1
|
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.
Collapse
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
| |
Collapse
|
2
|
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.
Collapse
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
| |
Collapse
|
3
|
Chen L, Liu C, Ye Z, Huang S, Liang T, Li H, Chen J, Chen W, Guo H, Chen T, Yao Y, Jiang J, Sun X, Yi M, Liao S, Yu C, Wu S, Fan B, Zhan X. Predicting Surgical Site Infection Risk after Spinal Tuberculosis Surgery: Development and Validation of a Nomogram. Surg Infect (Larchmt) 2022; 23:564-575. [PMID: 35723640 PMCID: PMC9398487 DOI: 10.1089/sur.2022.042] [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] [Indexed: 11/17/2022] Open
Abstract
Background: The purpose of this study was to predict the surgical site infection risk after spinal tuberculosis surgery based on a nomogram. Patients and Methods: We collected the clinical data of patients who underwent spinal tuberculosis surgery in our hospital and included all the data in the least absolute shrinkage and selection operator (LASSO) regression analysis. Next, the selected parameters were analyzed using logistic regression. The logistic regression analysis and receiver operating characteristic (ROC) curve analysis were further used to obtain statistically significant parameters. These parameters were then used to construct a nomogram. The C-index, ROC curve, and decision curve analysis (DCA) were used to assess the predictive ability and accuracy of the nomogram, whereas internal verification was used to calculate the C-index by bootstrapping with 1,000 resamples. Results: A total of 394 patients with spinal tuberculosis surgery were included in the study, of whom 76 patients had surgical site infections whereas 318 patients did not. The predicted risk of surgical site infection in the nomogram ranged between 0.01 and 0.98. Both the value of the C-index of the nomogram (95% confidence interval [CI], 0.62–0.76) and the area under the curve (AUC) were found to be 0.69. The net benefit of the model ranged between 0.01 and 0.99. In contrast, the C-index calculated by the internal verification method of the nomogram was found to be 0.68. Conclusions: The risk factors predicting surgical site infection after spinal tuberculosis surgery included albumin, lesion segment, operation time, and incision length.
Collapse
Affiliation(s)
- Liyi Chen
- Spine and Osteopathy Ward, Guangxi Medical University First Affiliated Hospital, Nanning, Guangxi Province, China
| | - Chong Liu
- Spine and Osteopathy Ward, Guangxi Medical University First Affiliated Hospital, Nanning, Guangxi Province, China
| | - Zhen Ye
- Spine and Osteopathy Ward, Guangxi Medical University First Affiliated Hospital, Nanning, Guangxi Province, China
| | - Shengsheng Huang
- Spine and Osteopathy Ward, Guangxi Medical University First Affiliated Hospital, Nanning, Guangxi Province, China
| | - Tuo Liang
- Spine and Osteopathy Ward, Guangxi Medical University First Affiliated Hospital, Nanning, Guangxi Province, China
| | - Hao Li
- Spine and Osteopathy Ward, Guangxi Medical University First Affiliated Hospital, Nanning, Guangxi Province, China
| | - Jiarui Chen
- Spine and Osteopathy Ward, Guangxi Medical University First Affiliated Hospital, Nanning, Guangxi Province, China
| | - Wuhua Chen
- Spine and Osteopathy Ward, Guangxi Medical University First Affiliated Hospital, Nanning, Guangxi Province, China
| | - Hao Guo
- Spine and Osteopathy Ward, Guangxi Medical University First Affiliated Hospital, Nanning, Guangxi Province, China
| | - Tianyou Chen
- Spine and Osteopathy Ward, Guangxi Medical University First Affiliated Hospital, Nanning, Guangxi Province, China
| | - Yuanlin Yao
- Spine and Osteopathy Ward, Guangxi Medical University First Affiliated Hospital, Nanning, Guangxi Province, China
| | - Jie Jiang
- Spine and Osteopathy Ward, Guangxi Medical University First Affiliated Hospital, Nanning, Guangxi Province, China
| | - Xuhua Sun
- Spine and Osteopathy Ward, Guangxi Medical University First Affiliated Hospital, Nanning, Guangxi Province, China
| | - Ming Yi
- Spine and Osteopathy Ward, Guangxi Medical University First Affiliated Hospital, Nanning, Guangxi Province, China
| | - Shian Liao
- Spine and Osteopathy Ward, Guangxi Medical University First Affiliated Hospital, Nanning, Guangxi Province, China
| | - Chaojie Yu
- Spine and Osteopathy Ward, Guangxi Medical University First Affiliated Hospital, Nanning, Guangxi Province, China
| | - Shaofeng Wu
- Spine and Osteopathy Ward, Guangxi Medical University First Affiliated Hospital, Nanning, Guangxi Province, China
| | - Binguang Fan
- Spine and Osteopathy Ward, Guangxi Medical University First Affiliated Hospital, Nanning, Guangxi Province, China
| | - Xinli Zhan
- Spine and Osteopathy Ward, Guangxi Medical University First Affiliated Hospital, Nanning, Guangxi Province, China
| |
Collapse
|