Treatment Of Tuberculous Spondylitis Research Articles

Differentiated Approach to the Diagnosis and Treatment of Tuberculous Spondylitis in Adults

The purpose of this study is to generalize the results of a complex clinical-laboratory, radiological and immunological study of patients with spinal tuberculosis. A comprehensive examination analysis was carried out in 192 patients with tuberculous spondy litis who were in the department of surgery for osteoarticular tuberculosis of the Republican Specialized Scientific and Practical Medical Center of Tuberculosis and Pulmonology in Tashkent, Uzbekistan. Severe degrees of spinal disorders were found in 48.7% of patients. Magnetic resonance imaging (MRI) and multi-slice spiral computed tomography (MSCT) allow establishing the stage and activity of a specific process in the spine, as well as complications. Spinal column instability was detected in 143 (74.5%) patients, paravertebral abscesses in 116 (60.4%) patients, and epidural abscesses in 75 (39.0%) patients. Changes in immunological parameters in patients with spinal tuberculosis were associated both with impaired regulation of immunogenetic and with the direct influence of the immune system at various stages of the process. The detection of certain patterns of immune system disorders in patients with tuberculous lesions of the spine allowed us to make a differentiated approach to their treatment in order to increase the effectiveness of the treatment. It can be concluded that at present, tuberculosis of bones and joints, especially the spine, is detected in an advanced stage in 50-80% of cases and has a widespread and complicated character with profound anatomical and functional changes and the presence of severe spinal disorders in 48.7% patients in Uzbekistan. Regarding spondylitis, it is immensely important to make an accurate diagnosis based on the clinical presentations, laboratory, radiological and immunological findings and by periodic assessment of the response to treatment, which is essential in atypical cases.

Single-Stage Combined Anterior Corpectomy and Posterior Instrumented Fusion in Tuberculous Spondylitis With Varying Degrees of Neurological Deficit.

A combined anterior decompression and stabilization followed by posterior instrumented fusion promotes fusion of the affected segment of spine and prevents further progression of deformity. The objective of this study is to report on outcome of patients with tuberculous spondylitis, progressive neurologic deficit, and kyphotic deformity who underwent single-stage anterior corpectomy and fusion and posterior decompression with instrumented fusion. A total of 49 patients (29 males, 20 females) with varying grades of neurological deficit due to tuberculosis of the spine (thoracic, thoracolumbar, and lumbar) were included in this prospective study. The diagnosis of tubercular infection was established after clinical, hematological, radiological, and histological specimens taken at surgery. All were treated with combined anterior and posterior decompression, debridement, and stabilization with direct autologous bone grafting or wrapped bone graft in mesh or expandable cages. Neurological status and visual analog scale (VAS) pain score were recorded at each visit. X-rays, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and liver function were evaluated at 3, 6, and 12 months after surgery and then once a year thereafter. Results were analyzed in terms of neurological recovery (Frankel grade), bony union time, and correction of kyphotic deformity. The mean age was 37.8 years (range, 2-65 years). Mean preoperative VAS scores improved from 5.6 to 1.5. The average ESR and CRP returned to normal within 6 months in all patients. The mean time to fusion was 8.4 months for the whole group. The neurological deficit in 42 of 49 patients had excellent or good clinical outcome (P < .0001). A total of 10 of 17 patients improved from Frankel A and B to Frankel E (normal activity). Three patients each in the thoracic and thoracolumbar groups improved to Frankel D. Radiological measurements showed the mean kyphotic correction was 61%, 66%, and 67% in the thoracic, thoracolumbar, and lumbar/lumbosacral spine, respectively. Combined single-stage anterior decompression and stabilization followed by posterior instrumented fusion is safe and effective in the treatment of tuberculous spondylitis with neurological deficit in the thoracic and lumbar spine. This procedure helps to correct and maintain the deformity, abscess clearance, spinal-cord decompression, and pain relief as well as return to normal motor function. Bony fusion prevents further progression of deformity. 2.

