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Sareen A, Guha M, Bansal K, Hegde A, Boruah T. Single Sequence Whole-Spine Screening Magnetic Resonance Imaging: Diagnostic and Therapeutic Role in Multiple-Level Spinal Tuberculosis. Cureus 2024; 16:e52757. [PMID: 38389615 PMCID: PMC10882150 DOI: 10.7759/cureus.52757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/22/2024] [Indexed: 02/24/2024] Open
Abstract
INTRODUCTION Spinal tuberculosis (TB) is the most common form of skeletal tuberculosis. Paradiscal continuous vertebral involvement at a single level is the most prevalent pattern among all forms of spinal TB. There is a wide range of reported incidences of multiple-level non-contiguous spinal TB in the literature. We would like to discuss on the utility of single whole spine screening T2-weighted (T2W) mid-sagittal magnetic resonance imaging (MRI) film in diagnosing multiple-level spinal TB and therapeutic benefits it can provide. METHODS We have done a retrospective review of the collected data of patients in Vardhman Mahavir Medical College and Safdarjung Hospital from August 2017 to October 2021 to find the incidence of multiple-level spinal TB and possible factors attributed to this specific disease pattern. All the patients who had been diagnosed of spinal TB either microbiologically or histopathologically or by a good clinical response to anti-tubercular treatment (ATT) and had a whole spine screening MRI film, were included. Patients of spinal TB who did not have a whole spine screening MRI were excluded from the study. Multiple-level spinal TB was diagnosed when lesions were identified in vertebral levels other than a typical paradiscal lesion, and additional lesions were separated from the primary disease by at least one normal spinal segment. RESULTS Among the patients, 242 met the inclusion criteria, and 76 showed multiple-level non-contiguous spinal TB on MRI, incidence being 31.4%. The rest of the 166 patients showed typical single-segment contiguous lesions. By doing multivariate analysis to determine the independent risk factors for multiple-level spinal TB, extremes of age (<20 years and >50 years) have been found to be a significant factor with p value of 0.0001. Though drug resistance was not found to be a significant risk factor (p value 0.051), the proportion of patients having multiple-level TB was far more in the drug-resistant group (13/76). CONCLUSIONS Single sequence whole spine screening MRI film is an effective, economical, and time-saving tool to detect multiple-level spinal TB. Along with its diagnostic accuracy, it also provides therapeutic benefits like access to a more approachable site for biopsy.
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Affiliation(s)
- Atul Sareen
- Central Institute of Orthopaedics, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, IND
| | - Mayukh Guha
- Spine Surgery, Indian Spinal Injuries Centre, New Delhi, IND
| | - Kuldeep Bansal
- Spine Surgery, Yashoda Super Speciality Hospital, Ghaziabad, IND
| | - Amit Hegde
- Central Institute of Orthopaedics, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, IND
| | - Tankeswar Boruah
- Central Institute of Orthopaedics, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, IND
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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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Formigo M, Costa M, Martins J, Sarmento H, Cotter J. Disseminated Tuberculosis: A Case of Multiple Spread Mass. Cureus 2020; 12:e11149. [PMID: 33251059 PMCID: PMC7686920 DOI: 10.7759/cureus.11149] [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] [Accepted: 10/25/2020] [Indexed: 12/04/2022] Open
Abstract
Disseminated tuberculosis is associated with significant morbidity and mortality. It results from a lymphohematogenous dissemination of mycobacterium tuberculosis (MT) and its atypical clinical presentation often delays the diagnosis. Diagnosis is established by identifying MT obtained from a biopsy sample in culture or acid-fast smear. Evidence suggests an initial two-month phase of four-drug therapy followed by a two-drug phase for six to nine months. A 61-year-old man presented with back lumbar pain. He presented two masses, a left parasternal and a left axillary masses with approximately 6 cm each. He referred a 21% weight loss, anorexia and asthenia. His computed tomography revealed recent lumbar fractures and a left paravertebral space-occupying lesion; hilum and upper lobe masses; inflammatory/infectious micronodules; mediastinal adenomegaly, hypodense lesions in the spleen, sternum and left scapula. Magnetic resonance imaging revealed lumbar vertebral fractures, an anterior epidural collection, left iliac psoas muscle liquid collection. A mass puncture and biopsy were performed, resulting in a positive detection of MT in nucleic acid amplification (NAA). The patient started on quaternary antibacillary therapy with isoniazid, rifampin, pyrazinamide and ethambutol. Bronchofibroscopy revealed an hypervascularized and infiltrated submucosa. Later, histopathology was compatible with chronic granulomatous inflammatory process and bronchial lavage molecular test was positive for MT. At the moment, he is under two-drug antibacillary therapy with isoniazid and rifampin and masses are regressing.
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Affiliation(s)
- Mariana Formigo
- Internal Medicine, Hospital Senhora da Oliveira Guimarães, Guimarães, PRT
| | - Magda Costa
- Internal Medicine, Hospital Senhora da Oliveira Guimarães, Guimarães, PRT
| | - João Martins
- Oncology, Hospital Senhora da Oliveira Guimarães, Guimarães, PRT
| | - Helena Sarmento
- Internal Medicine, Hospital Senhora da Oliveira Guimarães, Guimarães, PRT
| | - Jorge Cotter
- Internal Medicine, Hospital Senhora da Oliveira Guimarães, Guimarães, PRT
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Darvishi M, Rashidi S, Abazari S. Tuberculous Sacroiliitis after a Penicillin Injection: A Case Report. Eur J Case Rep Intern Med 2020; 7:001495. [PMID: 32523913 PMCID: PMC7279915 DOI: 10.12890/2020_001495] [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: 01/15/2020] [Accepted: 02/13/2020] [Indexed: 12/04/2022] Open
Abstract
Tuberculosis is one of the major health problems in developing countries affecting different organs such as bone and joints. One of the most important involvements of osteoarticular tuberculosis is that of the sacroiliac joint. In addition, its incidence has increased over the past several years. Early diagnosis is necessary to prevent further disorders such as neurological and surgical complications. We report a tuberculous arthritis case in the right sacroiliac joint, which developed after penicillin injection. The patient was a 32-year-old man admitted to Besat hospital, Tehran, Iran. He complained of pain, erythema and swelling in his right buttock starting approximately 17 years previously, after a penicillin injection, which was followed by the emergence of an orifice with yellow secretions. Over the years, the secretions continued but the pain, swelling and erythema were resolved. At the time of admission, his vital signs were stable and normal. In the physical examination, an orifice with a small amount of yellow secretion was detected on the right buttock as claimed by the patient. Lung auscultation was clear. No lymphadenopathy was detected. Laboratory data were normal. During hospitalization, initial antibiotic therapy was prescribed. After Mycobacterium tuberculosis was detected in culture, a 4-drug anti-TB therapy encompassing rifampin, isoniazid, ethambutol and pyrazinamide was prescribed for 18–24 months, in addition to daily vitamin B6 and pantoprazole.
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Affiliation(s)
- Mohammad Darvishi
- Infectious Diseases and Tropical Medicine Research Center, Dept of Aerospace and Subaquatic Medicine, AJA University of Medical Sciences, Tehran, Iran
| | - Sana Rashidi
- Faculty of Medicine, Tehran Medical Branch, Islamic Azad University, Tehran, Iran
| | - Setayesh Abazari
- Faculty of Medicine, Tehran Medical Branch, Islamic Azad University, Tehran, Iran
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Sagane SS, Patil VS, Bartakke GD, Kale KY. Assessment of Clinical and Radiological Parameters in Spinal Tuberculosis: Comparison between Human Immunodeficiency Virus-Positive and Human Immunodeficiency Virus-Negative Patients. Asian Spine J 2020; 14:857-863. [PMID: 32160725 PMCID: PMC7788368 DOI: 10.31616/asj.2019.0251] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Accepted: 10/13/2019] [Indexed: 11/23/2022] Open
Abstract
Study Design Prospective comparative study.Purppse: A prospective comparative analysis of 30 patients with spinal tuberculosis (15 human immunodeficiency viruses [HIV] positive and 15 HIV negative). We compared the clinical and radiological parameters of the two groups. Overview of Literature With the increasing incidence of HIV and tuberculosis co-infection, spinal tuberculosis is increasing globally, especially in developing countries. The diagnosis of spinal tuberculosis presents a challenge due to nonspecific constitutional symptoms and late presentation. Methods A prospective study was conducted of 30 patients with spinal tuberculosis (15 HIV positive and 15 HIV negative) from August 2014–July 2016 for assessment of clinical and radiological parameters. Neurological assessment was done by classification of tuberculous paraplegia, and the amount of kyphosis was assessed by Cobb angle on a plain radiograph. Abscess size in anterior epidural space, the number of vertebral bodies involved and collapsed, and skip lesions were noted on magnetic resonance imaging. Results In the prospective analysis of 30 patients, HIV positive (n=15) and HIV negative (n=15), there was no significant difference in neurological grading between the two groups. The amount of vertebral body destruction and degree of kyphosis was significantly greater in HIV-negative patients as compared with HIV-positive patients. There was a significant difference in Cobb angle between the two groups. The amount of anterior epidural space abscess formation was greater in HIV-positive patients as compared with HIVnegative patients. Conclusions HIV-negative patients had greater vertebral body destruction and resultant kyphosis as compared with HIV-positive patients, who had greater anterior epidural abscess formation.
