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Xiao ST, Zhang HQ, Wang YX. Isolated neural arch tuberculosis with tuberculomas: case report. Skeletal Radiol 2024; 53:1417-1421. [PMID: 37712982 DOI: 10.1007/s00256-023-04450-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 08/12/2023] [Accepted: 08/26/2023] [Indexed: 09/16/2023]
Abstract
We reported a case of atypical spinal tuberculosis on the posterior elements of lumbar spine in a 52-year-old female. It was easy to be misdiagnosed as spinal tumor due to its imaging characteristics. We performed puncture biopsy to initially consider tuberculosis, and then the patient was accepted surgical treatment. The intraoperative removed specimen was sent to pathological examination, microbial culture, Xpert MTB/RIF and metagenomic next-generation sequencing (mNGS) and then the diagnosis of neural arch tuberculosis was confirmed. After operation, the patient obtained stable effect by anti-tuberculosis drug treatment. In a word, the uncommon case had an important reference significance for the diagnosis of atypical spine tuberculosis and differentiation from spinal tumors. It is critical to make right preliminary diagnosis by appropriate examination as it determined the next diagnosis and treatment in special and rare clinical cases.
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Affiliation(s)
- Shun-Tian Xiao
- Department of Spine Surgery and Orthopaedics, Xiangya Spinal Surgery Center, Xiangya Hospital of Central South University, Xiang Ya Road 87, Changsha, 410008, Hunan Province, China
- National Clinical Research Center for Geriatric Disorder, Xiangya Hospital of Central South University, Changsha, 410008, Hunan Province, China
| | - Hong-Qi Zhang
- Department of Spine Surgery and Orthopaedics, Xiangya Spinal Surgery Center, Xiangya Hospital of Central South University, Xiang Ya Road 87, Changsha, 410008, Hunan Province, China
- National Clinical Research Center for Geriatric Disorder, Xiangya Hospital of Central South University, Changsha, 410008, Hunan Province, China
| | - Yu-Xiang Wang
- Department of Spine Surgery and Orthopaedics, Xiangya Spinal Surgery Center, Xiangya Hospital of Central South University, Xiang Ya Road 87, Changsha, 410008, Hunan Province, China.
- National Clinical Research Center for Geriatric Disorder, Xiangya Hospital of Central South University, Changsha, 410008, Hunan Province, China.
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Na S, Lyu Z, Zhang S. Diagnosis and Treatment of Skipped Multifocal Spinal Tuberculosis Lesions. Orthop Surg 2023. [PMID: 37186216 DOI: 10.1111/os.13744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 03/04/2023] [Accepted: 03/24/2023] [Indexed: 05/17/2023] Open
Abstract
Spinal tuberculosis, also known as Pott's disease or tuberculous spondylitis, is usually secondary to primary infection in the lungs or other systems, and in most instances, is thought to be transmitted via blood. Typical manifestations of infection include narrowing of the intervertebral disc by erosion and bone destruction of adjacent vertebrae. Atypical spinal tuberculosis is a specific type of spinal tuberculosis. It mainly consists of single vertebral lesions, single posterior structure lesions, multiple vertebral lesions, and intra-spinal lesions. Skipped multifocal spinal tuberculosis is one of these types and is characterized by two or more vertebral lesions without the involvement of the adjoining intervertebral discs, regardless of their location. To date, only a few cases have been reported. Upon clinical admission, it can be treated conservatively or surgically, depending on the patient's symptoms. In addition, gene or biological therapies are being investigated. However, because of the exceptional imaging findings and insidious symptoms, it is often misdiagnosed as a neoplastic lesion, osteoporotic fracture, or other infectious spondylitis, increasing the risk of neurological deficit and kyphotic deformity, and delaying the optimal treatment window. In this study, we review the diagnosis and treatment strategies for skipped multifocal spinal tuberculosis lesions and enumerate the common differential diagnoses, to provide reference and guidance for clinical treatment and diagnosis direction.
