Spinal Tuberculosis Research Articles

A comparison of the biomechanical properties of three different lumbar internal fixation methods in the treatment of lumbosacral spinal tuberculosis: finite element analysis

There are various internal fixation methods in treating lumbosacral spinal tuberculosis. The study compared the stability and stress distribution in surrounding tissues/implants, such as discs, endplates and screw-rod internal fixation system, etc. when applying three different lumbar internal fixation methods to treat lumbosacral spinal tuberculosis. A finite element model was constructed and validated. The spinal stability was restored using three methods: a titanium cage with lateral double screw-rod fixation (group 1), autologous bone with posterior double screw-rod fixation (group 2), and a titanium cage with posterior double screw-rod fixation (group 3). For comparison, group 4 represented the intact L3-S1 spine. Finally, a load was applied, and the ranges of motion and Von Mises stresses in the cortical endplates, screw-rod internal fixation system and cortical bone around the screws in the different groups were recorded and analyzed. All six ranges of motion (flexion, extension, left/right lateral bending, left/right rotation) of the surgical segment were substantially lower in groups 1 (0.53° ~ 1.41°), 2 (0.68° ~ 1.54°) and 3 (0.55° ~ 0.64°) than in group 4 (4.48° ~ 10.12°). The maximum stress in the screw-rod internal fixation system was clearly higher in group 2 than in groups 1 and 3 under flexion, left/right lateral bending, and left/right rotation. However, in extension, group 1 had the highest maximum stress in the screw-rod internal fixation system. Group 2 had the lowest peak stresses in the cortical endplates in all directions. The peak stresses in the cortical bone around the screws were higher in group 1 and group 2 than in group 3 in all directions. Thus, titanium cage with posterior double screw-rod fixation has more advantages in immediate reconstruction of lumbosacral spinal stability and prevention of screw loosening.

TUBERCULIN SKIN TEST AND INTERFERON-γ RELEASE ASSAY ON THE DIAGNOSIS OF TUBERCULOUS SPONDYLITIS

Highlights TST and IGRA have a significant correlation with the diagnosis of patients with Tuberculous Spondylitis. Various factors may affect the results of TST and IGRA. Thus, the use of TST and IGRA can be adjusted according to the condition of the hospital, the availability of diagnostic tools, the health worker’s physical examination results, and the patient's medical history. Abstract Background: Tuberculous spondylitis or Pott’s disease is extrapulmonary tuberculosis that is still a concern to health workers because of the broad spectrum of its clinical symptoms. Delay in diagnosis is very common in this disease. Therefore, its diagnostic tool needs to be thoroughly reviewed to determine its effectiveness. The diagnostic tools studied in this study were Tuberculin Skin Test (TST) and Interferon-γ Release Assay (IGRA). Objective: To analyze the role of TST and IGRA as diagnostic tools for the diagnosis of tuberculous spondylitis. Material and Method: This study used a systematic review method to analyze topic-related kinds of literature written in English and Indonesian found on PubMed, Scopus, ProQuest, and Web of Science databases. The literature screening process was carried out based on the PRISMA 2020 Guidelines. Result: Sixteen types of literature were included for a total of 116 patients. TST was detected positive in 45 (63%) and negative in 21 (30%) of a total of 66 patients with Pott’s disease. IGRA was detected positive in 51 (77%), negative in 8 (12%), and indeterminate in 2 (3%) of a total of 61 patients with Pott’s disease. Conclusion: TST and IGRA results significantly correlate with the diagnosis of tuberculous spondylitis. Both tests are still relevant for use in the diagnosis of the disease. IGRA and TST are used according to the needs of health workers and patients’ health backgrounds.

Unusual presentation of Pott disease and diagnostic challenges in a resource-limited setting: a case report

BackgroundPott disease is rare and responsible for only 1%–2% of all tuberculosis cases. It poses diagnostic challenges in resource-limited settings due to unusual presentation and limited investigative capacity, resulting in debilitating sequelae if diagnosed late.Case presentationWe present a case of severe Pott disease of the lumbar spine, with a large paravertebral abscess tracking down to the gluteal region in a 27-year-old Black African Ugandan woman living with human immunodeficiency virus, whose main complaint was right lower abdominal pain. She was initially misdiagnosed from the peripheral clinics as a case of lumbago and later with a psoas abscess. The diagnosis of severe Pott disease was established at the regional referral hospital following an abdominal computed tomography scan, and the patient was appropriately initiated on anti-tuberculosis drugs. However, only abscess drainage and provision of a lumbar corset were possible, with no neurosurgical intervention done on the spine due to financial constraints. Clinical review at 2, 6, and 12 months revealed improvement.ConclusionsPott disease may present with non-specific symptoms such as abdominal pain resulting from pressure effects of an expansile cold abscess. This, coupled with limited diagnostic capacity in resource-limited settings; results in significant morbidity and possible mortality. Hence, there is need to train clinicians to increase their index of suspicion and equip health units with basic radiological equipment, such as x-ray, for timely detection and subsequent management of Pott disease.