Conservative &amp; Operative Management of Tuberculous Spondylitis in Children

Background: Tuberculosis is a deadly disease worldwide. Tuberculosis usually occurs in the lung, but there are other tuberculosis most commonly afflicted by the patient and involves the spine and is called tuberculosis of bones and joints. Management of tuberculous spondylitis is conservative and operative. Aim: This study aimed to compare the results of conservative and operative therapy in the management of tuberculous spondylitis in children. Methods: The sample used was teaching with tuberculous spondylitis in Dr. Soetomo General Hospital who underwent operative and conservative therapy that became group 1 and group 2. Inclusion criteria included patients aged &lt;18 years old, suffering from tuberculous spondylitis by conservative or operative therapy in Dr. Soetomo Hospital. Results: In patients receiving conservative therapy, the Visual analog scale (VAS) decreased significantly (p = 0.001), while frankle improved but not significantly (p = 0.157). Cobb’s angle of patients receiving conservative therapy increased significantly (p = 0.007). Patients who received operative therapy showed significant improvement of VAS and Frankle (p = 0.001 and p = 0.011). The patient’s Cobb’s angle after surgery decreased but it was not significant (p = 0.575). Conclusion: The role of surgical action has an important role in the treatment of tuberculous spondylitis and gives better results than conservatives in patients with pain, neurological deficits and Cobb’s angle progression.

SURGICAL TREATMENT OF TUBERCULOUS SPONDYLITIS IN A PATIENT, LIVING WITH HIV INFECTION, ON A BACKGROUND OF DEEP IMMUNOSUPPRESSION

Purpose: аnalysis of typical case of complicated course of tuberculous spondylitis in a female patient living with deep immunosuppression. Materials and methods: the Examination and treatment of the patient was carried out in accordance with national clinical guidelines for TB using standardized scales and by the presence of postoperative complications. Conclusion: late referral of the patient for medical care (after 7 months from disease onset), lasting, conservative (6 months) treatment without regard to sensitivity to anti-TB drugs, ineffective surgical on the treatment of tuberculous spondylitis has led to a complicated course of tuberculosis spondylitis. The error in tactics of treatment has led to the need for further multi-stage surgical treatment.

Efficacy of anterior column reconstruction in tuberculosis of the cervical spine with stand-alone titanium cage without anterior plating

Tuberculosis (TB) is a common disease, especially in underdeveloped countries. TB of the vertebral column constitutes nearly 50% of all lesions of osteoarticular TB. The most common site for the disease is the peridiscal region. The primary treatment option is usually anti-TB chemotherapy, but in some patients with severe pain and neural involvement, instability and a large abscess, surgery is recommended. To our knowledge there are no publications describing the use of a stand-alone titanium cage and bone graft without anterior plating in the treatment of tuberculous spondylitis (TBS). The aim of this study is to evaluate the efficacy of stand-alone titanium mesh cages in TB of the cervical spine. A retrospective study of 47 patients with cervical TBS was carried out at Ghurki Trust Teaching Hospital, Lahore, Pakistan, of whom 61.6% were aged 3–35 years and 28.4% were aged 36–70 years. Twenty-six were male and 21 were female. Preoperative spinal function was categorized as Frankel grade E in 26 patients, Frankel grade D in four patients, Frankel grade C in 10 patients, Frankel grade B in two patients and Frankel grade A in five patients. Following surgery, one patient categorized as Frankel grade A remained the same while the remaining four improved to grade C at follow-up. The rest of the patients improved to grade E at the 2-year follow-up. The mean preoperative Cobb angle was 39.06° [standard deviation (SD) 10.92°], which improved to –5.51° (SD 77°) (P < 0.05). When comparing the visual analogue scores, there was also a statistically significant difference in pain improvement. All patients underwent single-stage radical debridement, decompression and instrumentation. Anterior column reconstruction was performed in all patients using a stand-alone titanium cage. The use of titanium cages effectively corrects sagittal deformity in the TB-affected spine with no donor site morbidity.

A Case of Pott’s Disease: Cold Abscess in a Haitian Woman Presenting with Chronic Back Pain

Background: Tuberculous spondylitis is a bacterial infection caused by Mycobacterium tuberculosis. This bacteria usually attacks the lungs but can attack any part of the body such as the kidney, spine, and brain. Spine being the most frequently affected site, Spinal TB patients typically present with back pain but other constitutional or pulmonary symptoms may be absent, rendering the diagnosis difficult. Mycobacterium tuberculosis can remain dormant for decades after the initial infection and doesn’t always cause infections. Case: We report a case of a 23-year-old Haitian woman who presented with increased swelling in right lower flank and vague lower back pain for two years before being diagnosed with tuberculous spondylitis. Conclusion: Physicians in the USA often miss opportunities to identify patients with tuberculous spondylitis considering its endemic in various countries around the world. Symptoms may be vague and screening tests have limitations. We review current strategies for diagnosis, and treatment of tuberculous spondylitis in immigrant patients who have lived in endemic areas and discuss the clinical features and management the infection.