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Affiliation(s)
| | - Vishal Supda Patil
- Department of Orthopaedics, B.J. Govt Medical College and Sassoon General Hospital, Pune, India
| | | | - Kaustubh Yeshwant Kale
- Department of Orthopaedics, B.J. Govt Medical College and Sassoon General Hospital, Pune, India
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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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Perikal PJ, Srikantha U, Jagannath AT, Khanapure K, Varma RG, Hegde AS. Rare manifestation of common disease with an unique method of minimally invasive spine stabilization: Cervical 2-3 facet lesion. JOURNAL OF CRANIOVERTEBRAL JUNCTION AND SPINE 2018; 9:209-211. [PMID: 30443143 PMCID: PMC6187890 DOI: 10.4103/jcvjs.jcvjs_69_18] [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: 11/04/2022] Open
Abstract
Cervical granulomatous infections of the posterior elements are very rare, it is often difficult to diagnose due to rarity and variable presentation of symptoms. Any cervical surgical procedure carries a certain morbid risk to the patient. We present a case of cervical 2-3 facet joint lesion which was managed by a minimally invasive technique with a favorable outcome.
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Affiliation(s)
- Parichay J Perikal
- Department of Neurosurgery, Ramaiah Institute of Neurosciences, M S Ramaiah Medical College, Bangalore, Karnataka, India
| | - Umesh Srikantha
- Department of Neurosurgery, Aster CMI Hospital, Bangalore, Karnataka, India
| | - Aniruddha T Jagannath
- Department of Neurosurgery, Ramaiah Institute of Neurosciences, M S Ramaiah Medical College, Bangalore, Karnataka, India
| | - Kiran Khanapure
- Department of Neurosurgery, Ramaiah Institute of Neurosciences, M S Ramaiah Medical College, Bangalore, Karnataka, India
| | - Ravi Gopal Varma
- Department of Neurosurgery, Aster CMI Hospital, Bangalore, Karnataka, India
| | - A S Hegde
- Department of Neurosurgery, Ramaiah Institute of Neurosciences, M S Ramaiah Medical College, Bangalore, Karnataka, India
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Kanna RM, Bosco A, Shetty AP, Rajasekaran S. Unilateral sacroiliitis: differentiating infective and inflammatory etiology by magnetic resonance imaging and tissue studies. 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 2018; 28:762-767. [PMID: 30353317 DOI: 10.1007/s00586-018-5800-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Revised: 08/21/2018] [Accepted: 10/19/2018] [Indexed: 10/28/2022]
Abstract
PURPOSE Unilateral sacroiliitis (US) is an uncommon disease with varied etiology. The differentiation between infective and inflammatory causes for US based on MRI alone is often difficult. We studied the efficacy of MRI findings in comparison with tissue studies in the diagnosis of US. METHODS A retrospective analysis of patients who presented with US and evaluated with MRI, biopsy for histopathology and tissue cultures was performed. Patients with bilateral sacroiliitis, traumatic and postpartum sacroiliitis were excluded. Based on defined MRI criteria, the patients were divided into two groups-infective (group A) and inflammation (group B). RESULTS In total, 33 patients (mean age-33.4 ± 17.2 years) with MRI features of US had presented with unilateral gluteal pain (100%) and positive Patrick's test (91.9%). Based on the MRI features of severe subchondral marrow edema, widening of joint space, intra-articular abscess and periarticular muscle abscess, infective sacroiliitis (A) was diagnosed in 20/33 (60.6% cases). A total of 13/33 (39.3%) patients had features of inflammation (B), based on the following MRI criteria-subchondral sclerosis with minimal edema, erosions, maintained joint space without abscess/destruction. Tissue evidence of infection was positive in 13/20 (65%) patients in group A while it was negative in all group B patients. CONCLUSION MRI had high sensitivity (71%) and 100% specificity in diagnosing inflammatory sacroiliitis while it had low specificity, but 100% sensitivity for diagnosing infective sacroiliitis. Hence, patients diagnosed as inflammatory sacroiliitis in MRI are unlikely to benefit from further tissue studies while percutaneous biopsy is recommended in patients diagnosed in MRI as infective sacroiliitis.
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Affiliation(s)
- Rishi Mugesh Kanna
- Department of Orthopaedics, Traumatology and Spine Surgery, Ganga Hospital, 313, Mettupalayam Road, Coimbatore, 641043, India.
| | - Aju Bosco
- Department of Orthopaedics, Traumatology and Spine Surgery, Ganga Hospital, 313, Mettupalayam Road, Coimbatore, 641043, India
| | - Ajoy Prasad Shetty
- Department of Orthopaedics, Traumatology and Spine Surgery, Ganga Hospital, 313, Mettupalayam Road, Coimbatore, 641043, India
| | - S Rajasekaran
- Department of Orthopaedics, Traumatology and Spine Surgery, Ganga Hospital, 313, Mettupalayam Road, Coimbatore, 641043, India
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Nagashima H, Tanishima S, Tanida A. Diagnosis and management of spinal infections. J Orthop Sci 2018; 23:8-13. [PMID: 29066036 DOI: 10.1016/j.jos.2017.09.016] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Revised: 08/16/2017] [Accepted: 09/05/2017] [Indexed: 12/24/2022]
Abstract
The number of spinal infections has been increasing due to aging populations and larger numbers of immunocompromised hosts and intravenous drug users. Magnetic resonance imaging is a useful tool for the early diagnosis of spinal infections, and can yield positive findings just 3-5 days after disease onset. Before antibiotic administration, cultures must be initiated from blood and from specimens collected from the locus of infection. Based on the pathogens identified by culture, appropriate antibiotics should be selected with careful consideration of antimicrobial susceptibility and spinal tissue penetration. Antibiotic treatment of spinal infections should be continued for longer than for most other types of infections, although the optimal duration remains unknown. The indications for surgical treatment include progressive neurologic deficits, progressive deformity, spinal instability, persistent or recurrent infection, and unbearable pain. In most patients with spinal infection, the gold standard surgical treatment is anterior radical debridement followed by autologous strut bone grafting. The addition of posterior instrumentation has recently become popular. This procedure may be performed alone as an alternative surgical option in patients in poor condition, and if it dramatically reduces pain, subsequent observation may be reasonable. If progressive deformity is observed or pain relief is inadequate after posterior instrumentation, additional anterior debridement and bone grafting should be scheduled.
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Affiliation(s)
- Hideki Nagashima
- Department of Orthopedic Surgery, Faculty of Medicine, Tottori University, 36-1 Nishi-cho, Yonago, Tottori 683-8504, Japan.
| | - Shinji Tanishima
- Department of Orthopedic Surgery, Faculty of Medicine, Tottori University, 36-1 Nishi-cho, Yonago, Tottori 683-8504, Japan
| | - Atsushi Tanida
- Department of Orthopedic Surgery, Faculty of Medicine, Tottori University, 36-1 Nishi-cho, Yonago, Tottori 683-8504, Japan
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Osteoraticular Tuberculosis-Brief Review of Clinical Morphological and Therapeutic Profiles. CURRENT HEALTH SCIENCES JOURNAL 2017; 43:171-190. [PMID: 30595874 PMCID: PMC6284841 DOI: 10.12865/chsj.43.03.01] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/03/2017] [Accepted: 09/18/2017] [Indexed: 12/11/2022]
Abstract
Osteoarticular tuberculosis (OATB) is a rare form of tuberculosis (TB) whose incidence rose significantly nowadays especially in the underdeveloped countries. The main risk factors predisposing to this new challenge for the medical system are the Human Immunodeficiency Virus (HIV) epidemic, the migration from TB endemic areas and the development of drug and multidrug-resistant strains of Mycobacterium tuberculosis (Mt). The disease affects both genders and any age group although the distribution depending on gender is controversial and that depending on age has a bimodal pattern. In most cases the initial focus is elsewhere in the organism and the most frequent pathway of dissemination is lympho-haematogenous. The clinical picture includes local symptoms as pain, tenderness and limitation of motion, with some particularities depending on the segment of the osteoarticular system involved, sometimes accompanying systemic symptoms specific for TB and other specific clinical signs as cold abscesses and sinuses. The radiographic features are not specific, CT demonstrates abnormalities earlier than plain radiography and MRI is superior to plain radiographs in showing the extent of extraskeletal involvement. Both CT and MRI can be used in patient follow-up to evaluate responses to therapy. TBhas been reported in all bones of the body, the various sites including the spine (most often involved) and extraspinal sites (arthritis, osteomyelitis and tenosynovitis and bursitis). Two basic types of disease patterns could be present: the granular type (most often in adults) and the caseous exudative type (most often in children) one of which being predominant. The algorithm of diagnosis includes several steps of which detection of Mt is the gold standard. The actual treatment is primarily medical, consisting of antituberculosis chemotherapy (ATT), surgical interventions being warranted only for selected cases. It is essential that clinicians know and refresh their knowledge about manifestations of OATB.
