Spinal Tuberculosis Research Articles

A case report of bilateral psoas abscess with co-existing gluteal abscess in Pott`s disease of the spine in a middle-aged woman in a Specialist Hospital

Psoas abscess (PA) is the buildup of suppurative fluid in the fascia surrounding the psoas/iliopsosas muscle, is a rare condition, with diagnostic difficulty. Pott`s disease also called spinal tuberculosis occurs due to extra pulmonary tuberculosis. Backpain, fever, weight loss, lump in the groin and limping are its main symptoms. Curable by administering antitubercular therapy and sensitive antimicrobials with analgesics for indicative relief. Surgical procedures can be carried out to eliminate the accrued fluid based on the inter individual degree of presentation. In this case report, we report a rare case of bilateral psoas abscess with co-existing gluteal abscess and Potts’s disease. A 48-year old female presented with complaints of backpain, limping, lump in the flank/buttock and fever of two weeks. Abdominopelvic computed tomography scan showed massive right iliopsoas muscle collection with extension into the ipsilateral gluteal region and subcutaneous tissue. Similar collection was seen in the left psoas muscle superiorly. The bone window of the lumbosacral spine showed the anterior wedged collapse of the vertebral bodies with gibbus deformity. The patient had spontaneous rupture of the gluteal collection and surgical drainage of the right iliopsoas and left psoas collection was done. Anti-Kochs therapy was commenced and patient is currently doing great. The introduction of computed tomography (CT) and magnetic resonance imaging (MRI) has greatly improved the diagnosis of psoas abscess with Pott`s disease or in its isolated forms.

How to determine the course of preoperative chemotherapy for spinal tuberculosis: A single-center clinical study.

This study aims to explore the clinical efficacy and feasibility of preoperative 1-week chemotherapy for patients with spinal tuberculosis (STB) undergoing complete lesion removal. Clinical data of 76 patients with STB who underwent complete focal debridement in our hospital were collected from June 2020 to September 2023. The patients were divided into 38 cases of preoperative 1-week chemotherapy group (Group A) according to the length of preoperative chemotherapy, and 38 cases of preoperative 2 to 4-week chemotherapy group (Group B). Perioperative related, imaging, and laboratory examination indices as well as postoperative neurological function recovery, postoperative pain recovery, related complications, and clinical efficacy were analyzed to compare the clinical efficacy of the 2 groups. All patients successfully completed the treatment of stage I complete lesion removal combined with bone grafting fusion and internal fixation. The difference in erythrocyte setting rate and C-reactive protein at the same postoperative observation time between the 2 groups was not statistically significant (P > .05). The visual analogue scale scores of patients in the 2 groups decreased significantly with prolonged time, and the difference was statistically significant (P < .05). All patients achieved satisfactory clinical efficacy (P < .05). All patients achieved good clinical outcomes, the difference between the groups was not statistically significant (P > .05). The difference in incision healing rate at 3 months postoperatively and bone graft fusion rate at 6 months postoperatively was not statistically significant between the 2 groups (P > .05). The dissemination and recurrence of Mycobacterium tuberculosis were not statistically significantly different between the 2 groups after surgery (P > .05). In summary, with complete lesion clearance, 1 week of preoperative chemotherapy is feasible in patients with STB with varying degrees of neurological dysfunction.

A Retrospective Study on Endoscopic Surgery for the Treatment of Paravertebral Abscess in Spinal Tuberculosis Patients

A Retrospective Study on Endoscopic Surgery for the Treatment of Paravertebral Abscess in Spinal Tuberculosis Patients

Morphological and Clinical Aspects of Pott's Disease in Ancient Human Remains: A Scoping Review.

