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El Harras Y, Imrani K, Faraj C, Moatassim Billah N, Nassar I. Spine tuberculosis with an intercurrent active pulmonary location in a high incidence country: A rare case report. SAGE Open Med Case Rep 2024; 12:2050313X241248390. [PMID: 38659654 PMCID: PMC11041532 DOI: 10.1177/2050313x241248390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Accepted: 03/28/2024] [Indexed: 04/26/2024] Open
Abstract
Spinal tuberculosis usually presents as destroyed contiguous vertebral bodies associated with intervertebral discs and paravertebral or psoas abscesses. Atypical forms are uncommonly reported. Vertebral involvement without disk destruction is a rare form that improves satisfactorily after appropriate medical management. We report the case of a 36-year-old male who had spine tuberculosis without disk involvement, associated with intercurrent active pulmonary location with good clinical improvement after treatment and follow-up imaging showing spectacular regression of bone lesions. By reporting this case, we also review the literature on this rare form of tuberculosis.
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Affiliation(s)
- Yahya El Harras
- Radiology Department, Ibn Sina University Hospital, Mohammed V University, Rabat, Morocco
| | - Kaoutar Imrani
- Radiology Department, Ibn Sina University Hospital, Mohammed V University, Rabat, Morocco
| | - Chaymae Faraj
- Radiology Department, Ibn Sina University Hospital, Mohammed V University, Rabat, Morocco
| | - Nabil Moatassim Billah
- Radiology Department, Ibn Sina University Hospital, Mohammed V University, Rabat, Morocco
| | - Ittimade Nassar
- Radiology Department, Ibn Sina University Hospital, Mohammed V University, Rabat, Morocco
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Arifin J, Biakto KT, Johan MP, Anwar SFZ. Clinical outcomes and surgical strategy for spine tuberculosis: a systematic review and meta-analysis. Spine Deform 2024; 12:271-291. [PMID: 37975989 PMCID: PMC10867033 DOI: 10.1007/s43390-023-00785-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 10/23/2023] [Indexed: 11/19/2023]
Abstract
PURPOSE Spinal tuberculosis (TB) is a slow-developing disease that often causes cord compression, spinal instability, and deformity. Surgery is generally required in cases of refractory disease, severe kyphosis, neurological deficits, or lack of improvement. However, there is a lack of comprehensive evidence in comparing the efficacy of various surgical approaches. The study aims to provide a clearer understanding of the relative effectiveness of the available surgical modalities in the management of spinal TB. METHODS This review adhered to the PRISMA statement with searching conducted until 11th April 2023. Inclusion criteria included studies involving surgical procedures for spinal tuberculosis, with relevant clinical outcomes reported. Data extraction involved the collection of information on study and population characteristics, interventions used, relevant clinical outcomes, and reported complications. The risk of bias was evaluated using Cochrane's Risk of Bias in Non-randomized Studies tool. RESULTS Searching resulted in 20 cohort studies that analyzed surgical methods for spinal tuberculosis. Eleven studies had low bias and nine studies had moderate bias. The anterior approach was associated with faster perioperative duration [- 2.02 (- 30.71, 26.67), p < 0.00001], less blood loss [- 4242 (- 176.02, 91.18), p < 0.00001], shorter hospitalization [- 0.19 (- 2.39, 2.01), p < 0.00001], better angle correction [1.01 (- 1.82, 3.85), p < 0.00001], and better correction rates [11.36 (- 7.32, 30.04), p < 0.00001] compared to the posterior approach. Regarding neurological function recovery, the anterior and posterior approaches were equally effective, while the posterior approach was associated with a higher incidence of complications. The review also reported on the complications associated with the surgical approaches, and 9 out of 20 studies reported complications. The anterior approach was found to have fewer complications overall. CONCLUSION The anterior approach is thought to have fewer complications than both combined and posterior-only approaches, but the variability of the findings indicates that the decision-making process for selecting a surgical approach must consider individual patient and disease characteristics, as well as surgeon training.
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Affiliation(s)
- Jainal Arifin
- Department of Orthopaedics and Traumatology, Hasanuddin University, Jl. Perintis Kemerdekaan No. 10, Tamalanrea Indah, Makassar, Sulawesi Selatan, 90245, Indonesia
| | - Karya Triko Biakto
- Department of Orthopaedics and Traumatology, Hasanuddin University, Jl. Perintis Kemerdekaan No. 10, Tamalanrea Indah, Makassar, Sulawesi Selatan, 90245, Indonesia
| | - Muhammad Phetrus Johan
- Department of Orthopaedics and Traumatology, Hasanuddin University, Jl. Perintis Kemerdekaan No. 10, Tamalanrea Indah, Makassar, Sulawesi Selatan, 90245, Indonesia
| | - St Fatimah Zahrah Anwar
- Department of Orthopaedics and Traumatology, Hasanuddin University, Jl. Perintis Kemerdekaan No. 10, Tamalanrea Indah, Makassar, Sulawesi Selatan, 90245, Indonesia.
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Arifin J, Massi MN, Biakto KT, Bukhari A, Noor Z, Johan MP. Randomized controlled trial of vitamin d supplementation on toll-like receptor-2 (tlr-2) and toll-like receptor-4 (tlr-4) in tuberculosis spondylitis patients. J Orthop Surg Res 2023; 18:983. [PMID: 38129893 PMCID: PMC10740285 DOI: 10.1186/s13018-023-04445-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 12/05/2023] [Indexed: 12/23/2023] Open
Abstract
BACKGROUND Tuberculosis spondylitis accounts for approximately 50% of all cases of skeletal tuberculosis. Vitamin D plays a role in the immune system. Vitamin D helps in the activation of TLR-2 and TLR-4, which play a role in the process of tuberculosis infection. The objective of this study was to investigate the effect of oral supplementation with vitamin D on TLR-2 and TLR-4 levels in tuberculosis spondylitis patients. METHODS The true Experiment Design Pretest-Posttest with Control Group (Pretest-Posttest with Control Group) was used for this research. TLR-2 and TLR-4 were measured by ELISA. Repeated ANOVA, ANOVA tests, and Kolmogorov-Smirnov normality tests on the SPSS program were used to statistically analyze the results. RESULT In the dose groups of 10,000 IU and 5000 IU, significant increases in the levels of vitamin D, TLR-2, and TLR-4 were observed at weeks 4 and 8 (p < 0.05). In the control group, there was no significant increase. CONCLUSIONS Vitamin D supplements can significantly increase TLR-2 and TLR-4 levels. Supplementation with vitamin D 10,000 IU/day for 8 weeks can increase vitamin D levels > 50 ng/dl to optimally act as an immunomodulator.
