Tuberculous Spondylodiscitis Research Articles

Hematologic Inflammation Indices for Differentiating between Brucella, Pyogenic, and Tuberculous Spondylodiscitis.

Infectious spondylodiscitis is a life-threatening disease and has some challenges in terms of diagnostic, differentiative, and therapeutic processes. Therefore, rapid and effective management of infectious spondylodiscitis is necessary. Hematological inflammation indices (HIIs) such as the neutrophil/lymphocyte ratio and aggregate index of systemic inflammation are derived from blood cells and used as diagnostic, prognostic, predictive, and treatment monitoring indicators. This study aimed to evaluate HIIs for discriminating between infectious spondylodiscitis pathogens. This retrospective comparative study included 116 patients with infectious spondylodiscitis. According to the responsible infectious pathogens, three types of infectious spondylodiscitis were defined: Brucella (n = 51), pyogenic (n = 43), and tuberculous (n = 22). The HIIs were derived from baseline complete blood counts. The three types of infectious spondylodiscitis were statistically compared for the HII scores. We found that the Brucella group had significantly lower HII scores than the pyogenic group (p < 0.05). Also, the Brucella group had significantly lower HII scores than the tuberculous group (p < 0.05). However, no significant differences were found between the pyogenic and tuberculous groups regarding HIIs (p > 0.05). In conclusion, the HIIs may be considered in the differentiation between Brucella spondylodiscitis and other types of infectious spondylodiscitis.

A diagnostic model for differentiating tuberculous spondylodiscitis from pyogenic spondylodiscitis based on pathogen-confirmed patients.

This study aimed to distinguish tuberculous spondylodiscitis (TS) from pyogenic spondylodiscitis (PS) based on laboratory, magnetic resonance imaging (MRI) and computed tomography (CT) findings. Further, a novel diagnostic model for differential diagnosis was developed. We obtained MRI, CT and laboratory data from TS and PS patients. Predictive models were built using binary logistic regression analysis. The receiver operating characteristic curve was analyzed. Both internal and external validation was performed. A total of 81 patients with PS (n = 46) or TS (n = 35) were enrolled. All patients had etiological evidence from the focal lesion. Disc signal or height preservation, skip lesion or multi segment (involved segments ≥ 3) involvement, paravertebral calcification, massive sequestra formation, subligamentous bone destruction, bone erosion with osteosclerotic margin, higher White Blood Cell Count (WBC) and positive result of tuberculosis infection T cell spot test (T-SPOT.TB) were more prevalent in the TS group. A diagnostic model was developed and included four predictors: WBC<7.265 * (10^9/L), skip lesion or involved segments ≥ 3, massive sequestra formation and subligamentous bone destruction. The model showed good sensitivity, specificity, and total accuracy (91.4%, 95.7%, and 93.8%, respectively); the area under the receiver operating characteristic curve (AUC) was 0.981, similar to the results of internal validation using bootstrap resampling (1000 replicates) and external validation set, indicating good clinical predictive ability. This study develop a good diagnostic model based on both CT and MRI, as well as laboratory findings, which may help clinicians distinguish between TS and PS.

A Comparative Factor Analysis and New Magnetic Resonance Imaging Scoring System for Differentiating Pyogenic Versus Tuberculous Spondylodiscitis.

This study aimed to compare and analyze differences in clinical and magnetic resonance imaging (MRI) findings between tuberculous spondylodiscitis (TbS) and pyogenic spondylodiscitis (PyS), and to develop and validate a simplified multiparameter MRIbased scoring system for differentiating TbS from PyS. We compared predisposing factors in 190 patients: 123 with TbS and 67 with PyS, confirmed by laboratory tests, culture, or pathology. Data encompassing patient demographics, clinical characteristics, laboratory results, and MRI findings were collected between 2015 and 2020. Data were analyzed using logistic regression methods, and selected coefficients were transformed into an MRI-based scoring system. Internal validation was performed using bootstrapping method. Univariate analysis revealed that the significant risk factors associated with TbS included thoracic lesions, vertebral destruction > 50%, intraosseous abscess, thin-walled abscess, well-defined paravertebral abscess, subligamentous spreading, and epidural abscess. Multivariate analysis revealed that only thoracic lesions, absence of epidural phlegmon, subligamentous spreading, intraosseous abscesses, well-defined paravertebral abscesses, epidural abscesses, and absence of facet joint arthritis were independent predictive factors for TbS (all p < 0.05). These potential predictors were used to derive an MRI scoring system. Total scores ≥ 14/29 points significantly predicted the probability of TbS, with a sensitivity of 97.58%, specificity of 92.54%, and an area under the curve of 0.96 (95% confidence interval, 125.40-3,257.95). This simplified MRI-based scoring system for differentiating TbS from PyS helps guide appropriate treatment when the causative organism is not identified.