The present study is a scoping review of the literature on Pott's disease in ancient human remains. Comprehending the origin and history of Pott's disease is relevant to assessing this pathological condition from an evolutionary perspective. Tuberculosis (TB) is an ancient pulmonary disease that remains the leading cause of death from a single infectious agent, rating above HIV/AIDS. The disease typically affects the lungs but can also target other anatomical sites. Of those, the most common and characteristic are the skeletal changes involving the spine, such as in Pott's disease. Spinal tuberculosis accounts for approximately half of all cases of musculoskeletal tuberculosis. It can lead to loss of function in the lower limbs due to damage to the spinal column. Nevertheless, its origin and evolution are still not fully understood and need further investigation. The authors investigated the published studies on Pott's disease in ancient human remains, intending to survey the literature, map the evidence and identify gaps and future perspectives on TB in paleopathology. The search strategy was conducted between September 2021 and March 2023 using keywords including the terms "Pott disease" OR "tuberculosis" AND "skeletal remains" in PubMed Biomed Central, Scopus, and Google Scholar search engines and biomedical databases. Five hundred and three records were initially identified, and 66 studies were finally included and assessed for qualitative analysis. Finally, the included records were analyzed in terms of non-narrative data, including the type of publication, country of excavation, dating of the sample, the number of human remains, and their details. Furthermore, the type of bone lesion was indicated as well as the diagnostic method if detailed. Among articles identified, most were classified as original articles, and were published between 2011 and 2020. Close to 77% of the records reported excavation in Europe and the Near middle east. Included studies considered a total of 3388 human remains, mostly excavated in archaeological sites and necropolis. Interestingly, the reported prevalence was higher among young males and adults. Although most of the findings are consistent with the literature, since the majority of the human remains were from Europe and the Near Middle East, more research is necessary in other sectors of the world. The suggestion of a male predominance needs to be confirmed and questions about the possible pathognomic role of rib lesions as well Serpes endocranica symmetrica (SES) represent further areas of research that need to be explored.

Mechanism research of Tollip negative feedback regulation in TLR4 signaling pathways based on spinal tuberculosis: Detection of Tollip and NF-κB expression levels

The emergence of drug-resistant mycobacterium tuberculosis (MTB, or TB) strains has led to an increasing incidence of TB. Spinal tuberculosis is the most common extrapulmonary tuberculosis. In the present study, tollip, a negative feedback regulatory factor in TLR4 signaling pathway was chosen based on previous studies on osteoarticular tuberculosis. U937 cells were transfected with recombinant lentivirus containing shRNA (RNA interference, RNAi) or overexpression vector containing Tollip gene and tested in vitro. The expression levels of Tollip and TLR4 were detected by Real-time PCR and immunofluorescence techniques, and the cell morphology and infection effect were observed by DAPI staining. The results suggested that Tollip gene could negatively inhibit the expression of related factors in TLR4 signaling pathway, and thus is a potential biomarker for early diagnosis.

Debridement and Bone Graft Fusion via the Lateral Extracavitary Approach Combined with Lateral and Posterior Screw-rod Fixation in the Treatment of Thoracic Spinal Tuberculosis: A Retrospective Study of 38 Cases

ObjectivesThoracic spinal tuberculosis (TB) is still common, and surgical treatment can rapidly relieve pain, correct deformity, reduce bone loss and prevent further damage to neurological function. We have practiced an efficient and safe surgical method. MethodsFrom January 2013 to April 2021, 38 patients with thoracic spinal TB were included in our study. Debridement and bone grafting were performed via the lateral extracavitary approach, combined with two different fixation methods. Data from these cases were analyzed retrospectively. ResultsFor all cases, the C-reactive protein (CRP) level and erythrocyte sedimentation rate (ESR) of all the patients decreased to normal levels at the last follow-up. The average visual analog scale (VAS) score was 7.5±1.6 preoperatively and 0.6±0.8 at the last follow-up, showing a significant reduction. The average angle of kyphosis correction was 6.3±4.7°, and the loss of correction was 1.4±1.6°. Neurological function was significantly improved in all cases according to the American Spinal Injury Association (ASIA) classification. Solid fusion was observed in all cases at the last follow-up. ConclusionsDebridement and bone graft fusion via the lateral extracavitary approach combined with two fixation methods can be very effective in the treatment of thoracic spinal TB.