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Affiliation(s)
- Jainal Arifin
- Orthopaedic and Traumatology Department, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia
| | - Muhammad Nasrum Massi
- Clinical Microbiology Department, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia.
| | - Karya Triko Biakto
- Orthopaedic and Traumatology Department, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia
| | - Agussalim Bukhari
- Clinical Nutrition Department, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia
| | - Zairin Noor
- Orthopaedic and Traumatology Department, Faculty of Medicine, Lambung Mangkurat University, Banjarmasin, Indonesia
| | - Muhammad Phetrus Johan
- Orthopaedic and Traumatology Department, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia
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Shanmuganathan R, Ramachandran K, Shetty AP, Kanna RM. Active tuberculosis of spine: Current updates. NORTH AMERICAN SPINE SOCIETY JOURNAL 2023; 16:100267. [PMID: 37736557 PMCID: PMC10510092 DOI: 10.1016/j.xnsj.2023.100267] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 08/13/2023] [Accepted: 08/15/2023] [Indexed: 09/23/2023]
Abstract
Background Spinal tuberculosis (TB) is the most common extrapulmonary form of tuberculosis. In both developing and developed countries, TB has been on the rising trend due to factors such as increasing HIV coinfection, multidrug resistance of the organism, and global migration. Spinal TB, which most often affects the lower thoracic and thoracolumbar area, accounts for 50% of all musculoskeletal tuberculosis. Methods Using the Cochrane Database of Systematic Reviews, EMBASE, and PubMed, a systematic computerized literature search was performed. Analyses of studies published within the past 10 years were conducted. The searches were performed using Medical Subject Headings terms, with "spinal tuberculosis," "diagnosis," "epidemiology," and "etiology","management," "surgery," and "therapy" as subheadings. Results Progressive collapse, kyphosis, and neurological deficiency are hallmarks of the disease because of its destructive effect on the intervertebral disc and adjacent vertebral bodies. The condition may be identified using laboratory testing and distinctive imaging features, but the gold standard for diagnosis is tissue diagnosis using cultures, histology, and polymerase chain reaction. Uncomplicated spinal TB is today a medical condition that can be adequately treated by multidrug ambulatory chemotherapy. Surgery is reserved for individuals who have instability, neurological impairment, and deformity correction. Debridement, deformity correction, and stable fusion are the cornerstones of surgical treatment. Conclusions Clinical results for the treatment of spinal TB are generally satisfactory when the disease is identified and treated early. However, the major health issue and the biggest obstacle in achieving the goals of the "End TB strategy" is the recent rise in the emergence of drug resistance. Hence strict vigilance and patient perseverance in the completion of the treatment is the main need of the hour.
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Affiliation(s)
- Rajasekaran Shanmuganathan
- Department of Spine Surgery, Ganga Medical Centre and Hospitals Pvt. Ltd., Mettupalayam Rd, Coimbatore, 641043 India
| | - Karthik Ramachandran
- Department of Spine Surgery, Ganga Medical Centre and Hospitals Pvt. Ltd., Mettupalayam Rd, Coimbatore, 641043 India
| | - Ajoy Prasad Shetty
- Department of Spine Surgery, Ganga Medical Centre and Hospitals Pvt. Ltd., Mettupalayam Rd, Coimbatore, 641043 India
| | - Rishi Mugesh Kanna
- Department of Spine Surgery, Ganga Medical Centre and Hospitals Pvt. Ltd., Mettupalayam Rd, Coimbatore, 641043 India
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Rajasekaran S, Soundararajan DCR, Reddy GJ, Shetty AP, Kanna RM. A Validated Score for Evaluating Spinal Instability to Assess Surgical Candidacy in Active Spinal Tuberculosis-An Evidence Based Approach and Multinational Expert Consensus Study. Global Spine J 2023; 13:2296-2309. [PMID: 35220789 PMCID: PMC10538347 DOI: 10.1177/21925682221080102] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
STUDY DESIGN Modified Delphi Consensus and Observational Study. OBJECTIVE Instability in spinal tuberculosis (STB) leads to disabling spinal deformity and neurodeficit. Identifying and estimating instability remains subjective, mainly based on experience. This study aims to develop an objective scoring system to determine instability in STB. MATERIALS AND METHODS The study included 4 phases. (1) A panel of 10 experienced spine surgeons developed a questionnaire based on literature. (2) 68 spine surgeons from 12 countries opined on the importance of each factor in a survey. Five factors deemed important by >70% of participants were further analyzed (3) 60 representative cases of STB were analyzed for instability. A preliminary scoring system was developed, a threshold score for determining instability was derived, and (4) Results were validated. RESULTS All the 5 factors ("Spine at risk" signs, severity of vertebral body loss, Cervicothoracic/Thoracolumbar junction involvement, age ≤15, and kyphotic deformity ≥30°) considered important by >70% of participants were associated with instability and included in scoring: age ≤15 years (P-value, 0.05), cervicothoracic/thoracolumbar junction involvement (P-value, 0.028), sagittal deformity angle ratio (DAR) ≥ 15° (P-value, <.001), vertebral body loss-segmental ratio ≥.5 (P-value, <.001), and presence of spine at risk signs (P-value, <.001). A total score of ≥3/09 indicated definite instability with good sensitivity (77%) and excellent specificity (100%). Repeatability assessment showed a good agreement (.9625), and Cohen's kappa coefficient was strong (.809). CONCLUSION A simple objective scoring system for predicting instability in STB has been developed using 5 main factors; young age, junctional involvement, severity of the deformity, vertebral body loss, and presence of spine at risk signs.
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Affiliation(s)
| | | | | | - Ajoy P. Shetty
- Department of Spine Surgery, Ganga Hospital, Coimbatore, India
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Han B, Wang J, Hai Y, Sun D, Liang W, Yin P, Ding H. The Incidence, Changes and Treatments of Cervical Deformity After Infection and Inflammation. Neurospine 2023; 20:205-220. [PMID: 37016867 PMCID: PMC10080454 DOI: 10.14245/ns.2244744.372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 12/15/2022] [Indexed: 04/03/2023] Open
Abstract
A healthy cervical spine with normal movement is the basis of many daily activities and is essential for maintaining a good quality of life. However, the alignment, fusion, and structure of the cervical spine can change for various reasons, leading to cervical deformity, mainly kyphosis. Approximately 5%‒20% of spinal infections in the cervical spine cause cervical deformity. The deformity can recover early; however, the disease's long-term existence or the continuous action of abnormal stress may lead to intervertebral fusion and abnormal osteophytes. Many gaps and controversies exist regarding infectious cervical deformities, including a lack of clear definitions and an acceptable classification system thereby requiring further research. Moreover, there is no consensus on the indications for postinfectious cervical deformity associated with <i>Mycobacterium tuberculosis</i>, <i>Staphylococcus aureus</i>, and Brucellosis. Therefore, we reviewed and discussed the incidence, clinical manifestations, changes, and treatment of infectious and inflammatory secondary cervical deformities from common to rare to provide a theoretical basis for clinical decision-making.