Accurate Differentiation of Spinal Tuberculosis and Spinal Metastases Using MR-Based Deep Learning Algorithms.

To explore the application of deep learning (DL) methods based on T2 sagittal MR images for discriminating between spinal tuberculosis (STB) and spinal metastases (SM). A total of 121 patients with histologically confirmed STB and SM across four institutions were retrospectively analyzed. Data from two institutions were used for developing deep learning models and internal validation, while the remaining institutions' data were used for external testing. Utilizing MVITV2, EfficientNet-B3, ResNet101, and ResNet34 as backbone networks, we developed four distinct DL models and evaluated their diagnostic performance based on metrics such as accuracy (ACC), area under the receiver operating characteristic curve (AUC), F1 score, and confusion matrix. Furthermore, the external test images were blindly evaluated by two spine surgeons with different levels of experience. We also used Gradient-Class Activation Maps to visualize the high-dimensional features of different DL models. For the internal validation set, MVITV2 outperformed other models with an accuracy of 98.7%, F1 score of 98.6%, and AUC of 0.98. Other models followed in this order: EfficientNet-B3 (ACC: 96.1%, F1 score: 95.9%, AUC: 0.99), ResNet101 (ACC: 85.5%, F1 score: 84.8%, AUC: 0.90), and ResNet34 (ACC: 81.6%, F1 score: 80.7%, AUC: 0.85). For the external test set, MVITV2 again performed excellently with an accuracy of 91.9%, F1 score of 91.5%, and an AUC of 0.95. EfficientNet-B3 came second (ACC: 85.9, F1 score: 91.5%, AUC: 0.91), followed by ResNet101 (ACC:80.8, F1 score: 80.0%, AUC: 0.87) and ResNet34 (ACC: 78.8, F1 score: 77.9%, AUC: 0.86). Additionally, the diagnostic accuracy of the less experienced spine surgeon was 73.7%, while that of the more experienced surgeon was 88.9%. Deep learning based on T2WI sagittal images can help discriminate between STB and SM, and can achieve a level of diagnostic performance comparable with that produced by experienced spine surgeons.

Extrapulmonary Tuberculosis: A Retrospective Study in Eastern India Based on Diagnostic Modalities

Background: The most common site of tubercular infection is lungs, but various extrapulmonary sites also can be affected by tuberculosis (TB). Very few fine-needle aspiration-based studies supplemented by cartridge-based nucleic acid amplification test (CBNAAT) and radiology have been conducted in any center of tribal-based area situated in Eastern India. Materials and Methods: Sixty extrapulmonary TB cases (28 males and 32 females) received during 3 years (May 2018–April 2021) were included in this study. Results: Diagnoses of different extrapulmonary tubercular lesions were: lymphadenitis (n = 27), cold abscess (n = 18), breast abscess (n = 2), epididymitis (n = 4), oral cavity (n = 3), spine, long bone (n = 2 cases each) and fingertip and TB of the penis (n = 1 case each). Forty-six cases were diagnosed by fine-needle aspiration cytology. CBNAAT diagnosed ten cases where the result of aspiration cytology was inconclusive. Radiology directly diagnosed four cases, whereas it helped another seven cases indirectly to clinch the proper diagnosis of extrapulmonary tubercular lesions. Conclusion: Tuberculous lymphadenitis was the most common extrapulmonary lesion. Females outnumber male cases. Aspiration cytology aided by CBNAAT and radiology proved indispensable to diagnose extrapulmonary tubercular lesions, especially for economically constrained persons.