Tuberculous Spondylodiscitis with Psoas Abscess Descending into the Anterior Femoral Compartment Identified Using 2-deoxy-2-[18F]fluoroglucose Positron Emission Tomography Computed Tomography.

A 24-year-old immunocompetent woman underwent whole-body 18F-FDG PET/CT for the evaluation of MRI-suspicious tuberculous spinal lesions. The PET/CT results showed no pathological uptake in either lung, and there were no pathological changes on CT. There was increased uptake in the right psoas muscle, extending continuously down anterior to the right hip joint, posterior to and around the trochanteric region of the right femur, and into the right thigh, with an SUVmaxbw of 17.0. Subsequently, the patient underwent CT-guided biopsy as per protocol, which revealed drug-sensitive Mycobacterium tuberculosis, and the patient was started on standard tuberculosis treatment for 12 months.

Comprehensive Treatment of Generalized Tuberculosis with Endobronchial Valves

The article describes a clinical case of generalized tuberculosis manifested by tuberculous spondylodiscitis and disseminated pulmonary tuberculosis with extensive drug resistance and bilateral multiple destruction. The chemotherapy regimen compiled according to the sensitivity pattern of the pathogen, sequential implantation of two endobronchial valves and their long-term (18 months) synergic effect made it possible to cure pulmonary tuberculosis with healing of all multiple bilateral destruction. The same chemotherapy regimens allowed achieving cure of tuberculous spondylodiscitis. Co-infection of hepatitis C provided no negative impact on the treatment course.

Tuberculous Spondylodiscitis or Pott's Disease: Diagnostic Problem of Patients Referred to the Reference Health Center (CSRef) Commune III of Bamako for Anti-Tuberculosis Treatment

Introduction: Tuberculosis is an infectious disease that can affect different organs. The spinal disorder is called tuberculous spondylodiscitis (Pott's disease). The objective: Was to elucidate the aspects taken into account by caregivers in the diagnosis of tuberculosis spondylodiscitis in patients referred to the reference health center of commune III of Bamako for anti-tuberculosis treatment. Methodology: This was a descriptive, retrospective study covering all patients referred to CSRef CIII from different health structures with the diagnosis of Pott's disease for treatment during the study period. Results: During the study period, we collected 156 patients. The male sex represented 54% with a sex ratio of 1.18. The average age was 39.3 years with extremes of 12 and 92 years. All patients presented with spinal pain, fever was present in 11.11% of patients and 2.7% had respiratory symptoms. Tuberculin IDR was positive in 95.8% and 2 patients were AFB sputum positive. X-ray (of the lumbar spine) was negative in 18%; there were images of degenerative lesions in 41.6% and only 40.2% of patients had presumptive radiological signs. CT was carried out in all patients revealing 33.33% of sequelae of fractures and degenerative lesions and 55.55% of presumptive signs of tuberculous spondylodiscitis. Only 41.66 of the cases were referred by specialist doctors. Conclusion: In our context, the diagnosis of Pott's disease seems to be based mainly on chronic spinal pain and positive IDR and is not often made by appropriate personnel.

A comparative perspective on brucellar, pyogenic, and tuberculous spondylodiscitis.

