Management Of Spinal Tuberculosis Research Articles

Clinical and Radiological Correlation of Spinal Tuberculosis

Objective: The aim of this study is to establish a comprehensive understanding of the clinical and radiological features of spinal tuberculosis, and to evaluate their correlation in order to enhance diagnostic accuracy, management strategies, and patient outcomes. Study Design: This was a retrospective, observational, cross-sectional study. Place of Study: The research was conducted at the Department of Neuro-Sugery, Darul -Sehat Hospital and Neurology and Radiology Department of Creek General Hospital, both tertiary care hospital of Karachi. Duration of Study: Data were collected over a period of two years from January 2021 to December 2022. Methodology: A total of 120 patients diagnosed with spinal tuberculosis were included in this retrospective, observational, cross-sectional study.. Demographic data, clinical presentations, laboratory findings, and radiological findings were collected and analyzed. The radiological features were assessed using X-ray, computed tomography (CT), and magnetic resonance imaging (MRI) scans. Statistical analysis was performed to identify correlations between clinical and radiological findings and their associations with patient outcomes. Results: The mean age of patients was 46.3 years, with a slight male predominance. The most common clinical manifestations were back pain (89.3%), neurological deficits (57.3%), and constitutional symptoms (45.3%). The thoracic spine was predominantly affected (61.3%), followed by the lumbar (28%) and cervical regions (10.7%). Radiological findings demonstrated vertebral destruction (90.7%), disc space narrowing (83.3%), paravertebral abscesses (76%), and epidural involvement (58%). A strong correlation was observed between the severity of clinical manifestations and the extent of radiological abnormalities. Patients with extensive vertebral destruction and spinal cord compression showed significantly higher rates of neurological deficits. Conclusion: This study highlights the crucial role of clinical and radiological correlation in the diagnosis and management of spinal tuberculosis. Early recognition of the disease, prompt initiation of appropriate treatment, and regular monitoring of clinical and radiological progress can significantly improve patient outcomes and reduce long-term complications. Keywords: spinal tuberculosis, clinical features, radiological features, correlation, diagnosis, management, prognosis.

THORACIC TUBERCULOUS SPONDYLITIS WITH DECOMPRESSION AND POSTERIOR STABILIZATION TREATMENT: A CASE REPORT

Introduction. Tuberculosis (TB) spondylitis is one of the most common spinal infections. The management of spinal tuberculosis is difficult due to non-specific and variable clinical manifestation that leading to delayed identification and increases the risk of disease. The early identification and treatment are very important to avoid permanent damage in the future. Method. In this research, the researcher reports a case of a patient with tuberculous spondylitis involving the thoracic vertebral body which treated by decompression and posterior stabilization treatment. Results and Analysis. The physical examination revealed a mass appears in the midline of the back. Chest CT examination without contrast revealed a mass that caused destruction and compression of the right side of the Thoracal 7 (Th 7) vertebral body, partial destruction of the right Th7 lamina, and spinal intracanal pushing to the left of the Th7 level of the spinal cord which caused the destruction of 7th and 8th posteromedial right ribs nearby. During the two months of treatment, the patient was treated with a first-line oral regimen as standard treatment for extrapulmonary TB followed by seven-month follow-up phase. At follow-up after more than 2 months of initial TB drug administration, the back pain was persisted. The patient underwent level 7 thoracic decompression by means of laminectomy and flavectomy. Histopathological examination from biopsy showed fibrous connective tissue containing epitheloid tubercles with datia langhans which suggests the presence of tuberculous spondylitis. The diagnosis was confirmed by AFB staining. Discussion. This case is important to provide recognition of the risks and phenomena of the continuing incidence of spinal TB, despite the progress made in early diagnosis and effective management.