Multifocal musculoskeletal tuberculosis in an immunocompetent Iraqi patient

Abstract: Musculoskeletal tuberculosis (TB) is an ancient disease; features of spinal TB have been identified in Egyptian mummies dating back 9000 years. It accounts for 10%–35% of cases of extrapulmonary TB. The occurrence of noncontiguous, multifocal musculoskeletal TB in immunocompetent persons is rare even in countries which are endemic in TB. Here, we present a case of multifocal musculoskeletal TB involving multiple levels of the spine and a peripheral joint. A 25-year-old female from Baghdad presented to us with inflammatory back pain for 9 months. She had a negative medical history. Initially, she was treated as a case of pyogenic discitis based on her magnetic resonance imaging results and high inflammatory markers; she was given antibiotics without clinical improvement. Later on, she developed pleural effusion with new painful swelling in her left ankle joint. Aspiration of the left ankle joint was performed, and a biopsy was taken and sent for a TB-DNA polymerase chain reaction test, which was positive, leading to the final diagnosis of musculoskeletal TB. The correct diagnosis of musculoskeletal TB is clinically challenging and difficult, especially when there are multilevel lesions. Our findings indicate that multiple tuberculous lesions must be considered in the differential diagnosis of multiple musculoskeletal lesions, especially in endemic areas such as Iraq.

A diagnostic model for differentiating tuberculous spondylitis from pyogenic spondylitis: a retrospective case–control study

The purpose of this study was to describe and compare the clinical data, laboratory examination and imaging examination of tuberculous spondylitis (TS) and pyogenic spondylitis (PS), and to provide ideas for diagnosis and treatment intervention. The patients with TS or PS diagnosed by pathology who first occurred in our hospital from September 2018 to November 2021 were studied retrospectively. The clinical data, laboratory results and imaging findings of the two groups were analyzed and compared. The diagnostic model was constructed by binary logistic regression. In addition, an external validation group was used to verify the effectiveness of the diagnostic model. A total of 112 patients were included, including 65 cases of TS with an average age of 49 ± 15 years, 47 cases of PS with an average of 56 ± 10 years. The PS group had a significantly older age than the TS group (P = 0.005). In laboratory examination, there were significant differences in WBC, neutrophil (N), lymphocyte (L), ESR, CRP, fibrinogen (FIB), serum albumin (A) and sodium (Na). The difference was also statistically significant in the comparison of imaging examinations at epidural abscesses, paravertebral abscesses, spinal cord compression, involvement of cervical, lumbar and thoracic vertebrae. This study constructed a diagnostic model, which was Y (value of TS > 0.5, value of PS < 0.5) = 1.251 * X1 (thoracic vertebrae involved = 1, thoracic vertebrae uninvolved = 0) + 2.021 * X2 (paravertebral abscesses = 1, no paravertebral abscess = 0) + 2.432 * X3 (spinal cord compression = 1, no spinal cord compression = 0) + 0.18 * X4 (value of serum A)−4.209 * X5 (cervical vertebrae involved = 1, cervical vertebrae uninvolved = 0)−0.02 * X6 (value of ESR)−0.806 * X7 (value of FIB)−3.36. Furthermore, the diagnostic model was validated using an external validation group, indicating a certain value in diagnosing TS and PS. This study puts forward a diagnostic model for the diagnosis of TS and PS in spinal infection for the first time, which has potential guiding value in the diagnosis of them and provides a certain reference for clinical work.

Selection of bone graft type for the surgical treatment of thoracolumbar spinal tuberculosis based on the spinal instability neoplastic score: a retrospective single-center cohort study

ObjectivesThis study aimed to establish a standard for selecting bone graft type for thoracolumbar spinal tuberculosis surgery based on the spinal instability neoplastic score (SINS).MethodsPatients with thoracolumbar tuberculosis who underwent one-stage debridement posteriorly and instrumentation were divided into a structural bone graft group (SBG) (51 cases) and a non-structural bone graft group (NSBG) (54 cases) according to their SINS. SBG was performed when the SINS was ≥ 13 and NSBG was performed when it was 7 ≤ SINS ≤ 12. Baseline data, clinical outcomes, and imaging outcomes were collected and statistically analyzed between the two groups.ResultsSignificant improvements in clinical and imaging outcomes were achieved in both groups. Compared to the SBG group, the operation time of the NSBG group was shorter, the intraoperative blood loss of the NSBG group was less, the bone fusion time of the NSBG group was faster.ConclusionNon-structural and structural bone grafting can achieve comparable therapeutic effects in patients with spinal tuberculosis, and a suitable selection of bone grafts based on quantitative SINS will make full use of the advantages of different bone grafts.