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Affiliation(s)
- Bo Han
- Department of Orthopedics, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Jianqiang Wang
- Department of Orthopedics, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Yong Hai
- Department of Orthopedics, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
- Corresponding Author Yong Hai Department of Orthopedics, Beijing Chao-Yang Hospital, Capital Medical University, GongTiNanLu 8#, Chao-Yang District, Beijing 100020, China
| | - Duan Sun
- Department of Orthopedics, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Weishi Liang
- Department of Orthopedics, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Peng Yin
- Department of Orthopedics, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Hongtao Ding
- Department of Orthopedics, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
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Rahyussalim AJ, Sulaiman AR, Winartomo A, Al Mashur MI, Nasser MK, Kurniawati T. Closed system paravertebral abscess evacuation on spinal infection: A case series. Int J Surg Case Rep 2023; 104:107941. [PMID: 36842396 PMCID: PMC9984947 DOI: 10.1016/j.ijscr.2023.107941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 01/26/2023] [Accepted: 02/16/2023] [Indexed: 02/19/2023] Open
Abstract
INTRODUCTION Paravertebral abscess is a common complication of spondylitis tuberculosis which has high prevalence in Indonesia. Surgical intervention such as open surgery or endoscopic debridement is needed to remove and drainage the abscess in addition to chemotherapy. However, this surgeries have several complications such as soft tissue damage and abscess contamination to the healthy tissue. We reported closed system strategy to evacuate the paravertebral abscess on spinal infection. METHODS The technique is performed by orthopaedic team under guidance of the C-Arm and ultrasound sonography (USG) in March-June 202. The needle which connected to 20 cc syringe is inserted into the lesion to aspirate the abscess. After evacuation of the abscess, 2-g broad spectrum antibiotic is injected through the needle to eradicate the bacteria locally. RESULTS We performed the closed system paravertebral abscess evacuation in three patients, a 30-year-old male, 43-year-old male, and 22-year-old female. All the patients had back pain and limitation spine movement due to pain and were diagnosed with spondylitis and paravertebral abscess based on the plain radiography and magnetic resonance imaging (MRI). It reported that up to 2000 cc abscess can be evacuated with this micro invasive technique. CONCLUSION The closed system is a micro-invasive procedure result in minimal soft tissue injury and faster recovery. It succesfully remove paravertebral abscess followed by direct antibiotic eradication on spinal infection.
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Affiliation(s)
- Ahmad Jabir Rahyussalim
- Orthopaedic Department, Cipto Mangunkusumo General Hospital, Faculty of Medicine Universitas Indonesia; Stem Cell Medical Technology Integrated Service Unit, Cipto Mangunkusumo General Hospital, Jakarta, Indonesia.
| | - Andi Rama Sulaiman
- Orthopaedic Department, Cipto Mangunkusumo General Hospital, Faculty of Medicine Universitas Indonesia
| | - Aryo Winartomo
- Orthopaedic Department, Cipto Mangunkusumo General Hospital, Faculty of Medicine Universitas Indonesia
| | - Muslich Idris Al Mashur
- Orthopaedic Department, Cipto Mangunkusumo General Hospital, Faculty of Medicine Universitas Indonesia
| | - Mochammad Kamal Nasser
- Orthopaedic Department, Cipto Mangunkusumo General Hospital, Faculty of Medicine Universitas Indonesia; Post Graduate Medical Doctor, Faculty of Medicine Universitas, Indonesia; Stem Cell Medical Technology Integrated Service Unit, Cipto Mangunkusumo General Hospital, Jakarta, Indonesia
| | - Trie Kurniawati
- Orthopaedic Department, Cipto Mangunkusumo General Hospital, Faculty of Medicine Universitas Indonesia; Stem Cell Medical Technology Integrated Service Unit, Cipto Mangunkusumo General Hospital, Jakarta, Indonesia
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Pathogenesis, Diagnostic Challenges, and Risk Factors of Pott's Disease. Clin Pract 2023; 13:155-165. [PMID: 36826156 PMCID: PMC9955044 DOI: 10.3390/clinpract13010014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 01/14/2023] [Accepted: 01/17/2023] [Indexed: 01/27/2023] Open
Abstract
Tuberculosis (TB) prevalence is increasing in developed nations and continuing to cause significant mortality in low- and middle-income countries. As a result of the uptick in cases, there also exists an increased prevalence of extrapulmonary TB. TB is caused by Mycobacterium tuberculosis (M. tb). When M. tb disseminates to the vertebral column, it is called Pott's disease or spinal TB. The frequency, symptoms, and severity of the disease range by the location of the spine and the region of the affected vertebrae. While the current literature shows that timely diagnosis is crucial to reduce the morbidity and mortality from Pott's disease, there is a lack of specific clinical diagnostic criteria for Pott's disease, and the symptoms may be very non-specific. Studies have shown that novel molecular diagnostic methods are effective and timely choices. Research has implicated the risk factors for the susceptibility and severity of Pott's disease, such as HIV and immunosuppression, poverty, and malnutrition. Based on the current literature available, our group aims to summarize the pathogenesis, clinical features, diagnostic challenges, as well as the known risk factors for Pott's disease within this literature review.
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Tian Q, Na L, Cao S, Tian Z, Guo Z. Clinical features and surgical management of tuberculous arthritis of the sacroiliac joint: a retrospective analysis of 33 patients. BMC Surg 2022; 22:322. [PMID: 35996098 PMCID: PMC9396852 DOI: 10.1186/s12893-022-01759-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Accepted: 08/03/2022] [Indexed: 12/04/2022] Open
Abstract
Background We reviewed 3 different types of tuberculous sacroiliitis via anterior and posterior approaches to determine the efficacy and safety of this surgical approach by describing clinical presentation, imaging, and surgical treatment. Methods We reviewed 33 patients with 3 different types of severe tuberculous sacroiliitis, of which 16 patients with anterior iliac abscess underwent anterior debridement. 17 patients underwent posterior debridement. Among them, 5 patients with lumbar tuberculosis underwent lesion debridement through fenestration, joint fusion, and interbody fusion and internal fixation. The mean postoperative follow-up was 16.9 months (12–25 months).Erythrocyte sedimentation rate (ESR), visual analogue scale (VAS) and the Oswestry Disability Index (ODI) were used to judge the postoperative condition and functional recovery.
Results All patients’ hip, back and lower back pain symptoms were significantly relieved after surgical treatment. At 3 months after operation, the VAS and ODI scores of all patients decreased significantly. Conclusion Surgical treatment of tuberculous sacroiliitis should be performed as soon as possible under the adjuvant chemotherapy of anti-tuberculosis drugs. According to the different characteristics of sacroiliac joint tuberculosis, appropriate surgical operations should be adopted according to our classification criteria.