Non-specific features of spondylodiscitis lead to a delay and challenge in the diagnosis/differential diagnosis/treatment processes, and thus, serious complications may arise. This study aims to compare brucellar, pyogenic, and tuberculous types of spondylodiscitis, considering their demographic, clinical, and laboratory differences. This may provide more rapid management and good outcomes. A total of 131 patients with infectious spondylodiscitis were included in the study. The patients were divided into brucellar (n=63), pyogenic (n=53), and tuberculous (n=15) types of spondylodiscitis and compared for demographic, clinical, laboratory, and imaging features. Tuberculous spondylodiscitis had higher scores for weight loss, painless palpation, thoracic spine involvement, and psoas abscess formation than other spondylodiscitis. Also, tuberculous spondylodiscitis had higher rates of neurologic deficit and lower rates of lumbar involvement than brucellar spondylodiscitis. Pyogenic spondylodiscitis is more likely to occur in patients who have a history of spine surgery compared to other forms of spondylodiscitis. Also, pyogenic spondylodiscitis had higher rates of fever, erythema, paraspinal abscess, white blood cell (WBC), and erythrocyte sedimentation rate (ESR) than brucellar spondylodiscitis. On the other hand, brucellar spondylodiscitis had higher rates of rural living and sweating than pyogenic spondylodiscitis. Weight loss, painless palpation, involved thoracic spine, psoas abscess, and neurologic deficit are symptoms favoring tuberculous spondylodiscitis. History of spine surgery, high fever, skin erythema, and paraspinal abscess are findings in favor of pyogenic spondylodiscitis. Rural living, sweating, and involved lumbar spine are symptoms that indicate brucellar spondylodiscitis. These symptoms can be used to distinguish the types of spondylodiscitis.

Vascular Challenges in Behçet's Disease: A Case Report Emphasizing Arterial Involvement

Behçet's disease, characterized by systemic manifestations primarily affecting the vascular system, presents unique challenges in diagnosis and management, particularly when arterial involvement occurs. This case report discusses a 50-year-old patient with Behçet's disease, highlighting the importance of recognizing and addressing arterial complications. The patient, diagnosed with bipolar aphthosis at 49, developed deep venous thrombosis and bilateral panuveitis, showing improvement with corticosteroids, azathioprine, and anticoagulation. A subsequent presentation a year later included deep vein thrombosis, loss of consciousness, and paraparesis, alongside mouth ulcers. Cerebral-medullary MRI revealed inflammatory arterial stenoses and tuberculous spondylodiscitis. A coincidental discovery of pulmonary embolism complicated therapeutic options, with satisfactory evolution following treatment. Discussion emphasizes the intricate nature of Behçet's disease, known for systemic and vascular involvement, especially in arteries. The rarity of cerebral arterial manifestations underscores the need for heightened awareness to diverse morphological presentations. Managing arterial complications requires a tailored therapeutic strategy, balancing immunosuppression and potential risks. Collaborative efforts among specialists are crucial for refining treatment approaches and improving outcomes. In conclusion, this case report underscores the importance of recognizing and addressing arterial complications in Behçet's disease for effective management. Continued research and multidisciplinary collaboration are essential to enhance our understanding and refine therapeutic interventions for this complex systemic disorder.

Surgical Treatment of Thoracolumbar Pott’s Disease at Niamey National Hospital (HNN) about 34 Cases

Pott's disease or tuberculous spondylodiscitis is one of the most serious forms of osteoarticular tuberculosis, responsible for spinal cord compression and/or "cauda equina" syndrome due to granulomatous and/or abscessed tuberculous epiduritis. Surgery therefore plays a key role in the management of this pathology, although surgical techniques vary widely from one author to another and from one department to another.&#x0D; The aim of our work is to describe the different techniques used in our department during the study period, and to evaluate the results.&#x0D; This is a prospective study concerning 34 cases of dorsolumbar and lumbar Pott's disease collised in the neurosurgery department of Niamey National Hospital from January 2020 to December 2021.&#x0D; Analysis of our results found 26 men and 8 women with a sex ratio of 3.25; the extreme ages were 11 and 76 years and the mean age was 40.53 years. 20 patients presented with dorsal cord compression syndrome, 12 with cauda equina syndrome, 6 with conus medullaris syndrome and 2 with multifocal localization.&#x0D; CT was performed in all patients and MRI in only one. All patients were treated with antibacillary chemotherapy. In 16 patients (47.06%), a posterolateral approach consisting of hemilaminectomy, pediculotomy and unilateral arthrectomy was used; in 9 patients (26.47%) a posterior approach consisting of fenestration; and laminectomy in 4 patients (11.76%). An anterior approach in 3 patients (8.82%), consisting of a corpectomy and an antero-lateral approach (pediculo-artrectomy-corpectomy) in 2 patients (5.89%). All our patients underwent debridement, evacuation of residual pus and sequestrectomy. Out of the debridement filling of the defect was performed in 23 cases with a spinous graft, 2 with fibula, 2 with a rib graft and one with an iliac bone graft.&#x0D; At 4 months post-surgery, radicular signs had completely disappeared in all patients, and sensory-motor deficit had improved in 30 patients (88.23%). There was a reduction in kyphosis in all patients who had benefited from an anterior approach, compared with 41.38 % who had undergone a posterior approach.