The value of histopathology combined with CapitalBio Mycobacterium real-time polymerase chain reaction test for diagnosing spinal tuberculosis.

To evaluate the diagnostic efficacy of CapitalBio Mycobacterium real-time polymerase chain reaction assay (CapitalBio test) in spinal tuberculosis (STB). The value of histopathology combined with the CapitalBio test in diagnosing STB was also assessed. We retrospectively analyzed the medical information of suspected STB. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and area under the curve (AUC) of histopathology, CapitalBio test, and histopathology combined with CapitalBio test were calculated to evaluate their diagnostic efficacy compared with a composite reference standard. A total of 222 suspected STB patients were included in the study. The sensitivity, specificity, PPV, NPV, and AUC of histopathology for STB were recorded to be 62.0, 98.0, 97.4, 68.3%, and 0.80, respectively. The sensitivity, specificity, PPV, NPV, and AUC of the CapitalBio test were 75.2, 98.0, 97.9, 76.7%, and 0.87, respectively, while that of histopathology combined with the CapitalBio test was 81.0, 96.0, 96.1, 80.8%, and 0.89, respectively. Histopathology and CapitalBio test exhibited high accuracy and are recommended in diagnosing STB. Histopathology combined with the CapitalBio test might give the best efficacy in STB diagnosis.

Proteomic analysis to identification of hypoxia related markers in spinal tuberculosis: a study based on weighted gene co-expression network analysis and machine learning

ObjectiveThis article aims at exploring the role of hypoxia-related genes and immune cells in spinal tuberculosis and tuberculosis involving other organs.MethodsIn this study, label-free quantitative proteomics analysis was performed on the intervertebral discs (fibrous cartilaginous tissues) obtained from five spinal tuberculosis (TB) patients. Key proteins associated with hypoxia were identified using molecular complex detection (MCODE), weighted gene co-expression network analysis(WGCNA), least absolute shrinkage and selection operator (LASSO), and support vector machine recursive feature Elimination (SVM-REF) methods, and their diagnostic and predictive values were assessed. Immune cell correlation analysis was then performed using the Single Sample Gene Set Enrichment Analysis (ssGSEA) method. In addition, a pharmaco-transcriptomic analysis was also performed to identify targets for treatment.ResultsThe three genes, namely proteasome 20 S subunit beta 9 (PSMB9), signal transducer and activator of transcription 1 (STAT1), and transporter 1 (TAP1), were identified in the present study. The expression of these genes was found to be particularly high in patients with spinal TB and other extrapulmonary TB, as well as in TB and multidrug-resistant TB (p-value < 0.05). They revealed high diagnostic and predictive values and were closely related to the expression of multiple immune cells (p-value < 0.05). It was inferred that the expression of PSMB9, STAT 1, and TAP1 could be regulated by different medicinal chemicals.ConclusionPSMB9, STAT1, and TAP1, might play a key role in the pathogenesis of TB, including spinal TB, and the protein product of the genes can be served as diagnostic markers and potential therapeutic target for TB.

Correlation of Plain Radiography and MRI Spine Evaluation in Spinal Tuberculosis

Correlation of Plain Radiography and MRI Spine Evaluation in Spinal Tuberculosis

Spinal Tuberculosis: Features and Early Predictive Factors of Poor Outcomes.

Tuberculosis is still endemic in Tunisia. Among musculoskeletal involvement, spinal tuberculosis (STB) or «Pott's Disease» is the most common and can lead to serious neurological complications. The purpose of our study was to focus on STB features (clinical, biological, and radiological) and to identify factors associated with early unfavorable outcomes. This was a monocentric retrospective study, over a period of 20 years (2000-2020). Only patients treated appropriately were included. Patients' informations were noted. We defined the favorable outcome criterion as weight gain, apyrexia, improvement of the general state, relief of pain, improvement in the classic inflammatory markers (CRP), and absence of vertebral deformities, neurological impairment, or sepsis. The outcome was considered unfavorable otherwise. Our study involved 52 patients. Their average age was 55.21 years±17.79. The average symptom duration was 8.9 months±6.54. Spinal pain was the most common functional sign (90.4%) often inflammatory. Physical signs were dominated by segmental spinal stiffness (71.2%). Spinal magnetic resonance imaging was performed in 38 patients. The disco-vertebral biopsy puncture confirmed the diagnosis in 15 cases. All patients received anti-tuberculosis treatments with an average duration of 10.02±1.97months. The outcome at one month of follow-up was favorable in 32 cases. Poor prognosis factors were normochromic normocytic anaemia (p=0.018), initial lymphocytosis (p=0.048), and fever (p=0.01). However, vertebral fracture at standard X-ray was predictive of favorable outcome (p=0.001). STB is a frequent condition that needs to be treated rapidly. Poor prognosis factors were identified in this study such as normocytic normochromic anemia, initial lymphocytosis, and fever at baseline.