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Affiliation(s)
- Shibo Na
- Department of Spinal Surgery, Orthopaedic Center, The First Hospital of Jilin University, Changchun City, China
| | - ZhenShan Lyu
- Department of Spinal Surgery, Orthopaedic Center, The First Hospital of Jilin University, Changchun City, China
| | - Shaokun Zhang
- Department of Spinal Surgery, Orthopaedic Center, The First Hospital of Jilin University, Changchun City, China
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Cao S, Lv K, Peng C, Bai G, Gao X, Wang J, Cao J, Ning R, Chu J, Liu T. Efficacy and safety of erythropoietin in isolated spinal metastasis patients with total en bloc spondylectomy surgery: a case-control study. 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 2023; 32:1021-1028. [PMID: 36715756 DOI: 10.1007/s00586-023-07554-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 12/07/2022] [Accepted: 01/21/2023] [Indexed: 01/31/2023]
Abstract
OBJECTIVE The purpose of our study is to identify the effect of short-term and high-dose use of erythropoietin (EPO) in spinal isolated metastatic patients with Total en bloc spondylectomy (TES) surgery by assessing hematological parameters, transfusion volume, postoperative complications, recurrence-free survival (RFS), and overall survival (OS). METHODS From January 2015 and January 2022, 93 isolated spinal metastasis patients were selected and separated into 2 groups based on the treatment method used (EPO + TXA (Tranexamic acid) group, n = 47; and TXA group, n = 46). Indexes for evaluation included hemoglobin (Hb), hematocrit (Hct), red blood cells (RBC), RFS, OS, postoperative complications, postoperative Frankel Grade, drainage volume, transfusion rate, and mean units transfused. RESULTS The average follow-up duration was 38.13 months. There was no significant difference (P > 0.05) in RFS, OS, postoperative complications, postoperative Frankel Grade, drainage volume, and transfusion rate between the two groups. However, patients in EPO + TXA group have significantly higher Hb, Hct, and RBC values than those in the TXA group on postoperative days 1, 2, 3, and 5. Moreover, the mean transfusion volume in EPO + TXA group was significantly lower than those in the TXA group (P = 0.011). CONCLUSIONS Perioperative short-term and high-dose administration of EPO could improve the anemia-related hematological parameters and reduce the requirement for blood transfusion without increasing the risk of deep vein thrombosis and tumor progression in solitary spinal metastatic patients with TES surgery.
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Affiliation(s)
- Shuang Cao
- Department of Orthopedics, Changzheng Hospital, Naval Medical University, Shanghai, China
| | - Kai Lv
- Department of Orthopedics, Yueyang Hospital of Integrated Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Cheng Peng
- Department of Orthopedics, Changzheng Hospital, Naval Medical University, Shanghai, China
| | - Guangjian Bai
- Department of Orthopedics, Changzheng Hospital, Naval Medical University, Shanghai, China
| | - Xin Gao
- Department of Orthopedics, Changzheng Hospital, Naval Medical University, Shanghai, China
| | - Jing Wang
- Department of Orthopedics, Changzheng Hospital, Naval Medical University, Shanghai, China
| | - Jiashi Cao
- Department of Orthopedics, Changzheng Hospital, Naval Medical University, Shanghai, China
| | - Rende Ning
- Department of Orthopedics, Third Affiliated Hospital of Anhui Medical University, Hefei, Anhui Province, China.
| | - Jianjun Chu
- Department of Orthopedics, The Second People's Hospital of Hefei, Hefei, Anhui Province, China.
| | - Tielong Liu
- Department of Orthopedics, Changzheng Hospital, Naval Medical University, Shanghai, China.
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Cao S, Xin B, Yu Y, Peng C, Zhu C, Deng M, Gao X, Chu J, Liu T. Improvement of sleep quality in isolated metastatic patients with spinal cord compression after surgery. World J Surg Oncol 2023; 21:11. [PMID: 36647119 PMCID: PMC9843842 DOI: 10.1186/s12957-023-02895-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 01/10/2023] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND This study aimed to assess changes in quality of sleep (QoS) in isolated metastatic patients with spinal cord compression following two different surgical treatments and identify potential contributing factors associated with QoS improvement. METHODS We reviewed 49 patients with isolated spinal metastasis at our spinal tumor center between December 2017 and May 2021. Total en bloc spondylectomy (TES) and palliative surgery with postoperative stereotactic radiosurgery (PSRS) were performed on 26 and 23 patients, respectively. We employed univariate and multivariate analyses to identify the potential prognostic factors affecting QoS. RESULTS The total Pittsburgh Sleep Quality Index (PSQI) score improved significantly 6 months after surgery. Univariate analysis indicated that age, pain worsening at night, decrease in visual analog scale (VAS), increase in Eastern Cooperative Oncology Group performance score (ECOG-PS), artificial implant in focus, and decrease in epidural spinal cord compression (ESCC) scale values were potential contributing factors for QoS. Multivariate analysis indicated that the ESCC scale score decreased as an independent prognostic factor. CONCLUSIONS Patients with spinal cord compression caused by the metastatic disease had significantly improved QoS after TES and PSRS treatment. Moreover, a decrease in ESCC scale value of > 1 was identified as a favorable contributing factor associated with PSQI improvement. In addition, TES and PSRS can prevent recurrence by achieving efficient local tumor control to improve indirect sleep. Accordingly, timely and effective surgical decompression and recurrence control are critical for improving sleep quality.