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Affiliation(s)
- Qi Tian
- Xi'an Ninth Hospital, Xi'an, China.
| | - Linhao Na
- Xinjiang Medical University Affiliated First Hospital, Ürümqi, China
| | - Shicong Cao
- Xinjiang Medical University Affiliated First Hospital, Ürümqi, China
| | - Zheng Tian
- Xinjiang Medical University Affiliated First Hospital, Ürümqi, China
| | - Zheng Guo
- Xinjiang Medical University Affiliated First Hospital, Ürümqi, China
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Novita BD, Muliono AC, Wijaya S, Theodora I, Tjahjono Y, Supit VD, Willianto VM. Managing spondylitis tuberculosis in a patient with underlying diabetes and hypothyroidism: A case report. World J Clin Cases 2022; 10:7451-7458. [PMID: 36158013 PMCID: PMC9353897 DOI: 10.12998/wjcc.v10.i21.7451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Revised: 12/28/2021] [Accepted: 06/15/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Tuberculosis (TB) remains one of the highest Asia’s health problems. Spondylitis TB in diabetes mellitus (DM) and hypothyroidism patients is a rare case of extrapulmonary tuberculosis. However, there is a lack of therapeutic guidelines to treat spondylitis TB, particularly with type 2 DM (T2DM) and hypothyroidism as comorbidities. Here we present a case of spondylitis TB with T2DM and hypothyroidism in a relatively young patient and its therapeutic procedure.
CASE SUMMARY We report the case of a 35-year-old male patient from Surabaya, Indonesia. Based on anamnesis, physical examination, and magnetic resonance imaging, the patient has been categorized in stage II of spondylitis TB with grade 1 paraplegia. Surprisingly, the patient also had a high HbA1c level, high thyroid stimulating hormone, and low free T4 (FT4), which indicated T2DM and hypothyroidism. A granulomatous process was observed in the histopathological section. The antituberculosis drugs isoniazid and rifampicin were given. In addition, insulin, empagliflozin, and linagliptin were given to control hyperglycemia conditions, and also levothyroxine to control hypothyroidism.
CONCLUSION The outcome was satisfactory. The patient was able to do daily activities without pain and maintained normal glycemic and thyroid levels. For such cases, we recommend the treatment of spondylitis TB by spinal surgery, together with T2DM and hypothyroidism therapies, to improve the patients’ condition. Prompt early and non-invasive diagnoses and therapy are necessary.
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Affiliation(s)
- Bernadette Dian Novita
- Department of Pharmacology and Therapy, Faculty of Medicine, Widya Mandala Surabaya Catholic University, Surabaya 60113, East Java, Indonesia
| | - Ari Christy Muliono
- Department of Internal Medicine, Faculty of Medicine, Widya Mandala Surabaya Catholic University, Surabaya 60113, Indonesia
- Department of Internal Medicine, Premier Surabaya Hospital, Surabaya 60111, Indonesia
- Department of Internal Medicine, Gotong Royong Surabaya Hospital, Surabaya 60110, Indonesia
| | - Sumi Wijaya
- Faculty of Pharmacy, Widya Mandala Surabaya Catholic University, Surabaya 60113, Indonesia
| | - Imelda Theodora
- Department of Pathology Anatomy, Faculty of Medicine, Widya Mandala Surabaya Catholic University, Surabaya 60113, Indonesia
| | - Yudy Tjahjono
- Faculty of Pharmacy, Widya Mandala Surabaya Catholic University, Surabaya 60113, Indonesia
| | | | - Vincentius Michael Willianto
- Department of General Medicine, Faculty of Medicine, Widya Mandala Surabaya Catholic University, Surabaya 60113, Indonesia
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Mahadhipta H, Ajiantoro, Shihab RA, Saleh RF, Tobing JFL, Gatam L, Husin S, Phedy, Gatam AR. A case report of percutaneous endoscopic debridement for treating lumbar tuberculous spondylitis with large psoas abscess. Int J Surg Case Rep 2022; 93:106850. [PMID: 35298989 PMCID: PMC8927711 DOI: 10.1016/j.ijscr.2022.106850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 02/19/2022] [Accepted: 02/22/2022] [Indexed: 11/02/2022] Open
Abstract
Introduction and importance Case presentation Discussion Conclusion Early diagnosis and management of spondylitis tuberculosis have special importance in preventing complications We reviewed the evaluation of clinical outcome, laboratory findings, and radiological post-minimal invasive endoscopic debridement in spinal tuberculosis with psoas abscess Post percutaneous endoscopic debridement, patients had a good response in eradicating germs with clinical, laboratory, and radiology findings improvement with resorption of psoas abscess This study is concerned that a combination of the administration of anti-tuberculous drugs and surgical treatment is the best choice for patients with spondylitis tuberculous with large psoas abscess
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Pinto D, Dhawale A, Shah I, Rokade S, Shah A, Chaudhary K, Aroojis A, Mehta R, Nene A. Tuberculosis of the spine in children - does drug resistance affect surgical outcomes? Spine J 2021; 21:1973-1984. [PMID: 34116216 DOI: 10.1016/j.spinee.2021.06.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 05/09/2021] [Accepted: 06/01/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT The emergence of drug resistance has complicated the management of spinal tuberculosis (TB). While it is well known that the medical management of drug-resistant spinal TB is more difficult, the surgical outcomes of the same have not been studied sufficiently, particularly in children. PURPOSE To analyze the surgical outcomes in a cohort of children treated for spinal TB, and to thus assess whether drug resistant (DR) disease is associated with poorer surgical outcomes. STUDY DESIGN/SETTING Retrospective observational study. PATIENT SAMPLE All children diagnosed and treated for tuberculous spondylodiscitis at a single center between January 2014 and June 2017. OUTCOME MEASURES Surgical outcomes in terms of neurological status and kyphosis angle at final follow-up, and complication rates. METHODS Radiographic and clinical data of children treated for spinal TB with minimum two-year follow-up were retrospectively analyzed. Data gathered included age, gender, level of spine affected, number of vertebrae involved, neurology (Frankel grade), microbiological reports, duration and type of anti-tuberculous therapy (ATT), details of Orthopaedic management and complications during treatment. In DR cases, the time from presentation to starting of second-line ATT was also assessed. Radiographs were reviewed to note the pre- and post-operative degree of kyphosis as well as the angle at final follow-up. Patients that developed major complications were compared statistically with those that did not. RESULTS Forty-one consecutive children (mean age 8.5 ± 4.2 years, 20 boys, 21 girls) were treated for spinal TB with a mean follow-up of 31.2 ± 6.4 months. Fifteen were managed conservatively, of which only one had DR-TB. Of the 26 managed surgically, 13 were managed with first-line ATT and 13 required second-line ATT. Of this latter group, eight had microbiologically proven drug resistance, whereas five were switched to second-line therapy presumptively because of failure to show an adequate response to first-line regimen. At last follow-up, all children had completed the prescribed course of ATT and had been declared cured. Neurological improvement was seen in all but one patient; and at last follow-up, 18 children were Frankel E, seven were Frankel D, and one was Frankel B. 1The immediate post-operative Kyphosis angle averaged 24.38° ± 15.21°. However, six children showed a subsequent worsening of kyphosis, and the Kyphosis angle at last follow-up averaged 30.96° ± 23.92°. Five children had major complications requiring revision surgery; complications included wound dehiscence, vertebral collapse, screw pull-out and implant breakage. Significantly higher number of patients in the group with complications had required second-line ATT (p < .05). CONCLUSIONS In a cohort of children treated surgically for spinal tuberculosis, a higher complication rate, and thus poor surgical outcomes, were found to be associated with drug resistant disease.