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Singh R, Magu NK, Rohilla RK. Clinicoradiologic Profile of Involvement and Healing in Tuberculosis of the Spine. Ann Med Health Sci Res 2016; 6:311-327. [PMID: 28503350 PMCID: PMC5414445 DOI: 10.4103/amhsr.amhsr_188_15] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND There is no much information about how tuberculous lesions of the spine progress/heal; what clinical and radiological features suggest progression/healing; what is the optimal duration of antitubercular treatment; and what clinical, laboratory, and radiological investigations and their frequency should be done to monitor the disease course. AIMS The present study aimed to evaluate what specific clinicoradiologic features suggest involvement and healing in tuberculosis of the spine. SUBJECTS AND METHODS Fifty spinal tuberculosis patients (30 males and 20 females) diagnosed clinicoradiologically were enrolled in the study. Patients were evaluated clinically, radiographically, and by magnetic resonance imaging (MRI) at regular intervals to monitor the disease course till 24 months of the initial presentation. RESULTS Wedge/collapse (23/50 cases), soft tissue mass (29/50 cases), disc narrowing (45/54 discs), and endplate erosions (89/107 endplates) were the plain radiological findings of tubercular spinal involvement. Earliest sign of healing on plain radiography was decrease in fuzziness of endplate, ultimately leading to either sclerosis of endplate or fusion of adjacent vertebrae. Initial MRI findings included bone marrow edema (50/50 cases), discitis (53/62 discs), endplate erosions (105/123 endplates), pre- and para-vertebral collections (45/50 cases), epidural involvement (26/50 cases), epidural spread (77/109 vertebrae), and subligamentous spread (42/50 cases). Earliest feature of healing on magnetic resonance (MR) examination was decrease in inflammatory soft-tissue masses and reduction in marrow edema. CONCLUSIONS Salient features of spinal involvement in tuberculosis on plain radiograph were paradiscal involvement, endplate destruction, and soft tissue masses. Marrow edema, paravertebral collections, subligamentous spread, extradural component, endplate erosion, and discitis suggested tubercular involvement of the spine on MRI. A decrease in these was observed to have prognostic value both in monitoring disease course and response to chemotherapy. Based on the clinicoradiologic findings of the present study, we propose decision-making algorithm, follow-up algorithm, and MR examination protocol for spinal tuberculosis. LEVEL OF EVIDENCE This was a Level II study.
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Affiliation(s)
- R Singh
- Department of Orthopedic Surgery, Paraplegia and Rehabilitation, Pt. B.D. Sharma PGIMS, Rohtak, Haryana, India
| | - N K Magu
- Department of Orthopedic Surgery, Paraplegia and Rehabilitation, Pt. B.D. Sharma PGIMS, Rohtak, Haryana, India
| | - R K Rohilla
- Department of Orthopedic Surgery, Paraplegia and Rehabilitation, Pt. B.D. Sharma PGIMS, Rohtak, Haryana, India
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Sacroiliac tuberculosis - A neglected differential in refractory low back pain - Our series of 35 patients. J Clin Orthop Trauma 2014; 5:146-53. [PMID: 25983488 PMCID: PMC4223813 DOI: 10.1016/j.jcot.2014.07.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2014] [Accepted: 07/19/2014] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION Osteo-articular tuberculosis accounts for 1-3% of which 5-8% involves sacro-illiac joint. Isolated sacroiliac involvement is very rare. It usually presents as vague back pain. Plain radiographs are often inconclusive. Due to rarity of lesion, vague symptoms and non-conclusive X-rays the diagnosis is further delayed. We present a series of 35 patients presented with sacroiliac tuberculosis. METHODS 35 patients were diagnosed of sacroiliac tuberculosis from January 2008 to December 2011. After a thorough history and clinical examination, patients were taken up for X-rays and MRI scans. Ultrasound guided needle aspiration was done from suspected area. After histological confirmation of the diagnosis, patients were treated with anti tubercular therapy. RESULTS Persistent low back pain and difficulty with walking were noted in all patients. There were 21 males (60%) and 14 females and the age ranged from 22 to 55 years (mean: 27 years). Most of the patients (91.4%) had unilateral disease (32 patients). Results of conservative management were good. 21 (60%) of our patients achieved bony ankylosis at the end of study. 9 patients did not respond to conservative management where surgical debridement was done. 4 of these cases had MDR tuberculosis. CONCLUSION Sacroiliac tuberculosis must be kept as a differential in all refractory low back pain particularly in endemic areas. MRI is very helpful in early diagnosis of disease. In the early stages of the infection aspiration using a closed needle biopsy is recommended. An open biopsy is essential when the aspirate yields no growth. Open debridement should be done in those not responding to conservative management.
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Wu P, Wang XY, Li XG, Shen XJ, Pang XY, Luo CK, Xu ZQ, Zeng H, Zhang PH, Peng W. One-stage posterior procedure in treating active thoracic spinal tuberculosis: a retrospective study. Eur J Trauma Emerg Surg 2014; 41:189-97. [DOI: 10.1007/s00068-014-0421-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2013] [Accepted: 06/02/2014] [Indexed: 12/19/2022]
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Lazrak F, Abourazzak FE, Elouzzani FE, Benzagmout M, Harzy T. A rare location of sacral tuberculosis: A report of three cases. Eur J Rheumatol 2014; 1:78-80. [PMID: 27708880 DOI: 10.5152/eurjrheumatol.2014.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2014] [Accepted: 04/14/2014] [Indexed: 11/22/2022] Open
Abstract
Tuberculosis remains one of the most common infectious diseases in the world. Vertebral tuberculosis is the commonest form of bone and joint tuberculosis; however, isolated sacral tuberculosis is rare. This atypical presentation may lead to a delay in diagnosis and treatment. We report three cases of sacral tuberculosis diagnosed in young women, aged 30, 23, and 35 years old, respectively. Lombosciatic pain was the main symptom in all cases. All patients had a biological assessment, plain radiographs, and CT scan. However, magnetic resonance imaging was done in only two cases. All patients underwent surgical sacral biopsy, and the diagnosis of tuberculosis was confirmed by histology in all cases. The evolution was satisfactory with the adjunction of antituberculous chemotherapy in all cases. Spinal tuberculosis should be the first and foremost differential diagnosis in the presence of atypical clinical and radiological features of a sacral lesion, particularly in developing countries. Early diagnosis and treatment could prevent or minimize the neurological morbidity in such cases.
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Affiliation(s)
- Faiza Lazrak
- Department of Rheumatology, CHU Hassan II University Hospital, Fez, Morocco
| | | | | | | | - Taoufik Harzy
- Department of Rheumatology, CHU Hassan II University Hospital, Fez, Morocco
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Hasan NMA. Pedicle involvement in tuberculous spondylitis and pyogenic spondylitis: Comparative magnetic resonance imaging study. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2014. [DOI: 10.1016/j.ejrnm.2014.02.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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Comparison of pyogenic spondylitis and tuberculous spondylitis. Asian Spine J 2014; 8:216-23. [PMID: 24761207 PMCID: PMC3996349 DOI: 10.4184/asj.2014.8.2.216] [Citation(s) in RCA: 76] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2013] [Revised: 10/14/2013] [Accepted: 10/16/2013] [Indexed: 12/15/2022] Open
Abstract
Pyogenic spondylitis and tuberculous spondylitis are common causes of spinal infection. It is difficult to differentiate tuberculous spondylitis and pyogenic spondylitis clinically and radiologically. Recently magnetic resonance imaging has been reported to be beneficial for early diagnosis and differential diagnosis of the spondylitis, and is being used extensively for diagnosis. However, the diagnosis must be considered in combination with corresponding changes in clinical manifestations, radiological findings, blood and tissue cultures and histopathological findings. Conservative treatments, including antimicrobial medications, are started initially. Surgical treatments, which include anterior or posterior approach, single-stage or two-stage surgery, with or without instrumentation, may be performed as indicated.
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Gupta AK, Kumar C, Kumar P, Verma AK, Nath R, Kulkarni CD. Correlation between neurological recovery and magnetic resonance imaging in Pott's paraplegia. Indian J Orthop 2014; 48:366-73. [PMID: 25143639 PMCID: PMC4137513 DOI: 10.4103/0019-5413.136228] [Citation(s) in RCA: 7] [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] [Indexed: 02/04/2023]
Abstract
BACKGROUND Spinal cord/nerve root compression secondary to a tubercular epidural abscess leads to neurological deficit. Depending on the extent and duration of compression, the end result after treatment may vary from complete recovery to permanent deficit. ASIA has been used extensively to correlate between MRI and neurological status due to traumatic spine injuries. MRI has stood as an invaluable diagnostic tool out of the entire range of current imaging modalities. However, inspite of considerable literature on the applications of MRI in spinal tuberculosis, there have been few studies to assess the relationship between the MRI findings and the neurological deficit as assessed by clinical examination. AIMS The objective of this study was to ascertain whether the findings of magnetic resonance imaging (MRI) correlate well with the actual neurological recovery status using the American Spinal Injury Association impairment scale (ASIA) in patients with spinal compression secondary to tuberculous spondylitis. MATERIALS AND METHODS 60 patients (mean age 43.6 years) diagnosed as spinal tuberculosis by MRI/cytology/histopathology were examined and classified into ASIA impairment scale A-E based on the ASIA and again reclassified after 6 months of therapy to assess functional recovery. Similarly, they underwent MR imaging at the start and at the completion of 6 months of therapy to assess the structural recovery. The MRI features of recovery were correlated with the actual neurological recovery as ascertained by the ASIA. RESULTS Before starting treatment 1 patient (2.08%) was in ASIA A, 2 (4.16%) were in ASIA B, 9 (18.75%) were in ASIA C, 36 (75%) were in ASIA D and 12 (20%) were in ASIA E. There was a significant difference in the epidural abscess thickness, thecal compression and cord compression between ambulatory (ASIA D and ASIA E) and non ambulatory patients (ASIA A, ASIA B and ASIA C). After 6 months of therapy 30 (90%) patients in ASIA D and 5 (55.5%) in ASIA C had complete neurological recovery. Both patients from ASIA B improved to ASIA D. Single patient who was in ASIA A before treatment remained non ambulatory (ASIA C) after treatment. Overall 33 (78.5%) patients showed complete recovery at final followup. Out of all the MRI features, only size of epidural abscess was found to be a poor prognostic factor for recovery of neurological deficit. CONCLUSIONS There are several parameters on MRI which correlate with the severity of neurological impairment according to ASIA score and resolution of those features on treatment is also correlated well with neurological recovery.