Hypercalcemia, from the Doctor's Office to the Hospital: The Path to Diagnosis in a Patient with Pott Disease

Hypercalcemia, from the Doctor's Office to the Hospital: The Path to Diagnosis in a Patient with Pott Disease

Survey of spinal tuberculosis in Basrah

Background. Tuberculous spondylitis (TS) or spinal tuberculosis is secondary either to pulmonary or intestinal tuberculosis and may be the initial manifestation of tuberculosis (TB). Spinal TB also called Pott’s disease is by definition, an advanced severe disease, requiring accurate evaluation and aggressive systemic therapy. Objective. This study was conducted to demonstrate the prevalence and clinical, laboratory, and management characteristics of patients with spinal tuberculosis in Basrah governorate. Methods. A cross-sectional descriptive retrospective and prospective study was conducted during the period of March 2020 to December 2021. All cases either registered at the tuberculous center / Basrah Health Director were viewed by phone calling or recall or newly diagnosed with spinal tuberculous which attended to Basrah Teaching Hospital. Those patients were followed after diagnosis and treatment initiation for any clinical improvement, worsening or no improvement after diagnosis. Results. Among 51 enrolled patients with spinal tuberculosis in this study, the age distribution was 20-39 years old 23 (45.09%). Most of the patients were males (32) with rates 62.74%. The most common site of vertebral involvement is dorsal segment 29 (56.86%). The most common presenting complaints were: back pain in 49 patients (96.07%). Regarding the examination findings, 2(13.33%) with deformity either kyphotic or gibbous deformity. Most of the examined patients had a power grade 1-3/5 (93.33%) in the lower limbs. Out of the 4 cases of cervical tuberculosis, all of them had been managed conservatively, while 6 out of 16 cases (37.5%) diagnosed with lumber lesions were managed conservatively, and 10 cases (62.5%) were managed surgically. Conclusion. The prevalence and characteristics of patients with spinal TB follow the global trend, although some differences were recorded, but it was not that significant. The surgical approach is still superior to the conservative one in the improvement of neurological deficits.

Comparison of Clinical Outcomes of Posterior-Only Transforaminal Debridement and Interbody Fusion With Preservation of Posterior Ligamentous Complex Versus Conventional Posterior-Only Debridement and Interbody Fusion for Thoracic Spine Tuberculosis: A Prospective, Randomized, Controlled, Clinical Trial - A Pilot Study.

The main objective of this study was to analyze the efficacy and feasibility of surgical management for patients with thoracic spinal tuberculous spondylitis (STB) by using posterior-only transforaminal debridement and interbody fusion (PTDIF) with preservation of posterior ligamentous complex (PLC) and noninferior of PTDIF compared with conventional posterior-only debridement and interbody fusion (CPDIF). From January 2019 to January 2022, a prospective, randomized, controlled trial was conducted in which patients with thoracic STB were enrolled and assigned to undergo either the PTDIF group (group A) or CPDIF group (group B) in a 1:1 ratio. The clinical efficacy was evaluated on average operation time, blood loss, hospitalization durations, visual analogue scale, Oswestry Disability Index scores, erythrocyte sedimentation rate (ESR), C-Reactive protein (CRP), and neurological function recovery using the American Spinal Injury Association's impairment scale and operative complications. Radiological measurements included kyphosis correction, loss of correction. The outcomes were compared between the groups at preoperation, postoperaion, and final follow-up. All 65 patients were completely cured during the follow-up. The intraoperative blood loss and operation time in group B were more than that in group A. All patients were pain-free at the final follow-up visit. ESR, CRP returned to normal limits in all patients 3 months after surgery. All patients had improved neurological signs. No significant difference was found in kyphosis angle correction, loss of correction between the 2 groups. PTDIF, with preservation of PLC, achieved debridement, decompression, and reconstruction of the spine's stability, similar to CPDIF in the surgical treatment of thoracic STB. PTDIF has less surgical trauma with less intraoperative blood loss and operation time.