Does anterior Column Reconstruction Works in the Surgical Management of Tuberculosis of the Spine?

Introduction Drug therapy still remains the main stay in the treatment of TB spine. However, surgery is indicated in some patients. According to the MRC guidelines, radical ventral debridement, fusion, and the reconstruction of the spinal column remain the gold standard of surgical treatment for tuberculous spondylitis as popularized by Hodgson and his coworkers as the “Hong Kong” procedure. The lack of resources such as theater time, and the dual impact of HIV disease and TB pandemic led to the development of other surgical management techniques. Thus, the anterior debridement and anterior column reconstruction has evolved as a method of surgical intervention. The aim of this study is to report on the adequacy and outcome of patients treated with this surgical technique. Patients and Methods This is a retrospective study of 54 TB spine patients (25 males and 29 females) who had anterior decompression and interbody fusion over a 3-year period (from 2012 to 2014). The indications for surgery were essentially the same as for 360 degrees decompression and fusion. The average age of our patients was 38.6 years and the disease was thoracic in 49 cases and thoracolumbar in only 5 cases. Except for six cases of single vertebral body involvement, all of our cases have two contiguous vertebral bodies involvement and required a four-body fusion. In four cases, we used fibular strut graft, while the titanium mesh cage with a mixture of allograft and autograft (the cut rib) was used in majority of the cases. The mean follow-up period was 13 months (ranging from 6 to 30 months). Results The average preoperative kyphosis was 30 degrees; this improved to an average of 21 degrees postoperatively but falls to 27 degrees on the last follow-up (overall 10% improvement in the kyphosis angle). The mean Frankel neurology grading at the last follow-up was D (improvement from B to E). No loosening or breakage of implants occurs and no graft/mesh displacement recorded. Conclusion Early results of the anterior decompression and interbody fusion indicates that the method is adequate and the outcome gratifying. We therefore conclude that the procedure is an effective and adequate surgical technique for treating TB spine, but with possible risk of major complications.

Paralysis developing as a paradoxical response during treatment for tuberculous spondylitis.

Dear Editor We read with great interest the published article by Park et al. [1] entitled Paralysis Developing as a Paradoxical Response During the Treatment for Tuberculous Spondylitis: A Case Report. The authors report the case of a 69-year-old woman who experienced bilateral lower extremity paralysis secondary to a paradoxical response. We think several more points should be discussed concerning therapy. Spinal tuberculosis is the most common and the worst form of tuberculosis lesions in the skeleton [2,3,4]. If the lesion is limited to the vertebrae and 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 on 76 cases with spinal tuberculosis between 1989 to 2002 without any neurological deterioration that all featured eventual excellent recovery. As a result, these authors developed a effective classification system abbreviated GATA (Gulhane Askeri Tip Akademisi). This new classification system has been using as a practical guide in the treatment of Pott disease. In the case that was presented in the article, despite the initiation of medical treatment, deterioration in the clinical status of the patient was observed. However, when we examined the MRI in Fig. 1, we noted vertebral collapse and abcess formation, which is type II in the GATA classification system. Type II treatment is anterior debridement and fusion. As a result, we believe that if surgical intervention is made at the time of diagnosis (early stage), the patient will heal more quickly without any neurological deterioration.

In reply: paralysis developing as a paradoxical response during the treatment for tuberculous spondylitis.

We appreciate your valuable comments. At the time of diagnosis, the orthopedic surgeon recommended an operation (anterior debridement and fusion) for the patient with vertebral collapse [1]. However, the patient refused the surgery and wanted to receive conservative treatment. Kotil et al. [2] reported that 44 patients with tuberculous spondylitis were managed conservatively with anti-tuberculous medication and spinal orthosis. Exclusion criteria were major motor deficit, deteriorating neurologic function, or spinal deformity greater than 30° at the affected level of spine. Forty-two patients (95.4%) were treated well without any progression of the spinal deformity. Consequently, the authors suggested indications for surgery in tuberculous spondylitis with the following conditions: 1) gross neurologic impairment and instability or deformity, 2) treatment failure, 3) neurologic deterioration, 4) paradoxical response, or 5) intolerance to anti-tuberculous medication. Additionally, Zhang et al. [3] suggested that there was no significant difference in the outcomes between the anti-tuberculous medication plus surgery and the medication alone, in a meta-analysis. However, there have been only two randomized controlled trials (331 patients) which were conducted in the 1970s and 1980s. Thus, a large, well-conducted, randomized controlled trial is needed to conclude the indications for surgery in tuberculous spondylitis. Therefore, conservative treatment including anti-tuberculous medication and rigid thoracolumbosacral orthosis (TLSO) was chosen for the patient.