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Affiliation(s)
- Anil Kumar Gupta
- Department of Orthopaedic Surgery, GSVM Medical College, Kanpur, Uttar Pradesh, India,Address for correspondence: Dr. Anil Kumar Gupta, Department of Orthopaedic Surgery, P-6, Medical College Campus, Kanpur - 208 002, Uttar Pradesh, India. E-mail:
| | - Chandan Kumar
- Department of Orthopaedic Surgery, GSVM Medical College, Kanpur, Uttar Pradesh, India
| | - Praveen Kumar
- Department of Radiodiagnosis, GSVM Medical College, Kanpur, Uttar Pradesh, India
| | - Ashok Kumar Verma
- Department of Radiodiagnosis, GSVM Medical College, Kanpur, Uttar Pradesh, India
| | - Rohit Nath
- Department of Orthopaedic Surgery, GSVM Medical College, Kanpur, Uttar Pradesh, India
| | - Chaitanya D Kulkarni
- Department of Radiodiagnosis, GSVM Medical College, Kanpur, Uttar Pradesh, India
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Ansari S, Amanullah MF, Ahmad K, Rauniyar RK. Pott's Spine: Diagnostic Imaging Modalities and Technology Advancements. NORTH AMERICAN JOURNAL OF MEDICAL SCIENCES 2013; 5:404-11. [PMID: 24020048 PMCID: PMC3759066 DOI: 10.4103/1947-2714.115775] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Spinal tuberculosis (TB) or Pott's spine is the commonest extrapulmonary manifestation of TB. It spreads through hematogenous route. Clinically, it presents with constitutional symptoms, back pain, tenderness, paraplegia or paraparesis, and kyphotic or scoliotic deformities. Pott's spine accounts for 2% of all cases of TB, 15% of extrapulmonary, and 50% of skeletal TB. The paradiscal, central, anterior subligamentous, and neural arch are the common vertebral lesions. Thoracic vertebrae are commonly affected followed by lumbar and cervical vertebrae. Plain radiographs are usually the initial investigation in spinal TB. For a radiolucent lesion to be apparent on a plain radiograph there should be 30% of bone mineral loss. Computed tomographic scanning provides much better bony detail of irregular lytic lesions, sclerosis, disc collapse, and disruption of bone circumference than plain radiograph. Magnetic resonance imaging (MRI) is the best diagnostic modality for Pott's spine and is more sensitive than other modalities. MRI frequently demonstrates disc collapse/destruction, cold abscess, vertebral wedging/collapse, marrow edema, and spinal deformities. Ultrasound and computed tomographic guided needle aspiration or biopsy is the technique for early histopathological diagnosis. Recently, the coexistence of human immunodeficiency virus infections and TB has been increased globally. In recent years, diffusion-weighted MRI (DW-MRI) and apparent diffusion coefficient values in combination with MRI are used to some extent in the diagnosis of spinal TB. We have reviewed related literature through internet. The terms searched on Google scholar and PubMed are TB, extrapulmonary TB, skeletal TB, spinal TB, Pott's spine, Pott's paraplegia, MRI, and computed tomography (CT).
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Affiliation(s)
- Sajid Ansari
- Department of Radiodiagnosis, B. P. Koirala Institute of Health Sciences, Dharan, Nepal
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Surgical treatment of thoracic spinal tuberculosis with adjacent segments lesion via one-stage transpedicular debridement, posterior instrumentation and combined interbody and posterior fusion, a clinical study. Arch Orthop Trauma Surg 2013; 133:1341-50. [PMID: 23860673 DOI: 10.1007/s00402-013-1811-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2013] [Indexed: 02/09/2023]
Abstract
PURPOSE To investigate the clinical efficacy and feasibility of one-stage surgical treatment for thoracic spinal tuberculosis with adjacent segments lesion by internal fixation, transpedicular debridement, and combined interbody and posterior fusion via a posterior-only approach. MATERIALS AND METHODS Twenty-one patients (thirteen males, eight females) with thoracic tuberculosis whose lesions were confined to two adjacent segments were studied retrospectively. All patients were treated with one-stage surgical treatment by internal fixation, transpedicular debridement, and combined interbody and posterior fusion via a posterior-only approach. The American Spinal Injury Association (ASIA) impairment scale was used to assess neurological function. Thoracic Cobb angle was used to assess thoracic kyphosis. Operating time, blood loss, complications, neurological function, deformity correction and interbody fusion were investigated. RESULTS Average mean operating time was 231.4 ± 31.9 min, and evaluated blood loss during operation was 880.2 ± 112.7 ml. All patients were followed up for 22-41 months postoperatively (average 29.8 ± 5.4 months). All patients had significant postoperative improvement in ASIA classification scores. The thoracic kyphotic angles were significantly decreased to 9°-25° postoperatively (average 16.7° ± 4.4°), and at final follow-up were 10°-27°(average 17.7° ± 4.4°). No severe complications or spinal cord injury occurred. The erythrocyte sedimentation rate recovered to normal within 3 months postoperatively in all patients. All patients got bony fusion within 6-9 months after surgery. CONCLUSIONS One-stage transpedicular debridement, posterior instrumentation and combined interbody and posterior fusion via a posterior-only approach can be an effective and feasible treatment method for thoracic spinal tuberculosis.
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Kim DU, Kim SW, Ju CI. Isolated coccygeal tuberculosis. J Korean Neurosurg Soc 2013; 52:495-7. [PMID: 23323174 PMCID: PMC3539088 DOI: 10.3340/jkns.2012.52.5.495] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2012] [Revised: 08/06/2012] [Accepted: 11/22/2012] [Indexed: 11/27/2022] Open
Abstract
Isolated tuberculosis of the coccyx is extremely rare. A 35-year-old man presented with a 3-month history of coccygeal and gluteal pain. Computed tomography and magnetic resonance imaging revealed osseous destruction and a large enhancing mass involving the coccyx with anterior and posterior extension. Pathologic examination of the surgical specimen revealed necrosis, chronic granulomatous inflammation, and multinucleated giant cells consistent with tuberculosis. This case highlights the importance of considering tuberculosis as a diagnosis even though unusual sites are involved.
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Affiliation(s)
- Do Un Kim
- Department of Neurosurgery, College of Medicine, Chosun University, Gwangju, Korea
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Wang H, Li C, Wang J, Zhang Z, Zhou Y. Characteristics of patients with spinal tuberculosis: seven-year experience of a teaching hospital in Southwest China. INTERNATIONAL ORTHOPAEDICS 2012; 36:1429-34. [PMID: 22358176 DOI: 10.1007/s00264-012-1511-z] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Received: 12/31/2011] [Accepted: 01/27/2012] [Indexed: 10/28/2022]
Abstract
PURPOSE The purpose of this study was to investigate the characteristics of patients managed for spinal tuberculosis at the orthopaedics department of a teaching hospital in Chongqing, China, between 2004 and 2010. METHODS The study used a retrospective chart review. The epidemiology, clinical features, laboratory test results, imaging study findings, and treatment methods were recorded. RESULTS The annual incidence of spinal tuberculosis was stable throughout the study period. There were 284 patients, 147 women and 137 men, with a mean age of 38.2 years. The majority of the lesions involved the thoracic spine (45.3%), followed by the lumbar spine (45.0%). Multiple level skip lesions were seen in 5.6% of cases. The erythrocyte sedimentation rate was normal in 26.8% of patients. The C-reactive protein (CRP) was normal in 30.2% of patients. Type A and type O were the most common blood types. Neurological involvement was seen in 21.8% of patients. Concomitant tuberculosis of the lung was seen in 73 (25.7%). The patients with middle school education and above account for 60.4% (102/169) in rural patients and 68.7% (79/115) in urban patients. Mean time from symptom onset to diagnosis was 18.0 months (range, three days to 360 months), and there was a significant difference between the rural patients (23.0 months) and the urban patients (10.7 months) (p=0.001, t=-3.300). Surgical treatment was performed in 233 patients (82.0%). The preferred surgical procedure was radical anterior debridement, bone grafting and internal fixation (132 patients, 46.5%). There were 13 patients (4.2%) with anti-tuberculous chemotherapy drug allergy or toxicity, streptomycin anaphylaxis and toxicity in 12, and isoniazide anaphylaxis and toxicity in one. No mortality was related to spinal TB. CONCLUSION The annual incidence of spinal tuberculosis remained unchanged throughout the study period and most of the patients did not pay much attention to the disease and received timely treatment. Thus, we should strengthen the census and treatment of spinal tuberculosis in Southwest China.