Non-traumatic spinal cord injury - etiological profile and associated factors: single rheumatological center experience.

Non-traumatic spinal cord injury (NTSCI) represents a medical-surgical emergency. In Burkina Faso, limited data exist on the etiological profiles of this syndrome in rheumatology. This study aimed to describe the etiological profile of NTSCI in the Rheumatology Department of the University Hospital Center of Bogodogo (CHU-B). This was a cross-sectional, retrospective study with descriptive and analytical aims, conducted from March 1, 2017, to December 31, 2023, in the Rheumatology Department of CHU-B. Patients diagnosed with non-traumatic spinal cord compression syndrome during hospitalization were included. The frequency in the Rheumatology Department of NTSCI was 2.94%, accounting for 104 patients. There were 68 men (65.38%), with a sex ratio of 1.88. The average age of the population was 57.91 years. All patients experienced back pain, with a lumbar location in 77 patients (74.04%). The average duration of the motor deficit was 2.97 months. A total of 3,532 patients were admitted to the conventional hospitalization unit of the Rheumatology Department at the CHU-B from March 1, 2017, to December 31, 2023. Among these, 104 patients had NTSCI, yielding a frequency of 2.94%. Spinal MRI was performed in 58 patients (55.77%), and the compression was extradural in 76.92% of cases (n = 80). The etiologies identified were Pott's disease in 32 patients (30.77%), followed by spinal metastases in 22 patients (21.15%). Twenty-nine patients (27.89%) experienced complications related to prolonged bed rest. No factor was significantly associated with the recovery of the motor deficit. Non-traumatic spinal cord injury is relatively rare in rheumatological practice in Ouagadougou. The etiology is predominantly Pott's disease, which confirms the geographical distribution of NTSCI causes.

Exploring expression levels of the cGAS-STING pathway genes in peripheral blood mononuclear cells of spinal tuberculosis patients

BackgroundThis study aimed to investigate the differential expression levels of the cGAS-STING pathway in peripheral blood mononuclear cells (PBMCs) of spinal tuberculosis (TB) patients with different progression and its feasibility as a diagnostic marker.MethodsPeripheral blood and medical records of 25 patients with spinal TB and 10 healthy individuals, were prospectively collected and analyzed. PBMCs and serum were extracted from peripheral blood and the expression levels of the cGAS-STING pathway in PBMCs were measured by real-time PCR (RT-PCR) and serum interferon β (IFN-β) expression levels were measured by enzyme-linked immunosorbent assay (ELISA). The expression of Interferon regulatory Factor 3 (IRF3) in PBMCs was measured using western blot. Statistical analysis was performed using the SPSS 26.0 statistical package.ResultsThe results showed that the expression level of the TANK-binding kinase 1 (TBK1) and IRF3 was significantly higher in PBMCs (P < 0.05), in patients with active lesions than in patients with stable lesions. The serum concentration of IFN-β was significantly higher in patients with active lesions (P = 0.028). Compared with healthy individuals, the expression level of the cGAS-STING pathway was elevated in PBMCs of TB patients (P < 0.05), and the difference in the expression level of IFN-β was not statistically significant (P > 0.05), and the serum IFN-β concentration was elevated (P < 0.05). The calculated AUC values for TBK1 and IRF3 in PBMCs, IFN-β in serum and erythrocyte sedimentation rate (ESR) to distinguish between patients with active and stable lesions were 0.732, 0.714, 0.839, and 0.714 respectively.ConclusionsThe expression level of TBK1 and IRF3 in PBMCs, and IFN-β in the serum of patients with spinal TB is positively correlated with disease activity. TBK1 has higher specificity and IFN-β in serum has higher sensitivity when used to differentiate between patients with active and stable lesions.