One-stage posterior approach for the treatment of tuberculous spondylitis with kyphosis

Background Patients with Pott's disease who are candidates for surgical intervention can be approached posteriorly, anteriorly, or combined. Each of these approaches has advantages and disadvantages. In this study we evaluated the results of one-stage posterior approach by using anterolateral rachotomy with radical excision of the lesion, correction of kyphotic deformity, and fixation with trans pedicular screw fixation (TPSF) in 22 patients with thoracic tuberculous spondylitis with kyphosis. Patients and methods A total of 22 patients with thoracic tuberculous spondylitis with kyphosis were treated by using the one-stage posterior approach. Preoperatively all patients were suffering from pain, and had neurological deficit (20 Frankle B and two Frankle C). The maximum kyphotic angle was 45°, whereas the minimum was 25°. All cases underwent radical excision of the lesion, strut iliac graft, and TPSF through posterior approach. Results Immediately postoperatively all patients showed improvement in pain severity; all patients with neurological deficits improved within 2 months after surgery; hematological parameters demonstrated a significant clinical improvement in all patients. Radiological follow-up showed solid fusion within 6 months in 20 patients. The mean kyphotic angle was corrected from 30 to 15° after surgery. Conclusion Anterolateral rachotomy of thoracic Pott's lesion by using radical excision of the lesion, strut iliac bone graft, and TPSF under the umbrella of antituberculous preoperative and postoperative give satisfactory results without the need for the more morbid and technically demanding anterior or combined procedures in patients with mild kyphosis (<45°).

Paralysis developing as a paradoxical response during the treatment for tuberculous spondylitis: a case report.

It can be difficult for clinicians to distinguish a paradoxical response to antituberculous therapy, worsening of an existing lesion despite adequate treatment, treatment failure, and drug resistance. We report a case of a 69-year-old woman who experienced bilateral lower extremity paralysis secondary to a paradoxical response. She had been suffering for 1 month from low back pain, due to tuberculous spondylitis. Her low back pain improved after antituberculous therapy. The low back pain, however, reappeared 2 months after treatment, accompanied by newly developed lower extremity weakness. Imaging studies showed an increased extent of her previous lesions. Consequently, the patient underwent a vertebral corpectomy with interbody fusion of the thoracolumbar spine. Histopathological examination showed chronic inflamed granulation tissue with no microorganisms. Although the antituberculous medication was not changed, the patient's symptoms and signs, including the paralysis, resolved after surgery.

Tuberculosis of spine: current views in diagnosis and management.

Tuberculosis is the chronic consumptive disease and currently the world's leading cause of death. Tuberculous spondylitis is a less common yet the most dangerous form of skeletal tuberculosis. The recent re-emergence of Mycobacterium tuberculosis (M. tuberculosis) hints at a possible resurgence of tuberculosis in the coming years. This article discusses the clinical manifestations, diagnosis and treatment of tuberculous spondylitis, and updates material that the author has previously published on the subject. Treatment should be individualized according to different indications which is essential to recovery. A treatment model is suggested on the basis of the author's vast personal experiences.

Tuberculous spondylitis after percutaneous vertebroplasty: misdiagnosis or complication?

So far, there have been few previous reports of tuberculous spondylitis occurring after percutaneous vertebroplasty. We report an unusual case of tuberculous spondylitis diagnosed after percutaneous vertebroplasty in a patient who had a history of pulmonary tuberculosis for the first time. A 58-year-old woman, who had a history of complete recovery from pulmonary tuberculosis six years previously, was hospitalized due to severe back pain after a fall. Radiological studies revealed a fresh compression fracture at the T12 thoracic vertebra. The back pain improved dramatically, and the patient was discharged two days after the vertebroplasty. However, cold sweats and a low grade fever with severe back pain developed four weeks after the procedure. Magnetic resonance imaging revealed a severe kyphosis and the T11-T12 disc space had collapsed with heterogeneous signal intensity. The results of the culture of the biopsy specimens were negative, and did not lead to identification of the causative micro-organism. However, the polymerase chain reaction for Mycobacterium tuberculosis was positive. Treatment for tuberculous spondylitis was started and she underwent posterior fusion and instrumentation from T9-L2 after the markers for infection returned to normal. After surgical intervention, the pain improved and the kyphotic deformity was corrected.