Management and outcomes of spinal tuberculosis in Africa: a scoping review protocol

AbstractBackgroundSpinal tuberculosis (TB) remains a major public health challenge in Africa, where 85% of the global deaths from TB is recorded. Patients with spinal TB have a high tendency to develop permanent disability, with significant financial costs. Most patients with spinal TB from Africa are unable to receive timely and effective intervention due to several socio-economic factors, deplorable healthcare infrastructure and inadequate specialized workforce. In addition, there is a lack of contextually appropriate evidence-based guidelines for management of this potentially debilitating but treatable condition. This scoping review protocol outlines how the authors aim to investigate the available evidence on the management and outcome of spinal TB in Africa.MethodsAJOL, Embase, Pubmed/Medline, Google Scholar and Conchrane will be searched for articles published on the management and outcome of TB since the inception of the database. All patients from any of the 54 African countries will be included regardless of the socio-demographics.ResultsThe primary outcomes will include the available treatment modalities and the clinical outcomes among patients managed for spinal TB in Africa. Secondary outcomes will include the epidemiology of spinal TB in Africa, information on the availability of diagnostic tools and the challenges faced in the management of spinal TB in Africa, including delays in treatment.DiscussionAnalysis of the outcomes and prognostic indicators will allow for a comparison of patient cohorts and the effectiveness of the different treatment modalities employed across Africa. This scoping review will be the first to address this research question.

Clinical Features and Outcomes of Spinal Tuberculosis in Central China.

The appropriate management of spinal tuberculosis (TB) is challenging for clinicians and the key to treat spinal TB. Surgery and long course anti-TB chemotherapy may not be necessary to all situations. This study aimed to characterize the clinical features and factors affecting treatment outcomes. A retrospective study of patients with spinal TB over a 5-year period at a teaching hospital in central China was conducted. Features of patients with spinal TB who received different treatment modalities and factors associated with patient outcomes at the end of chemotherapy were analyzed. Forty-five patients (21 men and 24 women) with spinal TB were available for analysis. The mean age was 55.39 ± 14.94 years. The most common vertebral area involved was the lumbar (42.2%). The mean number of vertebrae involved was 2.20 ± 0.59. 27 patients (60.0%) received surgical treatment, of which 21 (77.8%) received radical surgical treatment. Thirty-five patients (77.8%) had achieved a favorable status. Statistically, there was no significant correlation between favorable status and surgery, but among 27 surgical patients with spinal tuberculosis, patients receiving radical surgery tended to achieve good prognosis (P = 0.010; odds ratio = 0.053; 95% confidence interval 0.006-0.493). Moreover, there was no significant difference between long course and short course of anti-TB chemotherapy in prognosis in different treatment modalities. Although the patients with spinal TB who needed surgical treatment often got a better prognosis when they had radical surgery, surgery was not actually a factor for the favorable outcomes of patients with spinal TB. In different treatment modalities, there was no additional benefit in longer anti-TB chemotherapy periods.

A case of acute-onset paraplegia due to spinal tuberculosis in term pregnancy

Acute paraplegia in pregnancy is uncommon but can result from pathology including Guillain-Barre syndrome, acute transverse myelitis, and spinal tuberculosis, also known as Pott's disease of the spine. India has a high incidence of tuberculosis (2.8 million cases annually) therefore spinal tuberculosis is a particularly important disease to consider during pregnancy. Management of spinal tuberculosis in pregnancy poses a challenge especially at term gestation as immobilization of the spine and maintaining supination is difficult, particularly at delivery.

Is 6 Months of Antitubercular Chemotherapy as Effective as More Than 6 Months Regimen in Spinal Tuberculosis? A Systematic Review and Meta-analysis.