Is Restoration of Sagittal Spinopelvic Parameters Necessary in Spinal Tuberculosis of Lumbar and Lumbosacral Spine? Conservative versus Operative Management

The relationship of spinopelvic parameters with spondylolisthesis is widely explored. However, there is scarce evidence on correlation of tuberculosis of lumbar spine with respect to spinopelvic harmony. The current study aims to find the association between functional outcomes and spinopelvic parameters in lumbar spine tuberculosis treatment. A total of 47 patients with active tuberculosis confined to lumbar spine were prospectively analyzed and divided into 2 groups according to mode of intervention. Group A included 26 operatively managed patients and group B had 21 conservatively managed cases. Functional parameters comprising Oswestry Disability Index (ODI) and Visual Analog Scale (VAS) along with spinopelvic radiologic parameters (pelvic incidence [PI], pelvic tilt [PT], sacral slope [SS], lumbar lordosis [LL], PI-LL, sagittal vertical axis) in both groups were analyzed at 0 and 6 months of follow-up. Both the groups showed significant improvement from initial presentation to final follow-up in ODI (Group A: 85.4 ± 12.1-12.3 ± 3.2, P= 0.02; Group B: 82.5 ± 10.06-36.8 ± 11.9, P= 0.04) and VAS (Group A: 8.1 ± 1.2-1.4 ± 0.9, P= 0.02; Group B: 8.5 ± 0.09-3.5 ± 1.1, P=0.02). Statistically significant (P < 0.05) difference was observed in both functional outcome parameters between the 2 groups at 2-month and 6-month follow-up, compared with nonsignificant difference (P > 0.05) at presentation. Better improvements of spinopelvic parameters of PT, SS, LL, PI-LL were observed in Group A and in both groups the difference of these parameters correlated with differences of functional outcome parameters, though PI showed no correlation. The spinopelvic parameters played significant role in functional outcome. There is better functional outcome when LL is adequately restored. Surgical correction offered betterment of spinopelvic parameters like PT, SS, an sagittal vertical axis, which in turn leads to improvement in functional outcome.

Unlocking the Diagnostic Potential: A Systematic Review of Biomarkers in Spinal Tuberculosis.

Background/Objectives: Spinal tuberculosis (STB) is frequently misdiagnosed due to the multitude of symptoms it presents with. This review aimed to investigate the biomarkers that have the potential to accurately diagnose spinal TB in its early stages. Methods: A systematic search was conducted across multiple databases, yielding a diverse range of biomarkers categorized into complete blood count parameters, host inflammatory responses, bacterial antigens, and RNA-based markers. This review included studies on spinal tuberculosis patients, including blood serum biomarkers, while exclusion criteria included pediatric cases, cerebrospinal fluid or imaging biomarkers, co-infection with other bacteria, viruses, comorbidities, tumors, immune diseases, HIV infection, metabolic disorders, animal studies, opinion papers, and biomarkers relevant to health problems outside the disease. QUADAS-2 was used as a quality assessment tool for this review. This review identifies several promising biomarkers with significant diagnostic potential. Results: The neutrophil-to-lymphocyte ratio (NLR), monocyte-to-lymphocyte ratio (MLR), IFN-γ, CXCR3, CXCL9, CXCL10, PSMB9, STAT1, TAP1, and specific miRNA combinations demonstrated noteworthy diagnostic accuracy in distinguishing STB from other spinal pathologies. Additionally, these biomarkers offer insights into disease severity and progression. The review also highlighted the importance of combining multiple biomarkers to enhance diagnostic precision. This comprehensive systematic review underscores the potential of biomarkers to revolutionize the diagnosis of spinal tuberculosis. By integrating these markers into clinical practice, healthcare providers can achieve earlier and more accurate diagnosis, leading to improved patient care and outcomes. Conclusions: The combination of multiple biomarkers, including NLR, PSMB9, STAT1, and specific miRNAs, demonstrates promising diagnostic accuracy.

