatively. At a follow-up period of 24-46 months, final kyphosis correction was maintained at 11.6±5.4 degrees. Bony fusion was achieved in 55.5% cases. Neurological recovery occurred in 17 patients (94.4%). All patients became pain free, with final visual analogue score 0-2. The procedure in safe and has satisfactory results in early active cases of Pott paraplegia with less destruction of vertebral bodies.