Historically, osteoarticular tuberculosis (TB), including spinal TB, was treated with prolonged course of antitubercular therapy (ATT). Due to various challenges, there has been reluctance to explore the use of short-course ATT in spinal TB. However, with the success of short-course ATT being demonstrated in other forms of extrapulmonary TB, the subject is open for debate again. Therefore, we systematically reviewed various published literature to determine whether short-course treatment regimen (6 months) of ATT provides equivalent results in terms of disease healing as long-course treatment regimen (≥9 months) in the management of spinal TB. Five electronic databases (PubMed, MEDLINE, EMBASE, CENTRAL, and Web of Science) and their reference lists were searched to identify relevant randomized controlled trials with at least 1 year of follow-up that compared short-course with standard-course ATT for treatment of spinal TB. The methodological quality of included studies was assessed, and their data were extracted. A meta-analysis was used to calculate pooled effect sizes and 95% confidence interval (CI). The outcome measure was healed status of the disease at the final follow-up. Of 331 publications identified through literature search, eight publications describing six randomized studies were included. Moreover, 375 of 414 patients (90.58%) who received 6 months of ATT had healed status at their final follow-up compared to 404 of 463 patients (87.26%) who received ≥9 months of ATT. Overall, the healed status of spinal TB was equivalent in patients in both groups (pooled relative risk, 0.98; 95% CI, 0.92-1.04; p =0.439). However, there was considerable heterogeneity among the trials (I2=40.8%, p =0.149). The results suggest that the use of short-course (6 months) chemotherapy may be considered for the treatment of spinal TB in view of the similarity in the healing response achieved compared to treatment regimens of longer duration.

Tuberculosis of the spine and drug resistance: a review article.

Pott's spine is tuberculosis of spine caused due to hematogenous spread of mycobacterium from a primary focus. It constitutes about 50% of skeletal tuberculosis cases. Paradiscal type is the most common type of spinal tuberculosis. Untreated cases can lead to complications like a cold abscess, paraplegia, and deformity which may require surgical intervention. Rapid molecular methods have made the diagnosis of spinal tuberculosis and drug resistance faster and easier but it still remains a problem due to difficulties in sample collection and the paucibacillary nature of the Pott spine. Antitubercular drug therapy forms the mainstay of management. The emergence of MDR TB and XDR TB has posed a big challenge in the management of spinal tuberculosis. The literature regarding drug resistance in spinal tuberculosis and its management is lacking. We conducted a literature review of 29 studies and presented information on pathogenesis, diagnosis, and management of spinal tuberculosis and drug resistance. New shorter regimens for MDR and XDR TB are under trial in different parts of the world. We believe this article will provide information on spinal tuberculosis and drug resistance and help clinicians outline important research areas.

Effect of vitamin D combined with anti-tuberculosis drugs on serum IL-1β, IFN-γ and Th17 cell-associated cytokines for the management of spinal tuberculosis

Purpose: To investigate the effect of combination of vitamin D and anti-tuberculosis drugs on serum interleukin-1β (IL-1β), interferon-γ (IFN-γ) and helper T 17 (Th17) cell-associated cytokine levels for the treatment of spinal tuberculosis (TB).
 Methods: Ninety-two spinal TB patients were assigned without bias to two groups (46/group): study group (vitamin D combined with anti-TB drug group) and control group (anti-TB drug group). After treatment for 8 weeks, clinical effectiveness, adverse reactions, visual analog scale (VAS) score, spinal cord injury grade, and serum levels of IL-1β, IFN-γ, Th17, IL-10, TGF-β1, IL-17 and IL-23 were assayed with ELISA, and compared between groups.
 Results: Study group total effectiveness was significantly higher than that in the control group (95.65 % vs 80.43 %, p < 0.05). Before drug administration, VAS score, degree of spinal cord injury and serum levels of IL-1β, IFN-γ, IL-10, TGF-β1, IL-17 and IL-23 were comparable in the study and control patients (p > 0.05). However, post-treatment, these parameters significantly decreased in both groups (p < 0.05), but were markedly lower in study group patients, relative to controls (p < 0.05).
 Conclusion: The use of combined treatment of vitamin D and anti-TB drugs is an effective and safe way to alleviate inflammatory response and improve the immunity of spinal TB patients via the regulation of the levels of Th17 cell-related factors.

Spinal tuberculosis: proposed spinal infection multidisciplinary management project (SIMP) flow chart revision.