The influence of extended posterior instrumentatiоn on the vertebral growth after surgical correction of severe kyphosis in children

Objective. To study the effect of modern methods of spinal instrumentation for treatment of tuberculous spondylitis on growth of vertebrae after deformity correction in extensively growing children. Material and Methods. A total of 28 preschool age children were operated on for tuberculous spondylitis complicated by kyphosis exceeding 50°. Eight patients were operated on without posterior instrumentation, 20 patients - with additional posterior compressive implants. More than one year follow-up included assessment of the following metric parameters: anterior and posterior vertical size of fusion, anterior and posterior vertical size of the intact vertebra caudal to the anterior fusion inside and outside the instrumented zone. Results. Degenerative changes in the initially intact spinal motion segments within fixation zone were observed for 2 years after surgery in 17 out of 20 patients operated on with posterior instrumented fixation. These changes were presented by a sharp decrease in the intervertebral disc height and by a sclerosis of adjacent end plates. Conclusion. Children operated on with application of modern implants have not still reach the age of the growth stop, though follow-up periods are sufficiently long. This does not allow predicting the spine development in the adolescence.

Safety and Efficacy of Pedicle Screws and Titanium Mesh Cage in the Treatments of Tuberculous Spondylitis of the Thoracolumbar Spine

Study DesignThis is a retrospective series.PurposeWe wanted to analyze the safety and effectiveness of using the newer generation metallic implants (pedicle screws and/or titanium mesh) for the treatment of tuberculous spondylitis.Overview of the LiteratureThere have been various efforts to prevent the development of a kyphotic deformity after the treatment of tuberculous spondylitis, including instrumentation of the spine. Pedicle screws and titanium mesh cages have become more and more popular for treating various spinal problems.MethodsTwenty two patients who had tuberculous spondylitis were treated with anterior radical debridement and their anterior column of spine was supported with a tricortical iliac bone graft (12 patients) or by mesh (10 patients). Supplementary posterior pedicle screw instrumentation was performed in 17 of 22 patients. The combination of surgeries were anterior strut bone grafting and posterior pedicle screws in 12 patients, anterior titanium mesh and posterior pedicle screws in 5 patients and anterior mesh only without pedicle screws in 5 patients. The patients were followed up with assessing the laboratory inflammatory parameters, the serial plain radiographs and the neurological recovery.ResultsThe erythrocyte sedimentation rate and C-reactive protein levels were eventually normalized and there was no case of persistent infection or failure to control infection in spite of a mettalic implant in situ. The overall correction of kyphotic deformity was initially 8.9 degrees, and the loss of correction was 6.2 degrees. In spite of some loss of correction, this technique effectively prevented clinically significant kyphotic deformity. The preoperative Frankel grades were B for 1 patient, C for 4, D for 4 and E for 13. At the final follow-up, 7 of 9 patients recovered completely to Frankel grade E and only two patients showed a Frankel grade of D.ConclusionsStabilizing the spine with pedicle screws and/or titanium mesh in patients with tubercuous spondylitis effectively prevents the development of kyphotic deformity and this did not prevent controlling infection when this technique was combined with radical debridement and anti-tuberculous chemotherapy.

Simultaneous Anterior and Posterior Surgery in the Management of Tuberculous Spondylitis with Psoas Abscess in Patients with Neurological Deficits

Study DesignThis is a retrospective study.PurposeWe wanted to evaluate the treatment outcomes of performing simultaneous anterior and posterior surgery for patients with tuberculous spondylitis and psoas abscess.Overview of LiteratureAlthough various treatment options have been used for spinal tuberculosis, there are only a few reports on the treatment of tuberculous spondylitis with psoas abscess.MethodsBetween March 1997 and February 2006, we performed operations on 14 cases of tuberculous spondylitis with psoas abscess. All the cases underwent anterior debridement with an interbody bone graft and posterior fusion with using pedicle screws.ResultsUnder the Frankel classification, 1 case improved by two grades, 10 cases improved by 1 grade and 3 cases demonstrated no change. The Kirkaldy-Willis functional outcomes were classified as excellent in 10 cases and good in 4. One year after surgery, bony union was confirmed in all 14 cases. The mean kyphotic angle of the spinal lesion was 12.4° and the mean lordotic angle at the final follow-up was 6.4°. Postoperative complications (superficial wound infections) were encountered in 2 cases.ConclusionsOur results demonstrate that anterior debridement with interbody bone grafting and posterior instrumented fusion can provide satisfactory results for treating tuberculous spondylitis with psoas abscess in patients with neurological deficits.