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Affiliation(s)
- Shuang Cao
- Department of Orthopedics, Changzheng Hospital, Naval Medical University, Shanghai, China
| | - Baoquan Xin
- grid.267139.80000 0000 9188 055XSchool of Health Science and Engineering, University of Shanghai for Science and Technology, Shanghai, China
| | - Yue Yu
- grid.459419.4Department of Anesthesiology, Chaohu Hospital of Anhui Medical University, Hefei, Anhui Province China
| | - Cheng Peng
- Department of Orthopedics, Changzheng Hospital, Naval Medical University, Shanghai, China
| | - Chengzhang Zhu
- Department of Orthopedics, Changzheng Hospital, Naval Medical University, Shanghai, China
| | - Mengqiu Deng
- Department of Anesthesiology, Changzheng Hospital, Naval Medical University, Shanghai, China
| | - Xin Gao
- Department of Orthopedics, Changzheng Hospital, Naval Medical University, Shanghai, China
| | - Jianjun Chu
- Department of Orthopedics, the Second People’s Hospital of Hefei, Hefei, Anhui Province, China
| | - Tielong Liu
- Department of Orthopedics, Changzheng Hospital, Naval Medical University, Shanghai, China
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Cao S, Gao X, Zhang Y, Wang Y, Wang J, Wang T, Liu Y, Hou S, Zhang J, Zhou Y, Liu T. A comparison of two different surgical procedures in the treatment of isolated spinal metastasis patients with metastatic spinal cord compression: a case-control study. 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 2021; 31:1583-1589. [PMID: 34668050 DOI: 10.1007/s00586-021-07032-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 09/14/2021] [Accepted: 10/11/2021] [Indexed: 12/25/2022]
Abstract
OBJECTIVE The aim of the study was to compare total en bloc spondylectomy (TES) and separation surgery with postoperative stereotactic radiosurgery (SSRS) for isolated metastatic patients with spinal cord compression by assessing recurrence-free survival (RFS), overall survival (OS), postoperative complications, and quality of life scores (QoL). METHODS From October 2013 to December 2020, 52 isolated spinal metastasis patients with cord compression were selected and separated into two groups based on the surgical method used (TES group, n = 26; and SSRS group, n = 26). Indexes for evaluation included postoperative Frankel grade, postoperative ECOG-PS, RFS, OS, postoperative complications, operation time, intraoperative blood loss, and QoL. RESULTS The average follow-up duration was 31.44 months. There was no significant difference (P > 0.05) in postoperative complications and OS between the two groups. However, a significant difference in operation time, intraoperative blood loss, postoperative ECOG-PS, RFS, and mental health domain (6 months after surgery) was found between the two groups (P < 0.05). According to The Spine Oncology Study Group Outcomes Questionnaire assessment, the total pain and physical function domains scores were also elevated after surgery in both groups. However, no significant difference was observed between groups A and B (p = 0.450 and 0.446, respectively). CONCLUSIONS TES and SSRS were efficient methods for treating solitary spinal metastasis patients with metastatic spinal cord compression. Better local tumor control and mental health were found in the TES group, and most patients felt as if they were free of spinal tumors. Compared with TES, the SSRS caused less operation-related trauma. However, there was no significant difference in OS between the two groups.
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Affiliation(s)
- Shuang Cao
- Department of Orthopedics, Third Affiliated Hospital of Anhui Medical University, Hefei, Anhui Province, China
- Department of Orthopedics, Orthopaedic Oncology Center, Changzheng Hospital, Second Military Medical University, No. 415 Fengyang Road, Shanghai, Huangpu District, China
| | - Xin Gao
- Department of Orthopedics, Orthopaedic Oncology Center, Changzheng Hospital, Second Military Medical University, No. 415 Fengyang Road, Shanghai, Huangpu District, China
| | - Yue Zhang
- Department of Orthopedics, Orthopaedic Oncology Center, Changzheng Hospital, Second Military Medical University, No. 415 Fengyang Road, Shanghai, Huangpu District, China
| | - Yifan Wang
- Department of Orthopedics, Third Affiliated Hospital of Anhui Medical University, Hefei, Anhui Province, China
| | - Jing Wang
- Department of Orthopedics, Orthopaedic Oncology Center, Changzheng Hospital, Second Military Medical University, No. 415 Fengyang Road, Shanghai, Huangpu District, China
| | - Tao Wang
- Department of Orthopedics, Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui Province, China
| | - Ying Liu
- Department of Orthopedics, Third Affiliated Hospital of Anhui Medical University, Hefei, Anhui Province, China
| | - Shuming Hou
- Department of Orthopedics, Orthopaedic Oncology Center, Changzheng Hospital, Second Military Medical University, No. 415 Fengyang Road, Shanghai, Huangpu District, China
| | - Jiahao Zhang
- Department of Orthopedics, Orthopaedic Oncology Center, Changzheng Hospital, Second Military Medical University, No. 415 Fengyang Road, Shanghai, Huangpu District, China.
| | - Yejin Zhou
- Department of Orthopedics, Third Affiliated Hospital of Anhui Medical University, Hefei, Anhui Province, China.
| | - Tielong Liu
- Department of Orthopedics, Orthopaedic Oncology Center, Changzheng Hospital, Second Military Medical University, No. 415 Fengyang Road, Shanghai, Huangpu District, China.
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