Imaging in spinal infections: Current status and future directions

Imaging plays an important role in the diagnosis of spinal infections. Early diagnosis is paramount in the treatment of spinal infections and leads to improved outcomes. This article reviews the imaging and relevant clinical details of infections of the spine: pyogenic spondylodiscitis, tuberculous spondylodiscitis, septic facet arthritis, epidural abscess, and subdural abscess. Though radiographs can reveal subtle changes with infections, advanced imaging modalities have increased sensitivity to aid in early diagnosis. Magnetic resonance imaging (MRI) is emphasized given it is generally the most sensitive and specific advanced imaging modality. However, nuclear medicine imaging and computer tomography (CT) play a role diagnosis in cases where MRI is not available or contra-indicated. Additionally, CT is also important for image-guided biopsy to guide antimicrobial treatment.

Brucellar, Pyogenic, and Tuberculous Spondylodiscitis at Tertiary Hospitals in Saudi Arabia: A Comparative Retrospective Cohort Study.

Spondylodiscitis is rare yet the most common form of spinal infection. It is characterized by inflammation of the intervertebral disk space and adjacent vertebral body. In Western countries, the incidence of spondylodiscitis is increasing. Clinical outcomes most commonly reported in the literature are the 1-year mortality rate (range, 6%-12%) and neurologic deficits. This multicenter retrospective cohort study assessed patients diagnosed with infectious spondylodiscitis who received treatment at King Abdulaziz Medical City in Riyadh and Jeddah, Saudi Arabia. All enrolled patients were ≥18 years old and were diagnosed per radiologic and microbiological findings and clinical manifestations between January 2017 and November 2021. This study enrolled 76 patients with infectious spondylodiscitis, with a median age of 61 years. All patients presented with back pain for a median 30 days. Patients were stratified into 3 groups based on the causative pathogen: brucellar spondylodiscitis (n = 52), tuberculous spondylodiscitis (n = 13), and pyogenic spondylodiscitis (n = 11). All laboratory data and biochemical markers were not significantly different. However, C-reactive protein, erythrocyte sedimentation rate, and white blood cells were significantly different in the pyogenic spondylodiscitis group, with medians of 121 mg/dL (P = .03), 82 mmol/h (P = .04), and 11.2 × 109/L (P = .014), respectively. Back pain is a common clinical feature associated with infectious spondylodiscitis. The immense value of microbiological investigations accompanied with histologic studies in determining the causative pathogen cannot be emphasized enough. Treatment with prolonged intravenous antimicrobial therapy with surgical intervention in some cases produced a cure rate exceeding 60%.

Anterior versus Posterior Approach in Surgical Treatment of Tuberculous Spondylodiscitis of Thoracic and Lumbar Spine