Diagnosis and Treatment of Tuberclous Spondylitis and Pyogenic Spondylitis in Atypical Cases

Study DesignA retrospective study.PurposeThis is a study of the diagnosis and treatment of tuberculous spondylitis and pyogenic spondylitis in atypical cases.Overview of LiteratureThere have been several reports about clinical, hematological, pathological and radiological findings to differentiate pyogenic & tuberculous spondylitis.MethodsWe screened 55 patients diagnosed with tuberculous spondylitis and pyogenic spondylitis from January 1999 to June 2003. There were seven cases where it was difficult to make an accurate diagnosis. We reviewed the clinical manifestation, laboratory tests, radiological findings and confirmed the diagnoses by the use of biopsies and/or clinical response to treatment.ResultsFour cases, which were initially diagnosed as pyogenic spondylitis, had a clinical presentation of fever (37.4~38.5℃) on the day of hospitalization. These cases later turned out to be tuberculous spondylitis, as confirmed by an open biopsy and pathologic study. Three cases initially diagnosed as pyogenic spondylitis were treated with broad-spectrum antibiotics. Symptoms were aggravated in these cases, but improved after the use of an anti-tubercular drug. Bony union was observed in all cases in an averageof 4 months (range, 3~6 months).ConclusionsIn infectious spondylitis, it is important to establish an accurate diagnosis. An accurate diagnosis can be made by laboratory findings and by estimation of the response to treatment during follow-up. If there is no response or aggravation of symptoms despite treatment based on an initial diagnosis, the etiologic organism must be re-evaluated. A biopsy and observation of clinical response are needed to confirm the diagnosis.

Treatment of Tuberculous Spondylitis with Anterior Stabilization and Titanium Cage

We retrospectively reviewed 12 patients with spinal tuberculosis of the thoracic and lumbar spine who had radical débridement, anterior decompression, interbody arthrodesis with an anterior interbody titanium cage, and autologous bone grafts, combined with a standardized perioperative antituberculous regimen. Their mean age was 55.1 years and they were observed for a mean of 65.3 months. Indications for surgery included epidural abscess, structural destruction with instability, progressive kyphosis, and/or neurologic deterioration. Kyphotic deformity was corrected from a mean of 24.6 degrees (range, 15 degrees-32 degrees) to a mean of 10 degrees (range, 4 degrees-18 degrees). Tuberculous infection was controlled and bony fusion was achieved in all patients. No recurrence of infection or construct failure was recorded. All patients were safely mobilized within the first postoperative week; back pain fully resolved in eight patients and improved in the remaining four. We conclude that radical débridement followed by anterior stabilization with a titanium cage and bone grafting is a reasonable alternative for tuberculous spondylitis requiring surgical treatment. It enables accurate and lasting deformity correction and provides adequate stability to allow early mobilization. The presence of a titanium cage in an area of mycobacterial infection did not preclude infection control or lead to recurrence. Therapeutic study. Level IV (case series). Please see Guidelines for Authors for a complete description of levels of evidence.

Treatment of tuberculous spondylitis in persons of elder age groups

The results of the combined early surgical treatment of patients over 55 years of age with tuberculous spondylitis are analyzed. The conservative therapy tactics and surgical treatment method the combination of the radical operation in the tuberculous focus with external fixation of vertebrae by Byrovs apparatus are described. The method applied allows to reduce the terms of the bed postoperative period.

Surgical treatment of tuberculous spondylitis in the TB Dispensary

Treatment of tuberculous spondylitis in TB dispensaries remains a difficult task. Conservative treatment of spinal tuberculosis is effective only at the initial stage of the lesion. However, in recent years, focal forms of TB occur less frequently among newly diagnosed patients, and neglected and complicated forms of this disease, on the contrary, are more frequent, which is associated with diagnostic errors. In such cases, conservative treatment and antibacterial agents are ineffective; they are used only in the period of preoperative preparation and especially after surgery.