Association between nutritional scores and multilevel vertebral involvement in tubercular spine: a retrospective cohort study.

The objective of this study is to evaluate the prognostic value of nutritional scores comprising the Controlling Nutritional Status (CONUT) score and the Prognostic Nutritional Index (PNI), in prediction of multilevel vertebral involvement (> 2 vertebra) in Spinal Tuberculosis (STB). Retrospective analysis of 39 STB patients was conducted to assess nutritional indices (CONUT and PNI) and the numbers of vertebral affection. Spearman's correlation was used to examine the association between these variables. Receiver Operating Characteristic (ROC) curves were utilized to determine optimal cutoff values, with Area Under the Curve (AUROC) evaluation. Additionally, multiple logistic regression was performed as a predictive model. There were 24 males and 15 females, with a mean BMI of 18.88kg/m² (± 1.37). Spearman's correlation analysis revealed negative correlations between BMI, PNI (rho - 0.68, p < 0.001) and multilevel vertebra involvement, while ESR (rho 0.83, p < 0.001), CRP (rho 0.81, p < 0.001), and CONUT score (rho 0.83, p < 0.001) positively correlated with multilevel vertebral affection (> 2 vertebra). Age and comorbidities showed no correlation with the level of vertebral affection. ROC analysis revealed a CONUT Score ≥ 3 cutoff (sensitivity-95.7%, specificity-87.5%) and PNI ≤ 38.605 (sensitivity-78.3%, specificity-93.8%) for predicting multilevel STB (> 2). PNI exhibited superior specificity and positive predictive value where as CONUT score was a better parameter for sensitivity, negative predictive value and diagnostic accuracy. Both CONUT score and PNI were significant predictors of vertebral involvement in univariate analysis, with multivariate analysis identifying CONUT score as the sole predictor of multilevel vertebral affection. Nutritional scores, including CONUT score and PNI, emerged as significant predictors of multilevel STB. CONUT score displayed superior sensitivity, negative predictive value, and overall diagnostic accuracy, while PNI served as a nutritional marker with high specificity and positive predictive value in predicting multilevel involvement in spinal tuberculosis.

Surgery for deformities in pediatric spinal tuberculosis: single centre review of 51 cases.

To retrospectively report on the clinical presentation, radiological features, indication, and outcome of surgical management of children with posttubercular spinal deformities with long term outcome. This retrospective study was conducted in a single center operated by a single surgeon from 2002 to 2022, and data from an electronic medical record was reviewed. The indications for surgery included failure of medical treatment, to prevent deformity (depending on location, extent of bone loss, stabilization patterns (A, B, or C), and the presence of "Spine at Risk" signs) or correct deformity and in the presence of major neurodeficit. 51 children (< 15years) of mean age 12.5, and mean follow-up of 7years (2-15) were included. Pain, deformity/instability, and limb weakness were seen in 34 (66.6%) patients (mean mJOA score was 13.44, which improved to 14.7 and 16.8 at immediate postoperative and latest follow-up), with 17 (33.3%) patients presenting with deformity alone. Dorsal affection was commonest (60.8%), followed by lumbosacral (19.6%) and cervical (19.6%), with multilevel/skip lesions seen in four patients. The mean coronal/sagittal Cobb at presentation was 24.2°/40.96°, which improved to 8.2°/25.6° in the immediate and 8.8°/24.8° at the latest follow-up. Gene Xpert positivity was found in 95%, AFB culture positivity in 84%, and histopathology was positive in 91%. All patients had posterior surgery with an additional anterior reconstruction in 6. The complication rate was 5.8% (N = 3); 2 had implant loosening requiring revision surgery, 1 with prolonged discharging sinus with MDR TB, healed with chemotherapy. Pediatric post-tuberculous spinal deformities require identification of those who are likely to worsen, and close follow-up is mandatory. Failure of medical management, major destruction of vertebral bodies, type C stabilization pattern, and worsening deformity/neurodeficit require surgery with a good outcome.

