A 15-year-old girl with a large lumbosacral abscess. Diagnosis: spinal tuberculosis

Mini-open anterior approach focal cleaning combined with posterior internal fixation for thoracolumbar tuberculosis: Follow-up of 149 cases

OBJECTIVE

To investigate the clinical efficacy and safety of mini-open anterior approach focal cleaning combined with posterior internal fixation for thoracolumbar tuberculosis.

METHODS

A total of 149 patients with thoracolumbar tuberculosis were reviewed retrospectively and divided into 3 groups: mini-open anterior approach (group A), conventional anterior extraperitoneal approach (group B), and posterior approach (group C). After the operation, drainage tubes were routinely placed and the draining fluid was collected on the 4th day for the PCR detection of Mycobacterium tuberculosis (MTB), Mycobacterium tuberculosis DNA test (MTD), and Roche culture. Patients' surgical information, Cobb's angles, and postoperative complications were also compared.

RESULTS

There was no significant difference in operation time, blood loss, hospital stay, or preoperative Cobb's angle among three groups. There existed obvious differences in the postoperative Cobb's angle and incidence of postoperative complications between group A and group C, as well as group B and group C. There was no obvious difference in the positive rate of MTB among the three groups by rapid culture plus Roche culture test. However, statistically significant differences in the positive rate of MTB were found between group A and group C by PCR detection, and between group A and group B by MTD.

CONCLUSION

Mini-open anterior approach focal cleaning combined with posterior internal fixation resulted in small Cobb's angles, low incidence of postoperative complications and low positive rates of MTB, without increasing operation time, blood loss and hospital stay, rendering it as a safe and effective method to treat patients with thoracolumbar tuberculosis.

Diagnosis of tuberculous vertebral osteomyelitis (TVO) in a developed country and literature review

STUDY DESIGN

Review of medical and radiological records and literature to study the diagnosis of tuberculous vertebral osteomyelitis (TVO) and the differential diagnosis between TVO and pyogenic vertebral osteomyelitis (PVO).

OBJECTIVE

To identify the correct criteria for the diagnosis.

SETTING

National Spinal Injuries Centre, UK.

METHODS

(1) Medical and radiological records of 10 patients diagnosed as vertebral osteomyelitis and treated elsewhere but later admitted to the NSIC were reviewed retrospectively. (2) Medical literature on vertebral osteomyelitis were reviewed.

RESULTS

(1) Case review: Before the study, four of the 10 patients TVO had been diagnosed based on positive bacteriology. Of the other six, the diagnosis of PVO had been made in one based on positive blood culture of staphylococcus while in another without any positive result of bacteriology. The diagnosis had been uncertain in four because of negative results of both bacteriology and histology on both tuberculous and pyogenic infection. The author made the diagnosis of TVO in all 10 cases based on clinical manifestations and plain radiographs. Highly raised ESR with moderate rise of or normal WBC in eight cases supported TVO. Computer tomography and magnetic resonance imaging did not contribute to the differential diagnosis. Laminectomy in five patients led to some clinical improvement. The five patients without surgery deteriorated. Two of them died. (2) LITERATURE REVIEW: A total of 188 articles were reviewed. The crucial role of plain radiographs in the diagnosis of TVO and the high incidence of false-negative of tuberculosis in both bacteriological and histological tests were neglected in most articles. Polymerase chain reaction (PCR) was more reliable in diagnosing tuberculosis.

CONCLUSION

Clinical manifestations, discrepancy between ESR and WBC, plain radiographs and PCR are keys to a correct diagnosis of TVO.

Abscesos cutáneos como forma de presentación de la enfermedad de Pott

Interest in skeletal tuberculosis has been growing in our environment due to the presence of patients with immunodeficiency and those from areas where tuberculosis is endemic. Clinical presentation in the form of skin abscesses with an osteoarticular focus is rare, hindering early diagnosis and treatment. We describe the case of an 8-year-old immigrant boy with a diagnosis of bone tuberculosis based on the presence of skin fistulas.