We propose a revised flow chart of spinal infection multidisciplinary management project (SIMP) aimed to standardize the diagnostic process and management of spinal tuberculosis (TB). We reviewed data from all TB cases with osteoarticular involvement treated at a large tertiary teaching hospital in Bologna, Northern Italy, from January 2013 to December 2017. We cross-linked notified osteoarticular TB cases with SIMP database and we analysed clinical, diagnostic, and treatment data of all cases managed by SIMP. Osteoarticular TB accounted for the 7.8% (n=40) of all TB cases notified between 2013 and 2017 (N=513). Among the identified cases, 52% (n=21/40) had spine involvement: all were enrolled and evaluated by SIMP multidisciplinary group. Females accounted for 57% (12/21) of patients, the median age was 52 years (range 24-82). In the 67% (n=14/21) of cases, the major clinical symptom of spinal TB was back pain reported for a median of 4.5 months (range 1-12 months) before hospital admission. The interferon gamma release assay was positive in 75% (n=16/21) of patients. All patients performed MRI with gadolinium, which indicated spondylodiscitis in 90%. 18F-FDG-PET/CT revealed average maximum standardized uptake value (SUV max) of 12.54 (range 5.3-22) in 17/19 (89.5%). Bacteriological confirmation of TB was obtained in 86% of cases (n=18/21). One-third of patients (7/21) underwent surgery and 95% successfully completed the anti-TB treatment. Our data reveal that a multidisciplinary approach to spine tuberculosis facilitates early and accurate diagnosis and can improve medical and surgical management of this disease.

Characteristics and Management of Spinal Tuberculosis in Tuberculosis Endemic Area of Guizhou Province: A Retrospective Study of 597 Patients in a Teaching Hospital.

Background Tuberculosis (TB) is an endemic disease in Guizhou. Spinal TB accounts for approximately 50% cases of skeletal TB. The purpose of this study was to investigate the characteristics and management of patients treated for spinal TB in a certain hospital and to provide guidance for the prevention and treatment of spinal TB. Methods The clinic records of all patients diagnosed with spinal tuberculosis in a teaching hospital between January 2010 and December 2018 were collected. The epidemiology, clinical characteristics, imaging and laboratory findings, treatment methods, and prognosis were recorded and analyzed. Results During this nine-year period, 597 patients with spinal TB were identified. There were 313 males and 284 females with an average age of 43 years. The largest number of patients fell in the age group of 21–30 years; mean time from symptom onset to diagnosis in the hospital was 17 months. Back pain was the main clinical manifestation (89.34%). The most common imaging technique was computed tomography (CT, 96.80%), followed by magnetic resonance imaging (MRI, 84.01%). Majority of the lesions involved the lumbar spine (47.30%), followed by the thoracic spine (40.95%). 178 (29.82%) patients in this study had varying degrees of neurological impairment. 22.78% of the patients selected conservative treatment, and surgical treatment was performed in 483 patients (80.90%). Conclusions The incidence of spinal TB was generally on the rise throughout the study period. After diagnosed with spinal TB, all patients got appropriate treatment and achieved good efficacy, but most of the patients did not pay much attention to the disease and receive timely treatment. Thus, it is essential to strengthen the TB preventive strategies, improve the health awareness of residents and universal resident health examination.

The role of Technetium-99m-Ethambutol scintigraphy in the management of spinal tuberculosis

Spines is a common site of extrapulmonary Mycobacterium tuberculosis infection (MTI). Spine destruction due to MTI can mimic other etiologies. Treatment of choice for spinal tuberculosis (STB) is anti-TB drugs while surgery could be needed in other causes. The gold standard for STB diagnosis is histopathology examination from biopsy tissue. Technetium-99m-ethambutol (99mTc-EMB) scintigraphy can be used to detect and localize of TB. The aim of this study was to evaluate the role of 99mTc-EMB scintigraphy in STB management. Retrospective study was carried out from 2006 to 2014. Subject STB were patient STB with suspected of STB and underwent 99mTc-EMB scintigraphy. The histopathologic result was used as gold standard. Whole body planar acquisition was taken at 1 and 3 h postinjection of 370 MBq. Single-photon emission computed tomography/computed tomography acquisition was performed on suspected area. 99mTc-EMB image were analyzed by two nuclear medicine specialis. The 93 subject STB were included in this study. Histopathologic data were available in 40/93 subject STB. Positive and negative 99mTc-EMB scintigraphy were 32 and 8 subject STB. 99mTc-EMB scintigraphy result STB was concordance with the histopathologic finding in 37 subject STB. Sensitivity, specivicity, positive- and negative-predictive value, and accuracy of 99mTc-EMB scintigraphy 90.91%, 71.43%, 93.75%, 62.5%, and 87.5%, respectively. This study showed that patient STB with suspected 99mTc-EMB scintigraphy result could be directly treated with anti-TB. 99mTc-EMB scintigraphy has significant role in the management of STB.