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Affiliation(s)
- Hongwei Wang
- Department of Orthopedics, Xinqiao Hospital, The Third Military Medical University, Xinqiao Street, Chongqing, 400037, People's Republic of China
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Jain AK, Sreenivasan R, Saini NS, Kumar S, Jain S, Dhammi IK. Magnetic resonance evaluation of tubercular lesion in spine. INTERNATIONAL ORTHOPAEDICS 2011; 36:261-9. [PMID: 22038440 DOI: 10.1007/s00264-011-1380-x] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/25/2011] [Accepted: 09/26/2011] [Indexed: 11/30/2022]
Abstract
PURPOSE Information on Magnetic Resonance (MR) features of active and healed lesions in tuberculosis (TB) spine are lacking. We evaluated MRI findings in active and healed proven TB spine to establish the diagnostic features. MATERIALS AND METHOD Forty-nine consecutive spinal TB patients (20 male; 29 female) diagnosed clinicoradiologically and/or on histopathology, Fine Needle Aspiration Cytology (FNAC), bacteriology, or Polymerase Chain Reaction (PCR) were enrolled. Pretreatment MR scans were reviewed for diagnostic features, and eight-month follow-up MR scans were reviewed for healing changes. RESULTS Cervical spine (n = 6), dorsal spine (n = 14), and lumbar spine (n = 29) were affected. Fourteen had paraplegia. Mean vertebrae involved were 2.61 on X-ray with a total of 128 vertebrae (VB) and 3.2 on MRI (range, 2-15) with 161 VB. The lesions were more extensive on MRI (34.7%) than appreciated on X-ray. The disc was preserved partially or fully in 88.2% of instances. End plate erosions (159/161 VB), lost VB height (94/161), exudative lesion (158/161), granular lesion (3/161), pre and paravertebral collections (49/49 cases), marrow oedema (161/161), discitis (98%), epidural involvement (107/161), epidural spread (100/161), and subligamentous spread (156/161) were observed. Canal encroachment (10-90%) was seen in 37 cases. Mean motor and sensory scores with greater than 50% canal encroachment were 87/100 and 156/168, respectively. Cord oedema was observed in 11 cases (eight with neural deficit and three cases without). Cord atrophy was seen in one case each before and after treatment. A total of 83% of patients had a combination of paravertebral collections, marrow oedema, subligamentous and epidural extension, endplate erosions and discitis. On healing (n = 20), complete resolution of marrow oedema and collections, fatty replacement of bone marrow and resolution of cord signal intensity were observed. CONCLUSION The marrow oedema, preservation of disc space, subligamentous extension of abscess, septate paravertebral abscess, epidural extension, endplate erosions and discitis were consistently observed in 83% cases of TB spine on MRI.
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Affiliation(s)
- Anil Kumar Jain
- Department of Orthopedics, University College of Medical Sciences (University of Delhi) and Guru Teg Bahadur Hospital, New Delhi, India.
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Gong K, Wang Z, Luo Z. Single-stage posterior debridement and transforaminal lumbar interbody fusion with autogenous bone grafting and posterior instrumentation in the surgical management of lumbar tuberculosis. Arch Orthop Trauma Surg 2011; 131:217-23. [PMID: 20556616 DOI: 10.1007/s00402-010-1138-8] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2010] [Indexed: 11/25/2022]
Abstract
AIM To describe a case series to highlight the clinical effectiveness of single-stage posterior debridement and transforaminal lumbar interbody fusion (TLIF) with autogenous bone grafting and posterior instrumentation in the surgical management of lumbar tuberculosis. METHODS This case series involves 14 lumbar tuberculosis patients treated with the above given surgical procedure. The following parameters have been evaluated: visual analog scale (VAS) score, erythrocyte sedimentation rate (ESR) and C-reactive protein value, vertebral body loss, deformity angle, kyphotic angle, lumbar lordotic angle and fusion status of affected segment. The mean time of follow-up is 38.2 months (30-46). RESULTS Significant improvement was found in all radiologic parameters, and significant decrease in VAS and ESR were noted after surgery. Bony fusion was seen in all cases within a mean time of 4.3 months (range 3-7 months). No postoperative instrumental complication and recurrence were noted. CONCLUSION Single-stage posterior debridement and TLIF with autogenous bone grafting and posterior instrumentation is a safe and effective approach to treating with early-diagnosed and less-involved lumbar tuberculosis.
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Affiliation(s)
- Kai Gong
- Institute of Orthopaedics and Traumatology of PLA of China, Xijing Hospital, The Fourth Military Medical University, Xi'an, Shaanxi, People's Republic of China.
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Abstract
OBJECTIVE The incidence of tuberculosis (TB) is increasing in both developing and developed worlds, and children, in particular, represent a high-risk group for acquiring the disease. TB of the central nervous system is the most severe, life-threatening form of TB in infants and children. Approximately 10% of all patients with TB have central nervous system involvement. MATERIALS AND METHODS We have selected four pediatric cases of unusual spinal TB that presented to our institution during the last 5 years. These include TB arachnoiditis, intramedullary spinal cord tuberculoma, TB spondylitis of the odontoid peg, and one child with tuberculous extradural abscess. CONCLUSION TB may involve the intramedullary, extramedullary intrathecal compartment, or the extrathecal vertebral compartment in the form of an arachnoiditis, abscess, and spondylitis, respectively, often with unusual imaging presentations.
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Kotil K, Alan MS, Bilge T. Medical management of Pott disease in the thoracic and lumbar spine: a prospective clinical study. J Neurosurg Spine 2007; 6:222-8. [PMID: 17355021 DOI: 10.3171/spi.2007.6.3.222] [Citation(s) in RCA: 72] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT The aim of this study was to evaluate conservative medical management of 44 patients with Pott disease. The prognostic significance of various clinical, radiological, and long-term follow-up findings in these patients was also evaluated. METHODS Between January 1990 and January 2005 data were collected prospectively at the authors' clinic in 44 patients with Pott disease in the thoracic or lumbar spine. These patients had no major neurological deficits or severe spinal deformities. The study population consisted of 21 male (48%) and 23 female (52%) patients, with a mean age of 42.1 years (range 10-70 years). The most common region of Pott disease was the thoracolumbar junction (18 cases; 41%), followed by the thoracic (16 cases; 36%) and lumbar (10 cases; 23%) regions. All patients presented with abscesses. With the exception of two cases, all had kyphotic angles smaller than 30 degrees. At presentation, 20 patients had neurological signs of spinal cord compression during clinical examination. Both clinical and biopsy findings were used in all cases for diagnosis. A diagnosis was confirmed by a positive biopsy specimen culture in 19 (43.2%) of 44 cases, and histopathological findings were compatible with the results of these cultures in all cases. All patients were treated with antituberculous chemotherapy, and the diseases in only two (4.5%) was resistant to the regimen. An independent observer assessed the clinical and imaging findings after a mean follow-up duration of 40 months. Forty-two (95.4%) of the 44 patients were successfully treated with conservative medical management and attained acceptable spinal deformity angles, and none of these patients had any residual instability, radiculopathy, or neurological compromise. Only 4.5% of the patients experienced residual spine deformity (as much as a 30 degrees kyphotic angle), which was clinically obvious but biomechanically stable. CONCLUSIONS Patients with Pott disease in the lumbar or thoracic region, without neurological deficits or kyphosis, can be treated conservatively in the vast majority of cases. Indications for surgery need to be redefined given these new data.
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Affiliation(s)
- Kadir Kotil
- Department of Neurosurgery, Haseki Education and Research Hospital, Istanbul, Turkey.
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Michael JWP, Brunkwall J, Fätkenheuer G, Seifert H, Winnekendonk G, Zöller JE, Eysel P. [A vascular pedicled duplicated fibula transplant for treatment of lumbar instability following tuberculous spondylodiscitis]. Unfallchirurg 2006; 110:86-8. [PMID: 17058055 DOI: 10.1007/s00113-006-1173-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Operative treatment of tuberculous spondylodiscitis is still an important part of the treatment for lumbar spine instability. We report on a patient who suffered an extensive relapse with microbiological confirmation of tuberculous spondylodiscitis following operative spinal treatment for unspecific spondylodiscitis. X-Ray examination showed development of pronounced lumbar instability, which was first treated with the aid of an external fixateur and later by means of a doubled fibular bone graft with a vascularised stem with no dorsal instrumentation, which led to bony consolidation.
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Affiliation(s)
- J W-P Michael
- Klinik und Poliklinik für Orthopädie der Universität zu Köln, Joseph-Stelzmann-Str. 9, 50924 Köln.
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Ramlakan RJS, Govender S. Sacroiliac joint tuberculosis. INTERNATIONAL ORTHOPAEDICS 2006; 31:121-4. [PMID: 16673102 PMCID: PMC2267531 DOI: 10.1007/s00264-006-0132-9] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/14/2006] [Revised: 02/27/2006] [Accepted: 02/28/2006] [Indexed: 10/24/2022]
Abstract
Infections of the sacroiliac joint are uncommon and the diagnosis is usually delayed. In a retrospective study, 17 patients who had been treated for tuberculosis sacroiliitis between 1994 and 2004 were reviewed. Two patients were excluded due to a short follow-up (less than 2 years). Low back pain and difficulty in walking were the most common presenting features. Two patients presented with a buttock abscess and spondylitis of the lumbar spine was noted in two patients. The Gaenslen's and FABER (flexion, abduction and external rotation) tests were positive in all patients. Radiological changes included loss of cortical margins with erosion of the joints. An open biopsy and curettage was performed in all patients; histology revealed chronic infection and acid-fast bacilli were isolated in nine patients. Antituberculous (TB) medication was administered for 18 months and the follow-up ranged from 3 to 10 years (mean: 5 years). The sacroiliac joint fused spontaneously within 2 years. Although all patients had mild discomfort in the lower back following treatment they had no difficulty in walking. Sacroiliac joint infection must be included in the differential diagnosis of lower back pain and meticulous history and clinical evaluation of the joint are essential.