P225. Adherence of mycobacterium tuberculosis on material surface of nano-hydroxyapatite/polyamide 66 composite and long-term results of clinic application to spinal tuberculosis

P225. Adherence of mycobacterium tuberculosis on material surface of nano-hydroxyapatite/polyamide 66 composite and long-term results of clinic application to spinal tuberculosis

Diagnostic accuracy of GeneXpert in the diagnosis of spinal tuberculosis: A systematic review and meta-analysis.

Tuberculosis remains a significant global health issue, with spinal tuberculosis being a severe form of extrapulmonary tuberculosis. Despite the high morbidity associated with spinal tuberculosis, effective and rapid diagnostic methods are limited. The aim of this study was to evaluate the diagnostic accuracy of the GeneXpert compared to other microbiological methods in diagnosing spinal tuberculosis. A systematic review and meta-analysis were conducted following the PRISMA guidelines. Six databases (PubMed, Scopus, EBSCO, EMBASE, ScienceDirect, and Cochrane Central) were searched for relevant studies as of August 31, 2023. Studies were selected based on predefined inclusion criteria, focusing on patients diagnosed with spinal tuberculosis and comparing GeneXpert to microbiological culture, acid-fast bacilli (AFB) staining, and polymerase chain reaction (PCR). Two authors independently performed data extraction and quality assessment, and the meta-analysis was conducted using Meta-DiSc 2.0. Fourteen studies comprising retrospective cohort, prospective cohort, and cross-sectional designs were included. GeneXpert demonstrated a pooled sensitivity of 92% (85-96%) and specificity of 71% (51-86%) compared to culture. AFB smear had the highest specificity at 80% (70- 88%) but the lowest sensitivity at 27% (20-35%). The PCR had sensitivity and specificity of 83% (67-92%) and 58% (31-81%), respectively. Substantial heterogeneity was noted across the studies. This study highlighted that GeneXpert had high sensitivity and moderate specificity in diagnosing spinal tuberculosis, making it an alternative to conventional methods. However, further validation through larger, interventional studies is necessary to standardize its use in clinical practice.

Transcriptome analysis of the diseased intervertebral disc tissue in patients with spinal tuberculosis

ObjectiveTo investigate the differential expression genes (DEGs) in spinal tuberculosis using transcriptomics, with the aim of identifying novel therapeutic targets and prognostic indicators for the clinical management of spinal tuberculosis.MethodsPatients who visited the Department of Orthopedics at the Second Hospital, Lanzhou University from January 2021 to May 2023 were enrolled. Based on the inclusion and exclusion criteria, there were 5 patients in the test group and 5 patients in the control group. Total RNA was extracted and paired-end sequencing was conducted on the sequencing platform. After processing the sequencing data with clean reads and annotating the reference genome, FPKM normalization and differential expression analysis were performed. The DEGs and long non-coding RNAs (LncRNAs) were analyzed for Kyoto Encyclopedia of Genes and Genomes (KEGG) and Gene Ontology (GO) enrichment. The cis-regulation of differentially expressed mRNAs (DE mRNAs) by LncRNAs was predicted and analyzed to establish a co-expression network.ResultsThis study identified 2366 DEGs, with 974 genes significantly upregulated and 1392 genes significantly downregulated. The upregulated genes are associated with cytokine-cytokine receptor interactions, tuberculosis, and TNF-α signaling pathways, primarily enriched in biological processes such as immunity and inflammation. The downregulated genes are related to muscle development, contraction, fungal defense response, and collagen metabolism processes. Analysis of LncRNAs from bone tuberculosis RNA-seq data detected a total of 3652 LncRNAs, with 356 significantly upregulated and 184 significantly downregulated. Further analysis identified 311 significantly different LncRNAs that could cis-regulate 777 target genes, enriched in pathways such as muscle contraction, inflammatory response, and immune response, closely related to bone tuberculosis. There are 51 genes enriched in the immune response pathway regulated by cis-acting LncRNAs. LncRNAs that regulate immune response-related genes, such as upregulated RP11-451G4.2, RP11-701P16.5, AC079767.4, AC017002.1, LINC01094, CTA-384D8.35, and AC092484.1, as well as downregulated RP11-2C24.7, may serve as potential prognostic and therapeutic targets.ConclusionThe DE mRNAs and LncRNAs in spinal tuberculosis are both associated with immune regulatory pathways. These pathways promote or inhibit the tuberculosis infection and development at the mechanistic level and play an important role in the process of tuberculosis transferring to bone tissue.

