Efficacy and safety of short-term chemotherapy for patients with spinal tuberculosis undergoing surgery in Chinese population: a meta-analysis

Clinical Features and Outcomes of Spinal Tuberculosis in Central China

Purpose

The appropriate management of spinal tuberculosis (TB) is challenging for clinicians and the key to treat spinal TB. Surgery and long course anti-TB chemotherapy may not be necessary to all situations. This study aimed to characterize the clinical features and factors affecting treatment outcomes.

Patients and Methods

A retrospective study of patients with spinal TB over a 5-year period at a teaching hospital in central China was conducted. Features of patients with spinal TB who received different treatment modalities and factors associated with patient outcomes at the end of chemotherapy were analyzed.

Results

Forty-five patients (21 men and 24 women) with spinal TB were available for analysis. The mean age was 55.39 ± 14.94 years. The most common vertebral area involved was the lumbar (42.2%). The mean number of vertebrae involved was 2.20 ± 0.59. 27 patients (60.0%) received surgical treatment, of which 21 (77.8%) received radical surgical treatment. Thirty-five patients (77.8%) had achieved a favorable status. Statistically, there was no significant correlation between favorable status and surgery, but among 27 surgical patients with spinal tuberculosis, patients receiving radical surgery tended to achieve good prognosis (P = 0.010; odds ratio = 0.053; 95% confidence interval 0.006–0.493). Moreover, there was no significant difference between long course and short course of anti-TB chemotherapy in prognosis in different treatment modalities.

Conclusion

Although the patients with spinal TB who needed surgical treatment often got a better prognosis when they had radical surgery, surgery was not actually a factor for the favorable outcomes of patients with spinal TB. In different treatment modalities, there was no additional benefit in longer anti-TB chemotherapy periods.

Brucellar Knee Arthritis with Knee Joint Tuberculosis: A Case Report and Review of the Literature

Brucella and Mycobacterium tuberculosis (MTB) primarily affect the spine and only rarely the knee joint in osteoarticular disease in adults. We present an unusual instance of brucellar knee arthritis combined with knee joint tuberculosis. A 59-year-old man was initially diagnosed with brucellar knee arthritis in the orthopedics department of our hospital, while two weeks of standardized treatment did not improve the joint discomfort and inflammation indexes. Subsequent evaluation of serum tuberculosis interferon-gamma release assays (TB-IGRAs) and the effectiveness of empirical anti-tuberculosis therapy confirmed the mixed infection of tuberculosis. This case report demonstrates that clinical signs and imaging for brucellar knee arthritis and knee joint tuberculosis are similar. Patients with both disorders are more likely to be misdiagnosed or have their diagnosis delayed; clinicians should be aware of this uncommon combination of mixed infections.