The Use of Free Vascularized Fibula Graft in Spinal Reconstruction: A Comprehensive Systematic Review.

The extensive search included the following databases: PubMed, ScienceDirect, Web of Science, Cumulative Index to Nursing and Allied Health Literature, and Cochrane for relevant studies published up to January 20, 2023, according to PRISMA 2020 guidelines. Demographic data, flap success, recipient vessels, and flap-related complications were evaluated. We identified 25 eligible studies involving 150 patients, consisting of 82 men and 68 women. Spinal reconstruction utilizing FVFG is mostly reported in the case of spinal neoplasm, followed by spinal infection (osteomyelitis and spinal tuberculosis) and spinal deformities. The cervical spine is the most common vertebral defect reported in the studies. All studies summarized in the present study reported successful spinal reconstruction, while wound infection was the most reported postoperative complication after spinal reconstruction utilizing FVFG. The results of the current study highlight the ability and superiority of using FVFG in spinal reconstruction. Despite being technically challenging, this strategy provides enormous benefits to patients. However, a further additional large-scale study is required to corroborate these findings.

Pott’s Disease– When &amp; How to Operate?

Background: Pott’s disease is a rare form of extrapulmonary tuberculosis that manifests in a variety of clinical patterns. Delays in diagnosis and treatment can lead to serious complications. About 10-40% of patients with spinal tuberculosis may have a neurological deficit. Urgent measures are needed to halt the progression of the disease and deformity, especially to prevent and overcome paraplegia. In regards to management, every case is different and has a unique procedure. It includes simple medical management, simple decompression and debridement, anterior approach, and posterior approach, etc. Surgical decompression of the cord and instrumentation are needed in many cases besides chemotherapy. Although the anterior approach is used for cervical Pott’s disease but this procedure is very time-consuming and technically difficult in the lumbar and dorsal spine, especially in compromised patients and morbidity is more. The posterior approach alone is enough for achieving adequate decompression, debridement, reduction, fusion, reconstruction of the body, and maintaining sagittal alignment in the dorsal and lumbar Pott’s spine. The aim of the study was to describe the treatment modality and observe the outcome of treatment methods and incidence rate of infection sites among the patients of Potts spine. Material &amp; Methods: This retrospective study was conducted at the Department of Neurosurgery, Bangabandhu Sheikh Mujib Medical University, Bangladesh. The study duration was 7 years, from March 2016 to January 2023. During this period, a total of 30 cases of Pott’s disease were included in the study following inclusion and exclusion criteria. Results: 53.33% had been from the youngest age group of 15-34 years, and 80 % were male. Very few participants had been female in the present study. Back pain was the primary complication for 50% of cases, while spinal infection was observed in the cervical region for 16.67% of cases, 43.33% had infections in the dorsal region, and 30 % in the lumbar region. 10.00% of the participants had been treated with non-surgical methods, with only anti-TB medication for 18 months or more. Posterior decompression was the most common treatment method, with 23.33% having only posterior decompression, and 40.00% having posterior decompression with the use of additional instruments. Conclusion: The study observed that Pott’s disease was most common among young adult males, and the most common sites of spinal infections were in the dorsal and lumbar regions in the present study population, contradictory to the general findings. Decompression treatment, with and without additional instruments, was the most common form of treatment among the present study population.

CURRENT CONCEPTS IN MANAGEMENT OF ACUTE KYPHOSIS IN SPINAL TUBERCULOSIS – A NARRATIVE REVIEW

Spinal tuberculosis typically affects the vertebral bodies, resulting in various degrees of kyphosis. Children &lt;10 years, thoraco-lumbar spine affliction, late presentation, vertebral loss &gt;1.5 bodies and presence of spine at risk signs reasonably predict patients who are prone for worsening kyphosis during both active and healed stages of the disease. Untreated kyphosis is ominous as it can result in spinal fatigue, neurological deficit, cosmetic disfigurement, and respiratory insufficiency. Kyphosis greater than [Formula: see text] and presence of risk factors for worsening kyphosis are considered as indications for surgery in active tuberculosis. Different surgical methods have been described with their own merits and demerits. Currently, posterior approach with or without anterior reconstruction is considered the standard technique as it is safe, efficacious, convenient, and versatile.