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Affiliation(s)
- R J S Ramlakan
- Spinal Unit, King George V Hospital, University of Kwa-Zulu Natal, Durban, South Africa.
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Chang MC, Wu HTH, Lee CH, Liu CL, Chen TH. Tuberculous spondylitis and pyogenic spondylitis: comparative magnetic resonance imaging features. Spine (Phila Pa 1976) 2006; 31:782-8. [PMID: 16582852 DOI: 10.1097/01.brs.0000206385.11684.d5] [Citation(s) in RCA: 67] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN We retrospectively compared magnetic resonance images (MRIs) of tuberculous (TB) spondylitis and pyogenic spondylitis. OBJECTIVE To identify differences between the diseases. SUMMARY OF BACKGROUND DATA Clinical and imaging findings of the 2 diseases are hard to distinguish. MRI may show important differences and aid in early diagnosis and treatment. METHODS We compared 22 MRI parameters in 33 patients with TB spondylitis (average age, 66 years) and in 33 patients with pyogenic spondylitis (average age, 65 years). RESULTS Seventeen parameters significantly differed between the groups. The most important were local and heterogeneous enhancement of the vertebral body in all patients with TB spondylitis, diffuse and homogeneous enhancement of the vertebral body in 94% of patients with pyogenic spondylitis, vertebral intraosseous abscess with rim enhancement (TB vs. pyogenic, 79% vs. 0%), disc abscess with rim enhancement (9% vs. 64%), and well-defined paraspinal abnormal signal intensity (82% vs. 18%). CONCLUSIONS Most parameters occurred in both diseases. Distinctive findings were a pattern of bone destruction with relative disc preservation and heterogeneous enhancement for TB spondylitis and a diskitis pattern (disc destruction) with peridiscal bone destruction and homogeneous enhancement for pyogenic spondylitis. These MRI parameters may facilitate the differential diagnosis of these diseases.
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Affiliation(s)
- Ming-Chau Chang
- Department of Orthopaedics and Traumatology, Veterans General Hospital-Taipei, National Yang-Ming University School of Medicine, Taipei, Taiwan, ROC.
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Mulleman D, Mammou S, Griffoul I, Avimadje A, Goupille P, Valat JP. Characteristics of patients with spinal tuberculosis in a French teaching hospital. Joint Bone Spine 2005; 73:424-7. [PMID: 16488649 DOI: 10.1016/j.jbspin.2005.10.013] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2005] [Accepted: 06/24/2005] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To investigate the characteristics of patients managed for spinal tuberculosis at the rheumatology department of the Tours Teaching Hospital, France, between 1986 and 2003. METHODS Retrospective chart review. The incidence, epidemiology, clinical features, imaging study findings, and diagnostic procedures were recorded. RESULTS The annual incidence of spinal tuberculosis was stable throughout the study period. There were 24 patients, 15 women and nine men with a mean age of 61 years; 15 patients were of French descent, three were of Portuguese descent, two were Asian, and four were North-African. Risk factors consisted of alcohol abuse in one patient, diabetes in two patients, glucocorticoid therapy in two patients, and a history of tuberculosis in six patients; none of the patients had AIDS. The cervical spine was involved in two patients, the thoracic spine in 11 patients, and the lumbar spine in 12 patients. Mean time from symptom onset to diagnosis was 4.3 months (range, 1-12 months). Percutaneous vertebral biopsy established the diagnosis in 16 of the 20 patients who underwent this procedure. CONCLUSION The annual incidence of spinal tuberculosis remained unchanged throughout the study period and was not influenced by immigration or the AIDS epidemic. The typical patient was an elderly Caucasian woman of French descent. Reactivation of untreated or inadequately treated tuberculosis was probably the main mechanism.
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Affiliation(s)
- Denis Mulleman
- Rheumatology Department, Trousseau Teaching Hospital and School of Medicine, François Rabelais University, 37044 Tours cedex 9, France
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Abstract
Spinal tuberculosis (Pott disease) is uncommon in developed countries. On imaging studies diagnosis of this lesion may not be considered or it might be mistaken for pyogenic osteomyelitis. Features most strongly indicative of a diagnosis of spinal tuberculosis are relative sparing of the disc space, large paraspinous abscesses, a thick rim of enhancement around the paraspinous and intraosseous abscesses, calcifications within the paraspinous collections, and a fragmentary pattern of osseous destruction. As the disease progresses, there is worsening of the osseous destruction, leading to collapse of the vertebral body and eventual progression to kyphotic deformity. Based on recent experience, the authors review the major imaging characteristics associated with spinal tuberculosis and describe the typical course of the disease as documented on plain radiographs, computerized tomography scans, and magnetic resonance images.
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Affiliation(s)
- Seth S Joseffer
- Department of Neurosurgery, New York University Medical Center, New York, New York, USA
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Nene A, Bhojraj S. Results of nonsurgical treatment of thoracic spinal tuberculosis in adults. Spine J 2005; 5:79-84. [PMID: 15653088 DOI: 10.1016/j.spinee.2004.05.255] [Citation(s) in RCA: 83] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2004] [Accepted: 05/24/2004] [Indexed: 02/03/2023]
Abstract
BACKGROUND The indications for surgery in spinal tuberculosis have been controversial, and more so recently, in the era of renewed understanding of the concept of multi-drug-resistant tuberculosis along with newer modalities of spinal instrumentation. Indications for surgery need to be redefined in this context. PURPOSE To assess the efficacy and results of nonsurgical treatment in thoracic spinal tuberculosis in adult patients, and redefine indications for surgery. STUDY DESIGN We present a retrospective analysis of 70 adults with thoracic spinal tuberculosis, with varying presentations, including abscesses and neurological deficits, seen at our spine clinic, in a period between August 1998 and August 2000, treated largely nonsurgically, with rewarding results. METHODS A retrospective study was made of 70 adult patients with thoracic spinal tuberculosis presenting at our spine clinic, between August 1998 and August 2000. All patients were subjected to medical management, unless there were specific indications for surgery, as per our protocol, wherein absolute indications of surgery in adults included advanced neurological deficit (less than Grade 3 by 5, by the 5-point grading system of the Medical Research Council), neurology worsening while on antituberculous chemotherapy, diagnosis in doubt on clinicoradiological evaluation and significant kyphosis (greater than 40 degrees) on presentation. Clinical and radiological assessment of results was made by an independent observer, at a mean follow up of 40 months. RESULTS Forty-four patients presented with abscesses, 21 of which were epidural. Seven had neurological signs of cord compression on clinical examination at presentation. Over 98% of our patients (69 of 70) were successfully treated conservatively, and none of these had any residual instability, radiculopathy or neurological compromise. Seventy-four percent had excellent to good results, with no mechanical residues of the disease, and 23% had residual kyphosis, which was clinically obvious, but biomechanically irrelevant. CONCLUSIONS We think that tuberculous spondylodiscitis in adults can be well managed conservatively in a vast majority of cases, and indications for surgery are few and specific.
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Affiliation(s)
- Abhay Nene
- The Spine Clinic, P.D. Hinduja National Hospital and Medical Research Centre, Veer Savarkar Road, Mahim, Mumbai 400-016, India.
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Raut AA, Narlawar RS, Nagar A, Ahmed N, Hira P. An unusual case of CV junction tuberculosis presenting with quadriplegia. Spine (Phila Pa 1976) 2003; 28:E309. [PMID: 12897510 DOI: 10.1097/01.brs.0000083257.63544.a9] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Isolated tubercular involvement of craniovertebral junction in a human immunodeficiency virus-positive patient causing paraplegia and sudden death with radiologic features is presented. OBJECTIVES Isolated involvement of craniovertebral junction by tuberculosis causing quadriparesis is a rare entity. The role of imaging features is presented in diagnosis of craniovertebral junction tuberculosis, which is a treatable disease. Early detection of this entity with prompt treatment can prevent a fatal outcome. SUMMARY OF BACKGROUND DATA Tuberculosis of the cervical spine is a rare and potentially dangerous manifestation of extrapulmonary tuberculosis. The incidence is probably less than 1% of all cases of spinal tuberculosis. However, in the developing countries this constitutes an increasingly important cause of craniovertebral junction instability and cervicomedullary compression. Most of the patients present with pain in the neck and local tenderness. Neurologic deficits of varying degrees have been reported in 24-40% of cases of craniovertebral junction tuberculosis. Quadriplegia followed by sudden death is exceptional (as seen in our case). The incidence of craniovertebral junction tuberculosis in immunocompromised patients is not known. Dramatic recovery is possible if craniovertebral junction tuberculosis is detected early in its course. Prompt medical and surgical treatment may avert a potential catastrophic event in such cases. Imaging methods such as computed tomography and magnetic resonance imaging are diagnostic of this condition and aid in the detection and prompt treatment of the same. METHOD Frontal radiograph of the cervical spine and chest, and lateral view of cervical spine followed by plain and contrast enhanced computed tomography scan of the cervical spine was performed to detect the lesion. RESULT These radiographic features were correlated with the clinical findings. The computed tomography findings of bone destruction, prevertebral and extradural peripherally enhancing soft tissue and infiltrating opacities in the lung apexes were consistent with tuberculosis. CONCLUSIONS The computed tomography findings described in this report are very specific for tuberculosis of the craniovertebral junction. Clinical and radiologic correlation could help in making the early diagnosis and prompt treatment possible.
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Affiliation(s)
- Abhijit A Raut
- Department of Radiology, K.E.M. Hospital, Parel Mumbai, India.