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Affiliation(s)
- Deepika Pinto
- Department of Orthopaedics, Bai Jerbai Wadia Hospital for Children, Parel, Mumbai 400012, India
| | - Arjun Dhawale
- Department of Orthopaedics, Bai Jerbai Wadia Hospital for Children, Parel, Mumbai 400012, India; Department of Orthopaedics, Sir H.N. Reliance Foundation Hospital, Girgaon, Mumbai 400004, India.
| | - Ira Shah
- Paediatric TB Clinic, Bai Jerbai Wadia Hospital for Children, Parel, Mumbai 400012, India
| | - Sarang Rokade
- Department of Orthopaedics, Bai Jerbai Wadia Hospital for Children, Parel, Mumbai 400012, India
| | - Avi Shah
- Department of Orthopaedics, Bai Jerbai Wadia Hospital for Children, Parel, Mumbai 400012, India
| | - Kshitij Chaudhary
- Department of Orthopaedics, Sir H.N. Reliance Foundation Hospital, Girgaon, Mumbai 400004, India
| | - Alaric Aroojis
- Department of Orthopaedics, Bai Jerbai Wadia Hospital for Children, Parel, Mumbai 400012, India
| | - Rujuta Mehta
- Department of Orthopaedics, Bai Jerbai Wadia Hospital for Children, Parel, Mumbai 400012, India
| | - Abhay Nene
- Department of Orthopaedics, Bai Jerbai Wadia Hospital for Children, Parel, Mumbai 400012, India
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Utomo P, Kaldani F, Yanto R, Prijosedjati RA, Yamani AR. Kyphotic angle correction and neurological status evaluation after operation in spinal tuberculosis patients: Single center retrospective study. Indian J Tuberc 2021; 68:464-469. [PMID: 34752314 DOI: 10.1016/j.ijtb.2021.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Revised: 12/19/2020] [Accepted: 02/03/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND Previous studies have indicated that correction of an established kyphosis in spine tuberculosis is both difficult and hazardous. There has not been any publication about evaluation of surgical correction of spine tuberculosis in Indonesia, despite of high incidence of spine tuberculosis cases. Therefore, we evaluated the outcome of kyphotic angle correction and neurological status after surgery of spinal tuberculosis patients for better understanding. METHODS Retrospectively, 96 patients with spinal tuberculosis that underwent operation in Soeharso Orthopedic Hospital from June 2016 to July 2019 were selected. Operation procedure includes laminectomy, debridement and posterior stabilization. We obtained plain x-ray of spine to evaluate the kyphotic deformity before and after surgery. We also examined neurological status of the patient before and after surgery. RESULTS The average pretreatment kyphotic angle in thoracic tuberculosis was 33.69° (range 8°-86°), which improved into a significant change to 13.27° (range 0°-56°). Correction angle was <25° in 34 people, 25°-50° in 17 people, and >50° in 4 people. While in the lumbar tuberculosis, it was 25.52° (range 6°-80°), and improved into 11.51° (range 2°-48°). Correction angle was <25° in 35 people, 25°-50° in 4 people, and >50° in 2 people. Improved neurological deficit was shown in 12% of patient with lumbar tuberculosis, and the rest had constant neurological deficit. While in thoracic tuberculosis found that 7% have improved neurological deficit and the rest is constant. None of them have worsen neurological status after the surgery. CONCLUSIONS Surgical treatment for kyphotic deformity in patient with thoracolumbar tuberculosis are effective and safe, even in high corrective angle (>50°).
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Affiliation(s)
- Pamudji Utomo
- Department of Orthopedic Surgery, Soeharso Orthopaedic Hospital, Surakarta, Indonesia.
| | - Fathih Kaldani
- Department of Orthopedic Surgery, Soeharso Orthopaedic Hospital, Surakarta, Indonesia
| | - Romani Yanto
- Department of Orthopedic Surgery, Soeharso Orthopaedic Hospital, Surakarta, Indonesia
| | - R Andhi Prijosedjati
- Department of Orthopedic Surgery, Soeharso Orthopaedic Hospital, Surakarta, Indonesia
| | - Abdaud Rasyid Yamani
- Department of Orthopedic Surgery, Soeharso Orthopaedic Hospital, Surakarta, Indonesia
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Shetty AP, Viswanathan VK, Rajasekaran S. Cervical spine TB - Current concepts in management. J Orthop Surg (Hong Kong) 2021; 29:23094990211006936. [PMID: 34711081 DOI: 10.1177/23094990211006936] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVE Cervical tubercular disease (CTB) is a rare pathology and constitutes 3-5% of all spinal TB. It includes atlantoaxial TB and sub-axial TB. As the literature evidence on this subject is scarce, majority of issues concerning CTB are still controversial. The current narrative review comprehensively discusses the various aspects related to CTB. Literature search: An elaborate search was made using keywords cervical tuberculosis, atlantoaxial tuberculosis, sub-axial tuberculosis, and cervico-thoracic tuberculosis, on pubmed and google (scholar.google.com) databases on 2 December 2020. We identified crucial questions regarding CTB and included relevant articles pertaining to them. RESULTS The initial search using keywords cervical tuberculosis, atlantoaxial tuberculosis, sub-axial tuberculosis, and cervico-thoracic tuberculosis yielded 4128, 76, 3 and 9 articles on 'pubmed' database, respectively. A similar search using the aforementioned keywords yielded 1,96,000, 2130, 117 and 728 articles on 'google scholar' database. The initial screening resulted in the identification of 178 articles. Full manuscripts were obtained for these articles and thoroughly scrutinised at the second stage. Review articles, randomised controlled trials and level 1 studies were given preference. Overall, 41 articles were included. CONCLUSION AATB and SACTB constitute 0.3 to 1% and 3% of spinal TB, respectively. The incidence of neuro-deficit in CTB is significantly more than other spinal TB. The general principles of management of CTB are similar to spinal TB elsewhere and medical therapy remains the cornerstone. Surgery is advocated in specific scenarios involving gross neuro-deficit, later stages of disease with significant bony/ligamentous disruptions, altered sagittal balance, drug resistance, and poor response to medications. The surgical approaches for AATB include anterior-alone, posterior-alone and combined approaches, although posterior access is the most preferred. Most of the studies on SACTB have supported the role of anterior approach. Additionally, posterior stabilisation may be necessary in specific scenarios. The overall long-term outcome in CTB is favourable.