Background Spinal tuberculosis is the most common encountered extra-pulmonary form of the disease and accounts for around 50% of musculoskeletal tuberculosis cases, thoracic spine is the most commonly affected, and involvement of lumbar and lumbosacral region is less common, spinal tuberculosis can cause severe neurological deficits, kyphotic deformities, and paraplegia. Aim of the Work The aim of this study is review the literature comparing the clinical, radiological and functional outcome of anterior versus posterior surgical debridement and fixation in patients with thoracic and lumbar tuberculous spondylodiscitis. Patients and Methods In this meta-analysis, we combined 25 studies that compared the clinical outcomes of the anterior and posterior approaches in treating 1797 patients with thoracic and lumber spinal TB. This study was approved by the Ethics Committee of Ain Shams University Faculty of Medicine. Written informed consent was not needed because of the study design (systematic review). Based on patient safety and the efficacy of the procedures, we raised three clinically crucial questions to determine the optimal surgical procedure in treating thoracic and lumbar tuberculosis. The primary data used as evidence to answer these questions were obtained from the treatment results, such as the radiologic data and patient-related outcomes. Results The results showed that there is no statically significant different in the operative time for the anterior approach (220.8-51.5 minutes) versus posterior approach (213.9-69.3 minutes), and no statistically significant difference was detected. Blood loss was significantly greater in the anterior approach (1125.0-275.5 mL) than in the posterior approach (710.4-192.4 mL). Conclusion The posterior approach showed a higher potential for maintaining the correction of deformity and a lower overall surgical complication rate; however, both groups showed no statistically significant differences in operative time, blood loss, radiological and clinical outcome; therefore posterior approach could be used as an alternative procedure to treat thoracic and lumbar tuberculosis patients in terms of pain control, Cobb’s angle, and reduction of complications, however; posterior-only approach alone cannot be used in cases of anterior abscess formation or multilevel involvement where an anterior debridement is mandatory, so; when deciding among the two procedures for treatment of thoracic and lumbar spinal tuberculosis, surgeons must thoroughly consider the patient’s specific features of spinal tuberculosis, the surgeon’s own surgical experience, the risks of surgical complications ranging from neurological to structural, and the different possible outcomes.

A clinical prediction model to differentiate tuberculous spondylodiscitis from pyogenic spontaneous spondylodiscitis.

Microbiological diagnosis of tuberculous spondylodiscitis (TS) and pyogenic spontaneous spondylodiscitis (PS) is sometime difficult. This study aimed to identify the predictive factors for differentiating TS from PS using clinical characteristics, radiologic findings, and biomarkers, and to develop scoring system by using predictive factors to stratify the probability of TS. A retrospective single-center study. Demographics, clinical characteristics, laboratory findings and radiographic findings of patients, confirmed causative pathogens of PS or TS, were assessed for independent factors that associated with TS. The coefficients and odds ratio (OR) of the final model were estimated and used to construct the scoring scheme to identify patients with TS. There were 73 patients (51.8%) with TS and 68 patients (48.2%) with PS. TS was more frequently associated with younger age, history of tuberculous infection, longer duration of symptoms, no fever, thoracic spine involvement, ≥3 vertebrae involvement, presence of paraspinal abscess in magnetic-resonance-image (MRI), well-defined thin wall abscess, anterior subligamentous abscess, and lower biomarker levels included white blood cell (WBC) counts, erythrocyte-sedimentation-rate (ESR), neutrophil fraction, and C-reactive protein (all p < 0.05). Multivariate logistic regression analysis revealed significant predictors of TS included WBC ≤9,700/mm3 (odds ratio [OR] 13.11, 95% confidence interval [CI] 4.23-40.61), neutrophil fraction ≤78% (OR 4.93, 95% CI 1.59-15.30), ESR ≤92 mm/hr (OR 4.07, 95% CI 1.24-13.36) and presence of paraspinal abscess in MRI (OR 10.25, 95% CI 3.17-33.13), with an area under the curve of 0.921. The scoring system stratified the probability of TS into three categories: low, moderate, and high with a TS prevalence of 8.1%, 29.6%, and 82.2%, respectively. This prediction model incorporating WBC, neutrophil fraction counts, ESR and presence of paraspinal abscess accurately predicted the causative pathogens. The scoring scheme with combination of these biomarkers and radiologic features can be useful to differentiate TS from PS.

DIAGNOSIS AND TREATMENT SPONDYLODISCITIS : THE LITERATURE REVIEW

In many regions of the globe, pyogenic spondylitis remains a significant concern. It is a disorder that affects a very small proportion of the population, but it can be quite severe and even fatal. Frequently, it is difficult to make a diagnosis due to the absence of evident signs or symptoms. It encompasses a vast array of clinical entities, including pyogenic spondylodiscitis, discitis, vertebral osteomyelitis, and spinal osteomyelitis, among others. The success rates of conservative treatment are comparable to those of surgical treatment, but complications and mortality rates are lower. In the absence of a clear indication for surgical intervention, conservative treatment should be considered first. Patients with cervical tract or tuberculous spondylodiscitis should endure closer diagnostic and clinical monitoring due to the increased risk of developing bone collapse and neurological deficits.