The role of Technetium-99m-Ethambutol scintigraphy in the management of spinal tuberculosis

Abstract Spines is a common site of extrapulmonary Mycobacterium tuberculosis infection (MTI). Spine destruction due to MTI can mimic other etiologies. Treatment of choice for spinal tuberculosis (STB) is anti-TB drugs while surgery could be needed in other causes. The gold standard for STB diagnosis is histopathology examination from biopsy tissue. Technetium-99m-ethambutol (99mTc-EMB) scintigraphy can be used to detect and localize of TB. The aim of this study was to evaluate the role of 99mTc-EMB scintigraphy in STB management. Retrospective study was carried out from 2006 to 2014. Subject STB were patient STB with suspected of STB and underwent 99mTc-EMB scintigraphy. The histopathologic result was used as gold standard. Whole body planar acquisition was taken at 1 and 3 h postinjection of 370 MBq. Single-photon emission computed tomography/computed tomography acquisition was performed on suspected area. 99mTc-EMB image were analyzed by two nuclear medicine specialis. The 93 subject STB were included in this study. Histopathologic data were available in 40/93 subject STB. Positive and negative 99mTc-EMB scintigraphy were 32 and 8 subject STB. 99mTc-EMB scintigraphy result STB was concordance with the histopathologic finding in 37 subject STB. Sensitivity, specivicity, positive- and negative-predictive value, and accuracy of 99mTc-EMB scintigraphy 90.91%, 71.43%, 93.75%, 62.5%, and 87.5%, respectively. This study showed that patient STB with suspected 99mTc-EMB scintigraphy result could be directly treated with anti-TB. 99mTc-EMB scintigraphy has significant role in the management of STB.

A Systematic Protocol Design and Management of spinal Tuberculosis by Using Antibiotics: Rifampicin, Isoniazid

A Systematic Protocol Design and Management of spinal Tuberculosis by Using Antibiotics: Rifampicin, Isoniazid

Spinal Tuberculosis: Current Concepts.

Study Design:Review article.Objectives:A review of literature on the epidemiology, diagnosis, and management of spinal tuberculosis (TB).Methods:A systematic computerized literature search was performed using Cochrane Database of Systematic Reviews, EMBASE, and PubMed. Studies published over the past 10 years were analyzed. The searches were performed using Medical Subject Headings terms, and the subheadings used were “spinal tuberculosis,” “diagnosis,” “epidemiology,” “etiology,” “management,” “surgery,” and “therapy.”Results:Tissue diagnosis remains the only foolproof investigation to confirm diagnosis. Magnetic resonance imaging and Gene Xpert help in early detection and treatment of spinal TB. Uncomplicated spinal TB has good response to appropriately dosed multimodal ambulant chemotherapy. Surgery is warranted only in cases of neurological complications, incapacitating deformity, and instability.Conclusions:The incidence of atypical clinicoradiological presentations of spinal TB is on the rise. Improper dosing, inadequate duration of treatment, and inappropriate selection of candidates for chemotherapy has not only resulted in the resurgence of TB but also led to the most dreadful consequence of multidrug resistant strains. In addition, global migration phenomenon has resulted in worldwide spread of spinal TB. The current consensus is to diagnose and treat spinal TB early, prevent complications, promote early mobilization, and restore the patient to his or her earlier functional status.

Spinal tuberculosis

Tuberculosis (TB) remains endemic in many parts of the developing world and is increasingly seen in the developed world due to migration. A total of 1.3 million people die annually from the disease. Spinal TB is the most common musculoskeletal manifestation, affecting about 1 to 2% of all cases of TB. The coexistence of HIV, which is endemic in some regions, adds to the burden and the complexity of management. This review discusses the epidemiology, clinical presentation, diagnosis, impact of HIV and both the medical and surgical options in the management of spinal TB. Cite this article: Bone Joint J 2018;100-B:425-31.