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Affiliation(s)
- Ajoy Prasad Shetty
- Department of Spine surgery, 76290Ganga Medical Centre and Hospital, Coimbatore, Tamil Nadu, India
| | | | - S Rajasekaran
- Department of Spine surgery, 76290Ganga Medical Centre and Hospital, Coimbatore, Tamil Nadu, India
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Mann TN, Warwick J, Chegou NN, Davis JH, Beltran CGG, Griffith-Richards S, Kidd M, du Toit J, Lamberts RP, Walzl G. Biomarkers to predict FDG PET/CT activity after the standard duration of treatment for spinal tuberculosis: An exploratory study. Tuberculosis (Edinb) 2021; 129:102107. [PMID: 34261033 DOI: 10.1016/j.tube.2021.102107] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 04/28/2021] [Accepted: 07/04/2021] [Indexed: 02/08/2023]
Abstract
OBJECTIVES 18F-Fluorodeoxyglucose (FDG) Positron Emission Tomography- Computed Tomography (PET/CT) scans can be used to assess healing following treatment for spinal tuberculosis (TB) but have limited accessibility and high cost. This study investigated the association between immune biomarkers and FDG-PET/CT activity after ≥9 months of treatment for spinal TB. METHODS Patients who had completed ≥9 months of treatment for spinal TB were recruited from a major hospital in the Western Cape, South Africa. Participants underwent a FDG-PET/CT scan and FDG- PET/CT activity was quantified for all spinal and extra-spinal sites. Participants also provided a blood sample, which was evaluated for 19 cytokines along with erythrocyte sedimentation rate (ESR). Correlations and multiple regression analyses were used to investigate the association between biomarkers and PET/CT measures. RESULTS Twenty-eight patients were recruited, of whom 24 (86%) had spinal and/or extra-spinal FDG-PET/CT activity. In the strongest multiple regression model, CXCL10/IP-10, VEGFA, IFN-γ, CRP and Factor D/Adipsin explained 52% of the variation in overall maximal FDG uptake. Conventional monitoring marker ESR showed no significant association with PET/CT measures. CONCLUSIONS The current findings offered encouragement that biomarkers to predict FDG-PET/CT activity may show some promise and identified candidate biomarkers for further investigation in this regard.
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Affiliation(s)
- Theresa N Mann
- Division of Orthopaedic Surgery, Department of Surgical Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, Francie van Zijl Drive, Tygerberg, 7505, Cape Town, South Africa; Institute of Orthopaedics and Rheumatology, Mediclinic Winelands Orthopaedic Hospital, Cnr Rokewood & Saffraan Ave, Die Boord, Stellenbosch, 7600, South Africa.
| | - James Warwick
- Division of Nuclear Medicine, Department of Medical Imaging and Clinical Oncology, Faculty of Medicine and Health Sciences, Stellenbosch University, Francie van Zijl Drive, Tygerberg, 7505, Cape Town, South Africa.
| | - Novel N Chegou
- DST/NRF Centre of Excellence for Biomedical TB Research and SAMRC Centre for TB Research, Division of Molecular Biology and Human Genetics, Department of Biomedical Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, Francie van Zijl Drive, Tygerberg, 7505, Cape Town, South Africa.
| | - Johan H Davis
- Division of Orthopaedic Surgery, Department of Surgical Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, Francie van Zijl Drive, Tygerberg, 7505, Cape Town, South Africa; Institute of Orthopaedics and Rheumatology, Mediclinic Winelands Orthopaedic Hospital, Cnr Rokewood & Saffraan Ave, Die Boord, Stellenbosch, 7600, South Africa.
| | - Caroline G G Beltran
- DST/NRF Centre of Excellence for Biomedical TB Research and SAMRC Centre for TB Research, Division of Molecular Biology and Human Genetics, Department of Biomedical Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, Francie van Zijl Drive, Tygerberg, 7505, Cape Town, South Africa.
| | - Stephanie Griffith-Richards
- Division of Radiodiagnosis, Department of Medical Imaging and Clinical Oncology, Faculty of Medicine and Health Sciences, Stellenbosch University, Francie van Zijl Drive, Tygerberg, 7505, Cape Town, South Africa.
| | - Martin Kidd
- Centre for Statistical Consultation, Department of Statistics and Actuarial Sciences, Faculty of Economic and Management Sciences, Stellenbosch University, Van Der Sterr Building, Bosman St, Stellenbosch, 7599, South Africa.
| | - Jacques du Toit
- Division of Orthopaedic Surgery, Department of Surgical Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, Francie van Zijl Drive, Tygerberg, 7505, Cape Town, South Africa.
| | - Robert P Lamberts
- Division of Orthopaedic Surgery, Department of Surgical Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, Francie van Zijl Drive, Tygerberg, 7505, Cape Town, South Africa.
| | - Gerhard Walzl
- DST/NRF Centre of Excellence for Biomedical TB Research and SAMRC Centre for TB Research, Division of Molecular Biology and Human Genetics, Department of Biomedical Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, Francie van Zijl Drive, Tygerberg, 7505, Cape Town, South Africa.
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Liang W, Zhang J, Ren Z, Maimaiti M, Mamati F, Abulizi Y, Xu T, Cao R, Sheng J, Sheng W. Comparison of the Clinical Efficacy of 3 Surgical Methods for Treating Spinal Tuberculosis in Children. Med Sci Monit 2020; 26:e926142. [PMID: 33361735 PMCID: PMC7771200 DOI: 10.12659/msm.926142] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background This study aimed to investigate the safety and clinical efficacy of 3 different surgical methods for treating spinal tuberculosis (ST) in children. Material/Methods We reviewed the cases of 62 children with ST who were treated in our hospital from January 2010 to December 2014. In this study, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) level, Frankel classification of neurological function, pain visual analog scale (VAS) score, and kyphosis Cobb (k-Cobb) angle were dynamically monitored to evaluate the efficacy of different surgical methods. Complications in the patients were evaluated at 3 time points: before surgery (T1), after surgery (T2), and during final follow-up (T3). The average follow-up was 27.4 months. Twenty-two patients underwent simple anterior debridement alone or combined with internal fixation (Method A), 13 patients underwent posterior debridement alone (Method B), and 27 patients received anteroposterior debridement and bone graft fusion together with internal fixation (Method C). Results In all 3 groups after surgery, ESR, CRP levels, VAS scores, and k-Cobb angles significantly decreased. However, compared with patients who received Methods B and C, patients who received Method A had a significant rebound in k-Cobb angle and a higher incidence of complications at the T3 time point. The overall reoperation rate during follow-up was 37.10%. Fourteen patients (22.58%) had kyphosis, 2 patients (3.23%) had tuberculosis recurrence combined with kyphosis, and other complications were reported in 5 patients (8.06%). Conclusions Considering the incidence of complications and level of postoperative biochemical indicators, we concluded that caution should be exercised in using an anterior approach to treat pediatric ST.