Clinical Outcome of Posterior Instrumented Stabilization and Transpedicular Decompression in Patients Presenting with Thoracic or Lumbar Spinal Tuberculosis in a Tertiary Care Center: A Descriptive Cross-sectional Study.

Posterior instrumented stabilization is a commonly done surgery in spinal tuberculosis. This study aims to evaluate the clinical, radiological, and neurological outcomes of posterior instrumented stabilization and transpedicular decompression in thoracic and lumbar spinal tuberculosis. A descriptive cross-sectional study was conducted for one and a half years with at least six months of follow-up in a tertiary care center. The study was approved by the Institutional Review Committee (Reference number: 119 (6-11-5) 2/075-076). Total sampling was done and the study included patients over 18 years of age with spinal tuberculosis of the thoracic or lumbar regions. These patients underwent posterior instrumented stabilization and transpedicular decompression at the tertiary care center. The age, site of involvement, Visual Analog Scale score for back pain, neurological status as per Frankel Neurology grading, and local kyphotic angle in X-ray were recorded. The median, interquartile range and percentage were calculated. The data was entered in Microsoft Excel 2016 and analysis was done using Epi Info software version 7.2. Thoracic level was most commonly involved in 14 (46.68%) cases. The median back pain as assessed by the Visual Analogue Scale score improved from 8 to 2 at the 6-month follow-up. There was improvement in the neurological grading of all cases and there was no loss of correction in the local kyphotic angle till the final follow-up. The median age of cases was 48 years (interquartile range: 28-62.50). Posterior instrumented stabilization and transpedicular decompression in adult patients with thoracic or lumbar spinal tuberculosis achieves improvements in clinical, radiological, and neurological outcomes.

Differentiation of tuberculous and brucellar spondylitis using conventional MRI-based deep learning algorithms

PurposeTo investigate the feasibility of deep learning (DL) based on conventional MRI to differentiate tuberculous spondylitis (TS) from brucellar spondylitis (BS). MethodsA total of 383 patients with TS (n = 182) or BS (n = 201) were enrolled from April 2013 to May 2023 and randomly divided into training (n = 307) and validation (n = 76) sets. Sagittal T1WI, T2WI, and fat-suppressed (FS) T2WI images were used to construct single-sequence DL models and combined models based on VGG19, VGG16, ResNet18, and DenseNet121 network. The area under the receiver operating characteristic curve (AUC) was used to assess the classification performance. The AUC of DL models was compared with that of two radiologists with different levels of experience. ResultsThe AUCs based on VGG19, ResNet18, VGG16, and DenseNet121 ranged from 0.885 to 0.973, 0.873 to 0.944, 0.882 to 0.929, and 0.801 to 0.933, respectively, and VGG19 models performed better. The diagnostic efficiency of combined models outperformed single-sequence DL models. The combined model of T1WI, T2WI, and FS T2WI based on VGG19 achieved optimal performance, with an AUC of 0.973. In addition, the performance of all combined models based on T1WI, T2WI, and FS T2WI was better than that of two radiologists (P<0.05). ConclusionThe DL models have potential guiding value in the diagnosis of TS and BS based on conventional MRI and provide a certain reference for clinical work.