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Lolge S, Maheshwari M, Shah J, Patkar D, Chawla A. Isolated solitary vertebral body tuberculosis--study of seven cases. Clin Radiol 2003; 58:545-50. [PMID: 12834638 DOI: 10.1016/s0009-9260(03)00120-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
AIM To describe the magnetic resonance imaging (MRI) findings in isolated solitary vertebral body tuberculosis. Also to emphasize tuberculosis as an important entity, besides neoplasms, in the differential diagnosis of pathologies involving a single vertebral body. MATERIAL AND METHODS The clinical and imaging features of seven patients (four men and three women; age range 18-60 years), with proved solitary vertebral body tuberculosis were retrospectively studied. RESULTS Isolated solitary vertebral body tuberculosis is seen in only 1.69% of the total proven cases of spine tuberculosis seen in our institute between 1993 and 2002. All patients presented with constitutional symptoms and localized pain and tenderness. MRI showed decreased signal intensity on T1-weighted images and increased signal intensity on T2-weighted images. Cortical break was seen in three patients of whom epidural and pre-vertebral extensions were seen in one each. CONCLUSIONS Although tuberculosis affecting a solitary vertebral body is rare it should be considered as an important differential diagnosis, besides neoplasms. In these cases MRI serves as the best imaging technique available for diagnosis. However, confirmation can only be made on histopathology or culture of the specimen.
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Affiliation(s)
- S Lolge
- Department of MRI, Dr Balabhai Nanavati Hospital and Research Center, Mumbai, India
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Kim SJ, Seok JW, Kim IJ, Kim YK, Kim DS. Multifocal Pott's disease (tuberculous spondylitis) incidentally detected on Tc-99m MDP bone and Ga-67 citrate scintigraphy in a patient with diabetes. Clin Nucl Med 2003; 28:286-9. [PMID: 12642705 DOI: 10.1097/01.rlu.0000057553.47611.fd] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Pott's disease is an uncommon extrapulmonary form of tuberculosis. Delay in diagnosis and management may cause serious complications. The authors describe Pott's disease incidentally detected on Tc-99m MDP bone and Ga-67 imaging in a patient with diabetes. Tc-99m MDP bone scintigraphy showed intensely increased uptake in the lower cervical spine and lumbosacral regions. Ga-67 scintigraphy revealed intensely increased uptake corresponding to the areas noted on Tc-99m MDP bone scintigraphy. Magnetic resonance imaging showed destructive lesions in the C5-C6 and L5-S1 intervertebral discs with destruction of adjacent end plates. Biopsy of the lumbosacral area was guided by computed tomography, and histologic examination of the bone specimen showed caseation, giant cells, and acid-fast bacilli. Posterior decompression and posterolateral spinal fusion with bone grafts were performed. Antituberculous chemotherapy with isoniazid, rifampicin, pyrazinamide, and ethambutol was started. The patient showed remarkable relief of symptoms during a period of 9 months of therapy. Both Tc-99m MDP bone and Ga-67 imaging can offer the convenience of screening the entire body to detect multiple sites of Pott's disease.
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Affiliation(s)
- Seong-Jang Kim
- Department of Nuclear Medicine, College of Medicine, Pusan National University, Korea
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Abstract
BACKGROUND CONTEXT Pott disease and tuberculosis have been with humans for countless millennia. Before the mid-twentieth century, the treatment of tuberculous spondylitis was primarily supportive and typically resulted in dismal neurological, functional and cosmetic outcomes. The contemporary development of effective antituberculous medications, imaging modalities, anesthesia, operative techniques and spinal instrumentation resulted in quantum improvements in the diagnosis, management and outcome of spinal tuberculosis. With the successful treatment of tuberculosis worldwide, interest in Pott disease has faded from the surgical forefront over the last 20 years. With the recent unchecked global pandemic of human immunodeficiency virus, the number of tuberculosis and secondary spondylitis cases is again increasing at an alarming rate. A surgical revisitation of Pott disease is thus essential to prepare spinal surgeons for this impending resurgence of tuberculosis. PURPOSE To revisit the numerous treatment modalities for Pott disease and their outcomes. From this information, a critical reappraisal of surgical nuances with regard to decision making, timing, operative approach, graft types and the use of instrumentation were conducted. STUDY DESIGN A concise review of the diagnosis, management and surgical treatment of Pott disease. METHODS A broad review of the literature was conducted with a particular focus on the different surgical treatment modalities for Pott disease and their outcomes regarding neurological deficit, kyphosis and spinal stability. RESULTS Whereas a variety of management schemes have been used for the debridement and reconstruction of tuberculous spondylitis, there has also been a spectrum of outcomes regarding neurological function and deformity. Medical treatment alone remains the cornerstone of therapy for the majority of Pott disease cases. Surgical intervention should be limited primarily to cases of severe or progressive deformity and/or neurological deficit. Based on the available evidence, radical ventral debridement and grafting appears to provide reproducibly good long-term neurological outcomes. Furthermore, recurrence of infection is lowest with such techniques. Posterior operative techniques are most effective in the reduction and prevention of spinal deformity. CONCLUSIONS Unlike historical times, effective medical and surgical management of tuberculous spondyitis is now possible. Proper selection of drug therapy and operative modalities, however, is needed to optimize functional outcomes for each individual case of Pott disease.
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Affiliation(s)
- Larry T Khoo
- Institute for Spine Care, Chicago Institute of Neurosurgery and Neuroresearch, Rush Presbyterian Medical Center, Chicago, IL 60614, USA
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Abstract
The clinical and imaging findings of patients with a confirmed diagnosis of tuberculous spondylitis were retrospectively analyzed to assess the diagnostic value of magnetic resonance imaging (MRI) and determine the different patterns of spine involvement. Fifty-three patients with plain radiographs and MRI of the entire spinal column were included in the study. Sagittal T1- and T2-weighted MRIs of the entire spine and axial T1- and T2-weighted MRIs at the levels of interest were retrospectively evaluated. Plain radiographic correlation was obtained in all patients. The lower thoracic and thoracolumbar spine was the most commonly involved region. Magnetic resonance imaging is effective in the early diagnosis of tuberculous spondylitis. It also detects lesions, which may not be apparent on plain radiographs.
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Affiliation(s)
- Senol Akman
- Sisli Etfal Teaching Hospital, Istanbul, Turkey
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Krishnan A, Patkar D, Patankar T, Shah J, Prasad S, Bunting T, Castillo M, Mukherji SK. Craniovertebral junction tuberculosis: a review of 29 cases. J Comput Assist Tomogr 2001; 25:171-6. [PMID: 11242209 DOI: 10.1097/00004728-200103000-00003] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE The purpose of this work was to describe the various imaging findings in craniovertebral tuberculosis and the importance of imaging in treatment in these patients. METHOD A retrospective review of MR and CT scans in 29 patients with craniovertebral tuberculosis was performed. The images were reviewed, paying special attention to both bony (skull base, atlas, and axis) and soft tissue involvement in addition to atlantoaxial dislocation, lateral subluxation of the dens, and compression of the spinal cord. RESULTS Suboccipital pain with neck stiffness was the most common presenting symptom in our patients. The skull was involved in 19 of the 29 cases, clivus involvement was seen in 11 patients, and occipital condyle involvement was present in 14 patients. Detailed analysis of atlas involvement due to tuberculosis showed the lateral masses to be predominantly affected. The dens was involved in 18 cases (62%). Soft tissue masses in the prevertebral area were seen in 22 patients, paravertebral in 27 patients, and epidural involvement in 25 patients was identified. Atlantoaxial displacement was present in seven cases, lateral mass-dens subluxation in five, and superior subluxation of the dens through the foramen magnum compressing the medulla was seen in two cases. Spinal cord compression with intrinsic cord changes was noted in 12 cases. All patients received multidrug antituberculous therapy for 1 year. The presence of neurologic deficit and instability of the atlantoaxial complex was pivotal in further management in these patients. CONCLUSION A high degree of clinical suspicion is necessary when confronted with patients with neck stiffness and tenderness over the upper cervical vertebrae. MRI in these patients provides a sensitive method for the diagnosis of craniovertebral tuberculosis.