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Affiliation(s)
- Weidong Liang
- Department of Spine Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China (mainland)
| | - Jian Zhang
- Department of Spine Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China (mainland)
| | - Zhouliang Ren
- Department of Spine Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China (mainland)
| | - Maierdan Maimaiti
- Department of Spine Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China (mainland)
| | - Fulati Mamati
- Department of Spine Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China (mainland)
| | - Yakefu Abulizi
- Department of Spine Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China (mainland)
| | - Tao Xu
- Department of Spine Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China (mainland)
| | - Rui Cao
- Department of Spine Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China (mainland)
| | - Jun Sheng
- Department of Spine Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China (mainland)
| | - Weibin Sheng
- Department of Spine Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China (mainland)
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Srivastava SK, Marathe NA, Bhosale SK, Raj A, Purohit S, Shaikh A, Dhole K. Outcome Analysis of Anterior Reconstruction with Rib Grafts in Tuberculosis of the Thoracic Spine. Asian J Neurosurg 2020; 15:648-652. [PMID: 33145221 PMCID: PMC7591174 DOI: 10.4103/ajns.ajns_52_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2020] [Revised: 04/07/2020] [Accepted: 05/07/2020] [Indexed: 11/23/2022] Open
Abstract
Introduction: Tricortical iliac bone is the gold standard as an autograft for the reconstruction of the anterior column in tuberculosis (TB) of the thoracic spine. However, the quantity of graft needed is significant. It creates a considerable defect in the pelvic bone, causing graft site complications, including pain, pelvic instability, fractured ilium, herniated muscle, or abdominal contents. To prevent these donor site morbidities, ribs that were removed during the versatile approach were used for anterior reconstruction. The aim of this study was to assess the clinical and radiological results of the reconstruction of the anterior column of the spine with the help of an excised rib during the versatile approach. Subjects and Methods: This retrospective study was undertaken at a tertiary care center with a study duration of 14 years. Between January 2004 and December 2016, 52 patients with thoracic Koch's spine had anterior column reconstructed with multiple rib grafts. A single surgeon performed all operations. Indications for the surgery in these patients were the presence of neurologic deficit (49 patients) and vertebral column instability (3 patients). The preoperative kyphosis angle and visual analog scale (VAS) score were compared with postoperative values using a paired t-test. Results: All patients underwent a minimum follow-up of 18 months and were evaluated clinicoradiologically. Good bony fusion with neurological recovery was achieved in all cases. The VAS score for back pain improved significantly postsurgery. There was one case of graft buckling treated conservatively. Discussion: Appropriate anterior reconstruction forms the cornerstone of successful surgical management of spinal TB. The “Versatile approach” used offers anterior and posterior access in the lateral position. In these patients, we obviated the need for iliac crest graft using multiple segments of the rib for anterior column reconstruction. This meticulous rib grafting technique gives good functional outcome in terms of solid bony fusion. Conclusion: Meticulous rib grafting technique gives 360° bony fusion and good functional outcome in surgery for thoracic spinal TB. It has the advantage of avoiding the complications associated with a tricortical iliac crest graft.
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Affiliation(s)
- Sudhir Kumar Srivastava
- Department of Orthopaedics, Seth G. S. Medical College and KEM Hospital, Mumbai, Maharashtra, India
| | | | - Sunil K Bhosale
- Department of Orthopaedics, Seth G. S. Medical College and KEM Hospital, Mumbai, Maharashtra, India
| | - Aditya Raj
- Department of Orthopaedics, Seth G. S. Medical College and KEM Hospital, Mumbai, Maharashtra, India
| | - Shaligram Purohit
- Department of Orthopaedics, Seth G. S. Medical College and KEM Hospital, Mumbai, Maharashtra, India
| | - Ashraf Shaikh
- Department of Orthopaedics, Seth G. S. Medical College and KEM Hospital, Mumbai, Maharashtra, India
| | - Kiran Dhole
- Department of Orthopaedics, Lokamanya Tilak Medical College and Sion Hospital, Mumbai, Maharashtra, India
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Wang MS, Han C, Wang JL, Liu FL. The prevalence, diagnosis and surgical risk factors of spinal tuberculosis in children. Trop Med Int Health 2020; 25:834-838. [PMID: 32358838 DOI: 10.1111/tmi.13411] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
OBJECTIVE To date, the burden of childhood spinal TB in China has not been estimated, and current treatment is hindered by a lack of evidence. This study aimed to review our experience of childhood spinal TB. METHODS We reviewed the medical records of paediatric patients (≤15 years) admitted for spinal TB (confirmed or possible) at Shandong Provincial Chest Hospital from January 2006 to December 2019. Demographic, clinical, laboratory and radiological data were collected from medical records and analysed retrospectively. RESULTS Seventy-two patients were diagnosed with spinal TB. 45 were male (62.5%), and 27 female (37.5%), with a mean age of 8.42 ± 4.47 (SD) years. During this 14-year period, the overall prevalence of spinal TB among childhood TB was 4.5%. T-SPOT.TB, AFB smear, mycobacterial culture, TB RT-PCR and biopsies were positive in 29.6%, 14.3%, 23.3%, 43.8% and 88.5% of assayed patients, respectively. The overall surgical rate of the studied patients was 40.3%. The requirement of surgery in childhood spinal TB was associated with pulmonary TB (OR = 4.000, 95% CI: 1.197, 13.367). CONCLUSION Spinal TB in children cannot be neglected. It remains a severe problem to public health, and more attention should be paid to initiating treatment early.
