Spinal Tuberculosis Research Articles

Spinal Tuberculosis (Pott’s Disease): A Case Report and Clinical Considerations

Spinal Tuberculosis (Pott’s Disease): A Case Report and Clinical Considerations

Bone features reinforce differential diagnosis between tuberculous spondylitis and brucellosis spondylitis.

Tuberculous spondylitis (TS) and brucellar spondylitis (BS) both cause major long-term morbidity and disability. Though Spondylodiscitis is sensitive to magnetic resonance images, some are difficult to differentiate. This study aims to identify specific bone changes on computed tomography (CT) images, further to differentiate TS from BS. We retrospectively analyzed and enrolled 70 patients with TS and 65 with BS at our hospital from December 2012 to January 2024. Information of bone destruction and formation, vertebral wall integrity, osteosclerosis, and sequestrum on CT images was collected and compared using the chi-square test or t-test. P < 0.01 was considered statistically significant. Bone destruction was greater in the TS group compared to the BS group (519.55 mm2 vs. 316.00 mm2, t = 6.01, P < 0.001), preferentially involving each third of the vertebral body horizontally (41.22% vs. 16.67%, χ2 = 77.76, P < 0.001; positive predictive value [PPV] = 80.6%) and the area under the endplate and equatorial portion of the vertebra longitudinally (80.53% vs. 28.20%, χ2 = 134.19, P < 0.001, PPV = 82.75%). Patients with BS more frequently exhibited fan-shaped osteosclerosis (12.82% vs. 1.15%, χ2 = 71.30, P < 0.001; PPV = 86.96%), longer bone formation surrounding the vertebra (18.06mm vs. 1.97mm, t = 14.28, P < 0.001), and longer anterior bone formation (3.86mm vs. 0.92mm, t = 6.51, P < 0.001). Anterior and closed bone formation was more common in the BS group than in the TS group (44.87% vs. 7.63%, χ2 = 152.53, P < 0.001; PPV = 77.78%). Fragmented and blocked sequestrum was more common in the TS group than in the BS group and tended to spread in and out of the erosions (22.14% vs. 0.64%, PPV = 98.31% and 22.14% vs. 0.00%, PPV = 100%, χ2 = 102.43, P < 0.001). TS and BS exhibit specific features of bone formation, bone destruction, and sequestrum on CT imaging. Our findings indicate that bone features on CT can help clinicians distinguish between two spinal infections.

A conservative management approach for spinal tuberculosis causing cauda equine syndrome in pregnancy

Background: Spinal tuberculosis in pregnancy leading to neurological sequelae is rare and a challenging condition to manage. The usual approach is to perform urgent decompression surgery, but patients with a more stable course of the disease may benefit from a conservative approach with anti-tuberculosis (ATT) therapy.Case presentation: A pregnant mother in her second trimester presented with a history of chronic backache exacerbated by right-sided foot drop, L5 root sensory loss and intermittent urinary retention. MRI revealed L5 vertebral collapse with para-vertebral collection causing cauda equine compression at the L5-S1 level. High ESR, strongly positive tuberculin test, and the clinical and radiological findings were compatible with a diagnosis of spinal tuberculosis. Based on the multi-disciplinary team’s decision, a conservative management approach with ATT and supportive therapy was initiated with close observation. The patient showed a remarkable response to ATT with clinical and radiological improvement. She underwent an elective caesarean section at 37 weeks and delivered a healthy baby. On the fourth week postpartum, she underwent decompressive surgery with complete neurological recovery,Discussion and conclusion: Spinal TB in pregnancy causing neurological impairment is usually managed with urgent surgical interventions. This is one of the few reported cases where a conservative approach was undertaken, with close observation and a positive outcome.Therefore, it is important to carefully select patients needing surgical interventions and those who would benefit better from a conservative approach. High suspicion, early diagnosis, prompt treatment initiation and close monitoring are vital components in achieving the best outcome.

Evaluation of clinical, laboratory, radiographical and histopathological characteristics in patients with spinal tuberculosis in the context of HIV infection: An analysis of 52 patients from a South African tertiary hospital.