Tuberculosis revisted: classic imaging findings in childhood

Tuberculosis (TB) remains one of the major public health threats worldwide, despite improved diagnostic and therapeutic methods. Tuberculosis is one of the main causes of infectious disease in the chest and is associated with substantial morbidity and mortality in paediatric populations, particularly in low- and middle-income countries. Due to the difficulty in obtaining microbiological confirmation of pulmonary TB in children, diagnosis often relies on a combination of clinical and radiological findings. The early diagnosis of central nervous system TB is challenging with presumptive diagnosis heavily reliant on imaging. Brain infection can present as a diffuse exudative basal leptomeningitis or as localised disease (tuberculoma, abscess, cerebritis). Spinal TB may present as radiculomyelitis, spinal tuberculoma or abscess or epidural phlegmon. Musculoskeletal manifestation accounts for 10% of extrapulmonary presentations but is easily overlooked with its insidious clinical course and non-specific imaging findings. Common musculoskeletal manifestations of TB include spondylitis, arthritis and osteomyelitis, while tenosynovitis and bursitis are less common. Abdominal TB presents with a triad of pain, fever and weight loss. Abdominal TB may occur in various forms, as tuberculous lymphadenopathy or peritoneal, gastrointestinal or visceral TB. Chest radiographs should be performed, as approximately 15% to 25% of children with abdominal TB have concomitant pulmonary infection. Urogenital TB is rare in children. This article will review the classic radiological findings in childhood TB in each of the major systems in order of clinical prevalence, namely chest, central nervous system, spine, musculoskeletal, abdomen and genitourinary system.Graphical

Tuberculosis of the spine.

Pott's spine, commonly known as spinal tuberculosis (TB), is an extrapulmonary form of TB caused by Mycobacterium TB. Pott's paraplegia occurs when the spine is involved. Spinal TB is usually caused by the hematogenous spread of infection from a central focus, which can be in the lungs or another location. Spinal TB is distinguished by intervertebral disc involvement caused by the same segmental arterial supply, which can result in severe morbidity even after years of approved therapy. Neurological impairments and spine deformities are caused by progressive damage to the anterior vertebral body. The clinical, radiographic, microbiological, and histological data are used to make the diagnosis of spinal TB. In Pott's spine, combination multidrug antitubercular therapy is the basis of treatment. The recent appearance of multidrug-resistant/extremely drug-resistant TB and the growth of human immunodeficiency virus infection have presented significant challenges in the battle against TB infection. Patients who come with significant kyphosis or neurological impairments are the only ones who require surgical care. Debridement, fusion stabilization, and correction of spinal deformity are the cornerstones of surgical treatment. Clinical results for the treatment of spinal TB are generally quite good with adequate and prompt care.

New Horizons in the Diagnosis of Tuberculosis of the Spine: The Role of Whole Genome Sequencing.

Prospective study. To evaluate the utility of whole genome sequencing (WGS) in drug resistance testing, lineage of the organisms, and organism- related factors responsible for bacilli settling in the spine. The workstream for the diagnosis of tuberculosis (TB) involves isolation and culture of the organism and drug resistance testing using phenotypic methods. Xpert MTB/RIF Ultra is a genetic-based method that detects for Mycobacterium tuberculosis DNA in the rpoB gene. Meanwhile, WGS is a newer genetic-based method that assesses the whole genome of the bacterium. Very few studies have reported the use of WGS for extrapulmonary TB. Herein, we used WGS to diagnose spinal TB. Tissues from 61 patients undergoing surgery for spinal TB underwent histologic examination, Xpert MTB/RIF Ultra, and culture and sensitivity testing. DNA from the cultured bacteria was sent for WGS. The test bacterial genome was compared to a reference strain of pulmonary TB. Acid-fast bacilli were observed in 9/58 specimens. Meanwhile, histology confirmed TB in all the patients. Bacilli were cultured in 28 patients (48.3%), and the average time to culture was 18.7 days. Xpert MTB/RIF Ultra was positive in 47 patients (85%). WGS was performed in 23 specimens. Overall, 45% of the strains belonged to lineage 2 (East Asian). There was one case of multidrug- resistant TB and two cases of non-tuberculous mycobacteria on WGS. We could not confirm any genomic difference between pulmonary and spinal TB strains. Xpert MTB/RIF Ultra of tissues or pus is the investigation of choice when diagnosing spinal TB. Meanwhile, WGS can diagnose multidrug-resistant TB and non-tuberculous mycobacteria more accurately. No mutations were identified in spinal and pulmonary TB bacteria.