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Affiliation(s)
- Mao-Shui Wang
- Department of Lab Medicine, Shandong Provincial Chest Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Chao Han
- Department of Geriatrics, Shandong Mental Health Center, Jinan, China
| | - Jun-Li Wang
- Department of Lab Medicine, The Affiliated Hospital of Youjiang Medical University for Nationalities, Baise, China
| | - Feng-Lin Liu
- Department of Thoracic Surgery, Shandong Provincial Chest Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
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Spinal tuberculosis: a comprehensive review for the modern spine surgeon. Spine J 2019; 19:1858-1870. [PMID: 31102727 DOI: 10.1016/j.spinee.2019.05.002] [Citation(s) in RCA: 111] [Impact Index Per Article: 22.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Revised: 05/07/2019] [Accepted: 05/07/2019] [Indexed: 02/03/2023]
Abstract
Nearly one-third of the human population is infected with tuberculosis. Of those with active disease, approximately 10% are impacted by skeletal tuberculosis. Though, traditionally a disease of the developing world and susceptible populations, with the rise of immigration, patients may present in developed countries. The microbe responsible is the mycobacterium tuberculosis complex bacillus. The infection begins in the anterior vertebral bodies. The natural history and presentation are notable for cold abscesses causing mass effect, early or late neurological deficit, and kyphotic deformity of the spine caused by anterior vertebral body destruction. The disease can be diagnosed with laboratory studies and characteristic imaging findings, but tissue diagnosis with cultures, histology, and polymerase chain reaction is the gold standard. The cornerstone of medical management is multidrug chemotherapy to minimize relapse and drug resistance, and can be curative for spinal tuberculosis with minimal residual kyphosis. Surgical management is reserved for patients presenting with neurological deficits or severe kyphosis. The mainstays of surgical management are debridement, correction of spinal deformity and stable fusion. With appropriate and timely management, clinical outcomes of the treatment of spinal tuberculosis are overall excellent.
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Abstract
STUDY DESIGN Review article. OBJECTIVES A review of literature on the epidemiology, diagnosis, and management of spinal tuberculosis (TB). METHODS A systematic computerized literature search was performed using Cochrane Database of Systematic Reviews, EMBASE, and PubMed. Studies published over the past 10 years were analyzed. The searches were performed using Medical Subject Headings terms, and the subheadings used were "spinal tuberculosis," "diagnosis," "epidemiology," "etiology," "management," "surgery," and "therapy." RESULTS Tissue diagnosis remains the only foolproof investigation to confirm diagnosis. Magnetic resonance imaging and Gene Xpert help in early detection and treatment of spinal TB. Uncomplicated spinal TB has good response to appropriately dosed multimodal ambulant chemotherapy. Surgery is warranted only in cases of neurological complications, incapacitating deformity, and instability. CONCLUSIONS The incidence of atypical clinicoradiological presentations of spinal TB is on the rise. Improper dosing, inadequate duration of treatment, and inappropriate selection of candidates for chemotherapy has not only resulted in the resurgence of TB but also led to the most dreadful consequence of multidrug resistant strains. In addition, global migration phenomenon has resulted in worldwide spread of spinal TB. The current consensus is to diagnose and treat spinal TB early, prevent complications, promote early mobilization, and restore the patient to his or her earlier functional status.
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Affiliation(s)
- S. Rajasekaran
- Ganga Hospital, Coimbatore, India,S. Rajasekaran, Department of Spine Surgery, Ganga Hospital, 313, Mettupalayam Road, Coimbatore 641043, India.
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Child and adult spinal tuberculosis at tertiary hospitals in the Western Cape, South Africa: 4-year burden and trend. Epidemiol Infect 2018; 146:2107-2115. [PMID: 30264687 DOI: 10.1017/s0950268818002649] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
The aim of this retrospective review was to assess the overall burden and trend in spinal tuberculosis (TB) at tertiary hospitals in the Western Cape Province of South Africa. All spinal TB cases seen at the province's three tertiary hospitals between 2012 and 2015 were identified and clinical records of each case assessed. Cases were subsequently classified as bacteriologically confirmed or clinically diagnosed and reported with accompanying clinical and demographic information. Odds ratios (OR) for severe spinal disease and corrective surgery in child vs. adult cases were calculated. A total of 393 cases were identified (319 adults, 74 children), of which 283 (72%) were bacteriologically confirmed. Adult cases decreased year-on-year (P = 0.04), however there was no clear trend in child cases. Kyphosis was present in 60/74 (81%) children and 243/315 (77%) adults with available imaging. Corrective spinal surgery was performed in 35/74 (47%) children and 80/319 (25%) adults (OR 2.7, 95% confidence interval 1.6-4.5, P = 0.0003). These findings suggest that Western Cape tertiary hospitals have experienced a substantial burden of spinal TB cases in recent years with a high proportion of severe presentation, particularly among children. Spinal TB remains a public health concern with increased vigilance required for earlier diagnosis, especially of child cases.
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Sacroiliac joint tuberculosis: surgical management by posterior open-window focal debridement and joint fusion. BMC Musculoskelet Disord 2017; 18:504. [PMID: 29187182 PMCID: PMC5708174 DOI: 10.1186/s12891-017-1866-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Accepted: 11/20/2017] [Indexed: 11/21/2022] Open
Abstract
Background Sacroiliac joint tuberculosis(SJT) is relatively uncommon, but it may cause severe sacroiliac joint destruction and functional disorder. Few studies in the literature have been presented on SJT, reports of surgical treatment for SJT are even fewer. In this study, we retrospectively reviewed surgical management of patients with severe SJT of 3 different types and proposed to reveal the clinical manifestations and features and aim to determine the efficiency and security of such surgical treatment. Methods We reviewed 17 patients with severe SJT of 3 different types who underwent posterior open-window focal debridement and bone graft for joint fusion. Among them,five patients with anterior sacral abscess had anterior abscess curettage before debridement. Two patients with lumbar vertebral tuberculosis received one-stage posterior tuberculous debridement, interbody fusion and instrumentation. Follow-up was performed 36 months (26 to 45 months) using the following parameters: erythrocyte sedimentation rate(ESR), status of joint bony fusion on CT scan, visual analogue scale (VAS) and the Oswestry Disability Index (ODI). Results Buttock pain and low back pain were progressively relieved with time. 6 months later, pain was not obvious, and ESR resumed to normal levels within 3 months. Solid fusion of the sacroiliac joint occurred within 12 months in all cases. No complications or recurrence occurred. At final follow-up, all patients had no pain or only minimal discomfort over the affected joint and almost complete functional recovery. Conclusions Posterior open-window focal debridement and joint fusion is an efficient and secure surgical method to treat severe SJT. If there is an abscess in the front of the sacroiliac joint, anterior abscess curettage should be performed as a supplement. Electronic supplementary material The online version of this article (10.1186/s12891-017-1866-9) contains supplementary material, which is available to authorized users.
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Comparison of clinical efficacy and safety among three surgical approaches for the treatment of spinal tuberculosis: a meta-analysis. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2016; 25:3862-3874. [DOI: 10.1007/s00586-016-4546-9] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/24/2015] [Revised: 03/22/2016] [Accepted: 03/22/2016] [Indexed: 01/27/2023]
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