Does spinal surgery for spinal tuberculosis during active infection predispose to post operative surgical site infection?: Experience From Kenyatta national hospital

Background : Spinal Tuberculosis (TB) is the most common form of skeletal TB. Its incidence has seen an increase over the past 3 decades due to the AIDS epidemic. Absolute non-operative treatment was offered in pre antibiotic era. Surgery has become an integral component in the management of spinal TB in current practice. The rate of SSI varies from 2% to 20% for all surgical spinal procedures. Objective : Does spinal surgery for spinal tuberculosis during active infection predispose to post operative Surgical Site Infection (SSI). The aim of this study was to note the incidence of infection in patients undergoing spinal surgery for tuberculosis. Methods : All patients who had complete medical records and had surgery for spinal tuberculosis were recruited into the study. The study period was from 2005 to 2015. Relevant data was collected and appropriately analyzed . Results: For all the patients, chemotherapy was started immediately after tuberculosis of the spine was diagnosed. Five patients had involvement of the lumbar region, one patient with involvement of the cervical region and the rest had involvement of the thoracic region. One patient had 3 vertebrae involved, 3 patients had one vertebrae involved and 14 patients had 2 vertebrae involved. Out of the 18 patients, 12 showed improvement after surgery, 4 patients had no difference after surgery and 2 patients worsened after surgery. Two patients showed improvement after 1 week; 3 patients after 2 weeks; 3 patients after 1 month; 4 patients after 2 months. Of the patients who worsened; 1 patient worsened by 1 grade while another worsened by 2 grades. No patient had any SSI. This was irrespective of whether they had instrumented spine surgery or not. Conclusion : This study shows that spinal surgery for spinal tuberculosis does not lead to increased surgical site infection even in the presence of active tuberculosis infection. Addition of spinal instrumentation to the surgical strategy does not predispose to increased infection rate. Larger studies need to be carried out to validate this data. Key words: Spinal tuberculosis, Spinal surgery, Surgical site infections

Outcome and management of spinal tuberculosis according to severity at a tertiary referral center.

Objective:Anti-tuberculosis (TB) treatment remains the mainstay of treatment of spinal TB. There is a lack of consensus regarding the timing of interventional procedures and surgery in the patients with spinal TB. This study aims to prospectively study the clinical outcome and management in patients presenting with spinal TB at our tertiary referral center and teaching hospital.Methods:Data were collected prospectively from 48 patients treated for spinal TB presenting to us from August 2011 to December 2012. All the patients were followed-up for the duration of anti-TB treatment.Results:The categorization of patients into different management groups was based on the clinical and radiological findings at the time of diagnosis. The patients with mild disease (n = 23) were successfully managed with anti-TB treatment alone. The other 25 patients needed an intervention either in the form of pigtail catheter drainage of the paravertebral collection (n = 18) or an extensive surgical debridement followed by the fusion techniques (n = 7). All the patients responded well to the treatment, and there were no significant complications in any of the patients. It had been observed that various stages of spinal TB demand different approaches for the treatment in the form of either chemotherapy alone, chemotherapy with pigtail drainage of the paravertebral collection, or surgery in conjunction with chemotherapy.Conclusions:Judicious use of pigtail drainage and surgical intervention in addition to anti TB treatment can be rewarding in the patients with spinal TB.

The changing trends in management of spinal tuberculosis: Are we hitting a better road?

The changing trends in management of spinal tuberculosis: Are we hitting a better road?

Management of Tuberculous Infection of the Spine.

Spinal tuberculosis accounts for nearly half of all cases of musculoskeletal tuberculosis. It is primarily a medical disease and treatment consists of a multidrug regimen for 9–12 months. Surgery is reserved for select cases of progressive deformity or where neurological deficit is not improved by anti-tubercular treatment. Technology refinements and improved surgical expertise have improved the operative treatment of spinal tuberculosis. The infected spine can be approached anteriorly or posteriorly, in a minimally invasive way. We review the various surgical techniques used in the management of spinal tuberculosis with focus on their indications and contraindications.

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.