VERTEBRAL TUBERCULOSIS FOLLOWED BY TRAUMATIC SPINE FRACTURE IN A CHILD -RARE CASE REPORT

Background Vertebral tuberculosis following a spinal trauma is a rare identity presenting as extrapulmonary TB associated with high degree of morbidity in a growing children. The objective of this report is to describe a paediatric case of traumatic spine fracture on the lower thoracic spine with tuberculosis disease. And thus show the importance of identifying the disease as soon as possible, because it is a rare and severe condition that can leave to serious sequelae. Case summery A adolescent boy presents to the orthopaedic OPD with the complaints of unable to walk, evening raise of temperature, loss of weight, deformity of spine since 3 months. Upon detail history, 3 months back child had a traumatic event following which he developed weakness of both the lower limbs. In the subsequent time he started developing evening rise of temperature, lethargy and loss of weight. His mother observed postural alteration, with constant pain in the middle back region with a deformity formation, unable to walk, inability to ex the lumbodorsal spine and pain on touching surrounding skin area. Clinical examination revealed that the child was pale, emaciated and afebrile with weight of 25 kgs. A tender gibbus was present over the dorso-lumbar region. Sensation of perianal region was intact with spasticity of both lower limbs. The bladder and bowel function were spared. No other external signs of inammation were detected. The rest of the physical examination was non-contributory. No prior history of contact with the tuberculosis patient. Mantoux test and Sputum examination was done. Radiologic evaluation done in the form of radiograph and magnetic resonance imaging. ConclusionSpinal tuberculosis is haematogenous in origin, and usually follows pulmonary tuberculosis. The two conditions may occur concomitantly, as is commonly seen in young children. Spinal tuberculosis is usually associated with a poor nutritional status and a depleted immune response. In our patient the source of infection might have been from a latent focus in the hilar nodes of the lung, although the patient denied any previous history of tuberculosis. Possibly after severe trauma the patient's immunity was lowered this has led to spread of the tuberculosis infection and the vertebral fracture hematoma could have provided a nidus for infection.

Computed Tomography-Guided Spinal Biopsy in Suspected Infective Spondylodiscitis: An Institutional Review of Its Utility.

Background Infectious spondylodiscitis is a debilitating condition and evidence-based medicine dictates confirming the diagnosis before treatment. Computed tomography-guided spinal biopsy plays a major role and hence we would like to determine its utility in current clinical practice. Purpose The purpose of this study is to determine the percentage of confirmatory positives of CT-guided spinal biopsy in patients who were clinicoradiologically diagnosed with infectious spondylitis. Material and Methods A retrospective analysis of patients who underwent CT-guided biopsy for suspected infectious spondylodiscitis from 2017 to 2021 in a tertiary medical center was done. The data were filtered and obtained from the electronic database of the institution. Results In all, 259 patients underwent CT-guided biopsy of the spine. The procedure provided confirmatory results in 149 (57.5%) biospecimens. Histopathology examination was confirmatory in 95 (36.6%) of the 241 biospecimens sent. The Mycobacteria Growth Indicator Tube (MGIT) was confirmatory in 51 (19.9%) of the 250 biospecimens sent and drug resistance was seen in 6/51 (11.7%) biospecimens. Xpert TB provided confirmatory results in 72 (27.8%) of the 254 biospecimens sent and rifampicin resistance was seen in 16/72 (22.2%) biospecimens. Bacterial culture was confirmatory in 29 (11.2%) of the 250 biospecimens sent. The complication documented in this study was 0.3%. Conclusion CT-guided spinal biopsy for suspected vertebral osteomyelitis is a safe and effective minimally invasive procedure. It demonstrates a positive yield in more than half of the patients. Knowing the outcome, the patients can be appropriately counseled prior to the procedure. CT-guided biopsy results were affected by prior administration of ATT (antitubercular therapy) in suspected tuberculous spondylitis patients.