South Africa (SA) has the highest prevalence of people with tuberculosis (TB) and HIV coinfection globally. People living with HIV have an increased risk of TB infection, and are more likely to develop extrapulmonary TB. Approximately 10 - 20% of extrapulmonary TB accounts for skeletal TB, with spinal involvement in 50 - 60% of instances. Previous studies have shown highly heterogenic results regarding the effect of HIV status on clinical and laboratory characteristics in patients with spinal TB (STB). To describe the clinical, laboratory, radiographical and histopathological characteristics of patients diagnosed with STB stratified by HIV status. Data from patients who were treated for STB at the Division of Orthopaedic Surgery, Groote Schuur Hospital, SA, between 2013 and 2016 were analysed. We compared clinical, laboratory, radiographical and histopathological parameters of STB patients with HIV infection to those without HIV infection. To assess differences in means between the two groups, an independent samples t-test was used for normally distributed continuous data, and a χ2 test for categorical data. To assess correlations between continuous data groups, the Pearson correlation coefficient was used. We assessed 52 patients with STB (mean (standard deviation (SD) age 38 (15.2) years, range 17 - 80 years), of whom 55.8% were female, and 59.6% HIV infected. Five (9.6%) patients were identified with multidrug-resistant TB of the spine, with four (19.0%) in the HIV-infected cohort and one in the HIV-uninfected cohort (p=0.058). Significantly more STB patients without HIV infection presented with neurogenic symptoms (29%, p=0.029). The mean (SD) overall erythrocyte sedimentation rate was 69.3 (35.9) mm/h, with no significant difference between HIV-infected and HIV-uninfected patients (p=0.086). The rate of vertebral collapse was higher in the HIV-infected cohort (39% v. 67%, p=0.048). HIV-infected patients showed a higher count of involved vertebrae (mean 3.0 v. 3.85; p=0.034). There was no correlation between CD4 count and the number of involved vertebrae. The mean (SD) number of granulomata per low-power field was 10 (12.6), with no difference between the two cohorts. However, we found a positive correlation between granuloma count and CD4 cell count in HIV-infected STB patients (Pearson 0.503, p=0.02), with significantly higher formation of granulomata at a CD4 cell count >400 cells/μL (p=0.045). In our cohort, HIV-infected patients with STB were more likely to present with vertebral collapse, and more vertebrae on average were diseased compared with HIV-uninfected patients with STB. CD4 cell count may affect granuloma formation, and it seems that HIV infection has a negative effect on cellular immunoresponse in STB, which emphasises the need for early antiretroviral therapy initiation.

Learning curve and complication analysis of oblique lateral interbody fusion in cases with single-segment lumbar tuberculosis: a retrospective single-center consecutive study

ObjectiveOblique lateral interbody fusion (OLIF) is becoming widely used in patients with single-segment spinal tuberculosis (STB). The learning curve and complications associated with OLIF for the treatment of STB are still unknown. This study aims to figure out the learning curve and associated complications experience of OLIF for the treatment of STB.MethodsBetween September 2018 and August 2023, 61 STB patients underwent OLIF plus percutaneous pedicle screw fixation (PPSF) were consecutively included in this research. Cumulative sum analysis (CUSUM) was applied to establish the learning curve of OLIF and determine the cut-off case number. All cases were divided into learning and experienced groups based on the cut-off case number. Clinical characteristics and relating surgical complications were compared and analyzed between the two groups.ResultsThe best-fitting curve was quadratic. The fitting equation was CUSUM (min) = 95.83 + 34.16x − 0.611 x 2 (x means operation case). The cut-off operation case number was 27 cases. The presence of significant differences particularly in the duration of operation, operative blood loss, overall incidence, and severity of postoperative complications was noteworthy between the two groups.ConclusionA total of 27 cases is the minimum number to master OLIF combined with PPSF for the treatment of patients with single-segment STB. When surgeons master this operation, the operative time, operative blood loss, overall incidence, and severity of postoperative complications will improve.

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.

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

Spinal tuberculosis (TB) remains a significant global health concern, necessitating the development of innovative treatment strategies. This clinical study aimed to evaluate the efficacy and safety of endoscopic debridement as a minimally invasive approach for treating paravertebral abscesses in patients with spinal tuberculosis. A total of 52 patients diagnosed with paravertebral tuberculosis abscesses were enrolled in this retrospective study. Patients were assigned to two groups: the endoscopic debridement group (n = 30) and the conventional open surgery group (n = 22), based on the type of surgery they received. Clinical outcomes were assessed at baseline, post-treatment, and follow-up visits at regular intervals, including surgery time, intraoperative blood loss, total hospital stay duration, pain relief, and neurological improvement. The results of this study demonstrate that endoscopic debridement is a highly effective treatment for paravertebral abscesses in patients with spinal TB. Patients in the endoscopic debridement group experienced significant improvements in surgery time, intraoperative blood loss, total hospital stay duration, pain relief, and neurological improvement compared to those in the conventional open surgery group. Additionally, the endoscopic approach resulted in fewer complications, such as wound infections and postoperative instability, with no cases of recurrence observed during the follow-up period. Therefore, this clinical study highlights the potential of endoscopic debridement as a safe and effective treatment modality for spinal tuberculosis. The technique not only effectively eliminates infected tissue but also ensures faster patient recovery and reduces postoperative complications. Additional research and long-term follow-up studies are necessary to confirm the long-term effectiveness and safety of endoscopic debridement as the standard treatment for spinal tuberculosis.

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.

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.

Percivall Pott (1713-1788): Father of Orthopaedics and Pioneer of Occupational Medicine.

Percivall Pott was an eighteenth-century English surgeon best known for three eponymous diseases: Pott's fracture, Pott's puffy tumour and Pott's disease of the spine. He wrote extensively, with treatises covering a wide range of surgical subjects, including cataracts, cranial trauma, hernias and neurology. Pott's practice came at a time when surgery was being transformed from the work of barbers into a scientific study. His publications had a wide-reaching impact, influencing contemporary practice and setting out building blocks for the work of those who came after him. This article aims to explore the life and career of Percivall Pott, looking in particular at his influence on the subjects of orthopaedics and occupational medicine.

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.