Pott’s disease: A wake-up call for an underestimated diagnosis

Introduction: Tuberculosis continues to be a major cause of death worldwide. The bacillus responsible for this condition, Mycobacterium tuberculosis, typically affects the lungs, but can also affect other regions, in which case it is called extrapulmonary tuberculosis. Osteoarticular manifestations represent the third most common form of this type of tuberculosis. The axial skeleton stands out as the most affected region; this is called tuberculous spondylodiscitis or Pott’s disease. Case Report: A 26-year-old male patient, living in Queimados, an informal worker, reported that about one month ago he presented weight loss of 7 kg, low back pain without irradiation (intensity 10/10), and a dry cough. One week ago, he started having chills with changes in the cough pattern, which became productive. Laboratory tests and serologies were unaltered. Alcohol-Acid Resistant Bacilli (BAAR): Positive +++ in 200 observed fields. Rapid molecular test (TRM): Detectable. Conclusion: To a great extent, the incidence of tuberculosis has been maintained by immunosuppressive diseases, such as human immunodeficiency virus (HIV). In contrast, tuberculous spondylodiscitis remains an underdiagnosed condition in most services, and its management is still under discussion.

Incidence and treatment trends of infectious spondylodiscitis in South Korea: A nationwide population-based study.

The incidence of infectious spondylodiscitis (IS) has increased in recent years due to an increase in the numbers of older patients with chronic diseases, as well as patients with immunocompromise, steroid use, drug abuse, invasive spinal procedures, and spinal surgeries. However, research focusing on IS in the general population is lacking. This study investigated the incidence and treatment trends of IS in South Korea using data obtained from the Health Insurance Review and Assessment Service. A total of 169,244 patients (mean age: 58.0 years) diagnosed from 2010 to 2019 were included in the study. A total of 10,991 cases were reported in 2010 and 18,533 cases in 2019. Hence, there was a 1.5-fold increase in incidence rate per 100,000 people from 22.90 in 2010 to 35.79 in 2019 (P < 0.05). The incidence rate of pyogenic spondylodiscitis per 100,000 people increased from 15.35 in 2010 to 33.75 in 2019, and that of tuberculous spondylodiscitis decreased from 7.55 in 2010 to 2.04 in 2019 (P < 0.05, respectively). Elderly individuals ≥ 60 years of age accounted for 47.6% (80,578 patients) of all cases of IS. The proportion of patients who received conservative treatment increased from 82.4% in 2010 to 85.8% in 2019, while that of patients receiving surgical treatment decreased from 17.6% to 14.2% (P < 0.05, respectively). Among surgical treatments, the proportions of corpectomy and anterior fusion declined, while proportion of incision and drainage increased (P < 0.05, respectively). The total healthcare costs increased 2.9-fold from $29,821,391.65 in 2010 to $86,815,775.81 in 2019 with a significant increase in the ratio to gross domestic product. Hence, this population-based cohort study demonstrated that the incidence rate of IS has increased in South Korea. The conservative treatment has increased, while the surgical treatment has decreased. The socioeconomic burden of IS has increased rapidly.

Clinical efficacy and imaging analysis for the surgical treatment of thoracolumbar infections in elderly patients: a retrospective study

Few reports have been conducted to comparing surgical results and safety evaluations between the different types of infections in geriatric patients with thoracolumbar infections. The aim of this study is to investigate the safety and efficacy of surgical treatment for thoracolumbar infections in elderly patients. 21 patients with pyogenic spondylodiscitis (PS) and 26 patients with tuberculous spondylodiscitis (TS) were enrolled in the study. All patients were treated using one-stage posterior debridement, decompression, and pedicle screw fixation. Comparison of operative safety parameters between the two groups. Clinical efficacy was evaluated using visual analogue scale (VAS) score, the American Spinal Injury Association (ASIA) grade, the short form (SF)-36 survey and Oswestry disability index (ODI) to determine patient quality of life pre- and post-operatively. Hospitalisation and intensive care unit duration in the PS group were significantly shorter than in the TS group (P < 0.05). The total incidence of post-operative complications for both groups was 44.7%. More complications occurred in the TS group, but the difference was not significant. The scores of VAS, ODI and SF-36 of all 47 patients were significantly improved compared with those before operation.The VAS and SF-36 scores (physical component) were significantly better in the PS group 6 months post-operatively, and the SF-36 (mental component) scores were significantly better in the PS group at the 1-year follow-up. Neurological status in both groups improved post-operatively, and 83% of patients reported satisfactory results based on the modified MacNab standard. Imaging results showed that bone graft fusion improved in both groups at 6 months, 1 year and at the final follow-up. One-stage posterior debridement, decompression, interbody fusion, and internal fixation can be considered a safe and effective method of treating spinal infections in the elderly. This method can improve nerve function, reconstruct spinal stability, and enhance the quality of life of elderly patients. Both PS and TS who underwent surgery achieve similar clinical and radiological results.

Role of MRI imaging in tuberculous and pyogenic spondylodiscitis

Role of MRI imaging in tuberculous and pyogenic spondylodiscitis

Mimics of Spinal Tuberculosis

Background: The incidence of atypical clinicoradiological presentations of spinal tuberculosis (TB) is on the upsurge. Lesions that share similar features should be evaluated thoroughly. Tissue diagnosis remains the only foolproof investigation to confirm the diagnosis before initiation of treatment. Objectives: To evaluate the lesions of spine masquerading as tuberculosis Materials and Methods: We present two cases who were provisionally diagnosed with a case of tubercular spondylodiscitis based on clinicoradiological findings. After failure of response from anti-tubercular drugs, they underwent operative management for decompression of neural elements and histological confirmation of the provisional diagnosis. Results: Clinical features such as back pain, weight loss, gait abnormalities with radiology such as magnetic resonance imaging, computed tomography-guided fine-needle aspiration cytology and GeneXpert helps in the early detection and initiation of treatment of spinal TB. However, in our case, 58-year-old female and 13-year-old male presented with clinic-radiological features consistent with spinal TB. Histopathology and immunohistochemistry confirm that the first case is due to Aspergillus spinal epidural abscess and second case due to round blue cell neoplasm consistent with Ewing’s sarcoma. Conclusion: This article highlights the importance of awareness of the different clinic-radiographic features of spinal lesions, which can mimic a tuberculous spondylodiscitis. In order to avoid delayed diagnosis, clinicians must be aware of differential diagnosis from common to rare entity which may interfere with other clinical conditions.

VERTEBRAL OSTEOMİYELİT: SON 10 YILDA NELER DEĞİŞTİ?

Objective: This study was conducted to describe the demographic, clinical, and microbiological characteristics of vertebral osteomyelitis in the last decade, mainly by comparing literature and the previous case series performed in our center.&#x0D; Material and Methods: This is a retrospective, observational, descriptive study performed between 2009-2019 at Istanbul University-Cerrahpasa, Cerrahpasa School of Medicine. All patients were divided into three main groups: pyogenic (PVO), tuberculous (TVO) and brucellar (BVO). &#x0D; Results: A total of 100 cases were included in this study. Of these 100 patients, 59 had pyogenic, 15 had brucellar and 26 had tuberculous spondylodiscitis. The disease developed postoperatively in 22 (37.4%) of the 59 PVO cases. The common isolated microorganism was Staphylococcus aureus (n = 11), followed by coagulase negative staphylococci (n = 6). BVO rate was lower than previous case series (15 vs. 24). The median time to improvement in the laboratory findings after the administration of the appropriate treatment was 14 days. PET-CT was diagnostic in 81.8% of PVO patients, similar to MRI. However, PET-CT diagnosis rate was significantly low in TVO patients (3 out of 9, p = 0.040).&#x0D; Conclusion: S. aureus remained the most common etiologic agent. Coagulase negative staphylococci infection rate, mainly related to spinal surgery, and postoperative spondylodiscitis rate is higher than before. Brucellar VO rate is lower, which is mostly related to effective animal vaccination and pasteurization. Although, MRI is the gold standard, PET-CT is a promising technique in diagnosis for PVO.