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MESH Headings
- Abscess/complications
- Abscess/diagnosis
- Abscess/diagnostic imaging
- Adolescent
- Adult
- Aged
- Aged, 80 and over
- Axis, Cervical Vertebra/diagnostic imaging
- Axis, Cervical Vertebra/pathology
- Cervical Atlas/diagnostic imaging
- Cervical Atlas/pathology
- Child
- Child, Preschool
- Female
- Humans
- Infant
- Magnetic Resonance Imaging
- Male
- Middle Aged
- Neck/diagnostic imaging
- Neck/pathology
- Occipital Bone/diagnostic imaging
- Occipital Bone/pathology
- Retrospective Studies
- Spinal Cord Compression/complications
- Spinal Cord Compression/diagnosis
- Spinal Cord Compression/diagnostic imaging
- Tomography, X-Ray Computed
- Tuberculosis, Osteoarticular/complications
- Tuberculosis, Osteoarticular/diagnosis
- Tuberculosis, Osteoarticular/diagnostic imaging
- Tuberculosis, Spinal/complications
- Tuberculosis, Spinal/diagnosis
- Tuberculosis, Spinal/diagnostic imaging
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Affiliation(s)
- A Krishnan
- Department of Radiology, King Edward Memorial Hospital, Bombay, India
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Oostveen JC, van de Laar MA. Magnetic resonance imaging in rheumatic disorders of the spine and sacroiliac joints. Semin Arthritis Rheum 2000; 30:52-69. [PMID: 10966213 DOI: 10.1053/sarh.2000.8368] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To review the value of magnetic resonance imaging (MRI) in diagnosis and evaluation of rheumatic diseases of the spine and sacroiliac joints. METHODS A review of the literature on MRI of the spine and sacroiliac joints in rheumatoid arthritis (RA), ankylosing spondylitis (AS), infectious spondylodiscitis, infection of the sacroiliac joint (SIJ), gout, calcium pyrophosphate deposition disease, nontraumatic vertebral compression fractures, insufficiency fracture of the sacrum, avascular necrosis of the vertebral body, sarcoidosis, and Paget's disease was performed. The reports were obtained from a Medline search. RESULTS In RA, AS, and crystal deposition disease, synovial tissue, atlantoaxial and subaxial subluxations, crystal deposition, and neurologic compromise can be adequately diagnosed with MRI of the cervical spine. Studies on MRI of SIJs in AS indicate that MRI enables early diagnosis of sacroiliitis. In most cases of infectious spondylodiscitis, avascular necrosis of the vertebral body, nontraumatic vertebral compression fractures, and insufficiency fractures of the sacrum characteristic findings on MRI suggest the correct diagnosis. Moreover, soft tissue abnormalities and neurologic compromise can be visualized. In infection of the SIJ, MRI shows findings suggesting an inflammatory process. In Paget's disease, MRI does not provide additional information as compared with plain radiography (PR) or computed tomography (CT). CONCLUSION In evaluation of spinal and SIJ abnormalities in many rheumatic diseases, MRI, in addition to PR, can replace conventional tomography, CT, and myelography. Moreover, MRI can visualize soft tissue abnormalities and neurologic compromise without use of intrathecal contrast.
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Affiliation(s)
- J C Oostveen
- Department of Rheumatology, Medisch Spectrum Twente Enschede, The Netherlands
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Lee TC, Lu K, Yang LC, Huang HY, Liang CL. Transpedicular instrumentation as an adjunct in the treatment of thoracolumbar and lumbar spine tuberculosis with early stage bone destruction. J Neurosurg 1999; 91:163-9. [PMID: 10505499 DOI: 10.3171/spi.1999.91.2.0163] [Citation(s) in RCA: 43] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT Because modern imaging techniques now allow for early diagnosis of spinal tuberculosis, more conservative management options are possible. The authors evaluated the effectiveness of transpedicular instrumentation for treatment of thoracolumbar and lumbar spinal tuberculosis in patients with mild bone destruction and the main symptom of "instability catch" (a sudden painful "snap" that occurs when one extends from a forward bent to an upright position). METHODS Eighteen patients (nine men and nine women, age range 49-71 years) with spinal tuberculosis were treated with transpedicular instrumentation that was supplemented with posterolateral fusion and chemotherapy. All patients were wheelchair dependent or bed-ridden due to severe instability catch, with a mean symptom duration of 2.5 months (range 1-6 months). Two contiguous vertebrae were involved in 17 patients, and a single vertebrae was involved in one. In five patients mild neurological deficits (Frankel Grade D) were present. During surgery, the screws were implanted into the two nonaffected pedicles nearest the lesion to stabilize the involved segments. No attempt at radical debridement or neural decompression was undertaken. The follow-up period ranged from 21 to 40 months. Postoperatively the instability catch was relieved within 10 days (excellent outcome) and within 1 month (good outcome) in seven and eight patients, respectively, and within 3 months (fair outcome) in two; in the remaining patient, the symptom did not resolve (poor outcome). A short duration of symptoms (generally < 3 months) and bone destruction of less than 50% in the involved vertebral bodies were observed in patients who made a good or excellent outcome. During the follow-up period, good maintenance of spinal alignment, stabilization of the involved segment, and resolution of the inflammatory process were shown; however, there was no strong evidence that fusion had occurred at the bony defect. Patients in whom a fair outcome was achieved experienced a longer duration of symptoms, and in each, one vertebral body with greater than 50% bone destruction was demonstrated. However, good maintenance of spinal alignment was also shown during the follow-up period. The patient whose outcome was poor had the longest history (6 months) of symptoms and the most extensive involvement of the spine (> 50% destruction of two adjacent lumbar vertebral bodies). Postoperatively, implant failure occurred and the patient developed a wound infection. CONCLUSIONS Transpedicular instrumentation provides rapid relief of instability catch and prevents late angular deformity in patients with thoracolumbar and lumbar spinal tuberculosis in whom limited (< 50%) bone destruction of the involved vertebral bodies has been shown and whose main symptom is instability catch.
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Affiliation(s)
- T C Lee
- Department of Neurosurgery, Chang Gung Medical College, and Chang Gung Memorial Hospital, Kaohsiung, Taiwan
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Pertuiset E, Beaudreuil J, Lioté F, Horusitzky A, Kemiche F, Richette P, Clerc-Wyel D, Cerf-Payrastre I, Dorfmann H, Glowinski J, Crouzet J, Bardin T, Meyer O, Dryll A, Ziza JM, Kahn MF, Kuntz D. Spinal tuberculosis in adults. A study of 103 cases in a developed country, 1980-1994. Medicine (Baltimore) 1999; 78:309-20. [PMID: 10499072 DOI: 10.1097/00005792-199909000-00003] [Citation(s) in RCA: 219] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Spinal tuberculosis (TB) accounts for about 2% of all cases of TB. New methods of diagnosis such as magnetic resonance imaging (MRI) or percutaneous needle biopsy have emerged. Two distinct patterns of spinal TB can be identified, the classic form, called spondylodiscitis (SPD) in this article, and an increasingly common atypical form characterized by spondylitis without disk involvement (SPwD). We conducted a retrospective study of patients with spinal TB managed in the area of Paris, France, between 1980 and 1994 with the goal of defining the characteristics of spinal TB and comparing SPD to SPwD. The 103 consecutive patients included in our study had TB confirmed by bacteriologic and/or histologic studies of specimens from spinal or paraspinal lesions (93 patients) or from extraspinal skeletal lesions (10 patients). Sixty-eight percent of patients were foreign-born subjects from developing countries. None of our patients was HIV-positive. SPD accounted for 48% of cases and SPwD for 52%. Patients with SPwD were younger and more likely to be foreign-born and to have multiple skeletal TB lesions. Neurologic manifestations were observed in 50% of patients, with no differences between the SPD and SPwD groups. Of the 44 patients investigated by MRI, 6 had normal plain radiographs; MRI was consistently positive and demonstrated epidural involvement in 77% of cases. Bacteriologic and histologic yields were similar for surgical biopsy (n = 16) and for percutaneous needle aspiration and/or biopsy (n = 77). Cultures for Mycobacterium tuberculosis were positive in 83% of patients, and no strains were resistant to rifampin. Median duration of antituberculous chemotherapy was 14 months. Surgical treatment was performed in 24% of patients. There were 2 TB-related deaths. Our data suggest that SPwD may now be the most common pattern of spinal TB in foreign-born subjects in industrialized countries. The reasons for this remain to be elucidated.
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Affiliation(s)
- E Pertuiset
- Viggo Petersen Center, Lariboisière Teaching Hospital, Paris.
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Abstract
Computed tomography (CT) and magnetic resonance imaging (MRI) are becoming increasingly accessible in veterinary medicine. Because of their ability to image the bony spine and spinal cord noninvasively and with exceptional detail, these techniques have revolutionized the way spinal disorders are diagnosed in both people and animals. Although the veterinary literature on this topic is limited, interpretation of CT and MR images of the spine are facilitated by the similarity of human and animal disease processes. This article provides an overview of imaging strategies, normal anatomy, and the CT and MRI features of degenerative, infectious, neoplastic, and vascular diseases of the spine.
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Affiliation(s)
- W H Adams
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Tennessee, Knoxville 37901-1071, USA
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Toda K, Yasunaga Y, Takemoto S, Terada Y. MR image and CT scan of a tuberculous abscess in the gluteus maximus muscle. Comput Med Imaging Graph 1998; 22:425-7. [PMID: 9890189 DOI: 10.1016/s0895-6111(98)00046-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
A 77-year-old man had rapidly increased intramuscular tuberculous abscess in his left buttock. Radiographs showed a bone defect in the left ischium. Postcontrast CT scanning revealed marginal enhancement. MR imaging showed low signal intensity on T1-weighted images and high signal intensity on T2-weighted images. T1-weighted MR images with Gd-DTPA enhancement showed enhancement of the wall. Bone defect and marginal enhancement on postcontrast MR images and on postcontrast CT images are image character of the intramuscular tuberculous abscess.
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Affiliation(s)
- K Toda
- Department of Orthopedic Surgery, Miharashi Ishikai Hospital, Mihara, Japan
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Kraft SL, Mussman JM, Smith T, Biller DS, Hoskinson JJ. Magnetic resonance imaging of presumptive lumbosacral discospondylitis in a dog. Vet Radiol Ultrasound 1998; 39:9-13. [PMID: 9491511 DOI: 10.1111/j.1740-8261.1998.tb00318.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
A three-year-old male Boxer dog had hyperesthesia, symmetrical epaxial, gluteal and hind limb muscular atrophy and rear limb ataxia. Neurological deficits included decreased conscious proprioception of the left hind limb, decreased withdrawal and increased patellar reflexes of both hind limbs. The dog had a urinary tract infection with positive culture for Staphylococcus intermedius. On survey radiography of the lumbosacral spine there was active bone proliferation spanning the L7 S1 intervertebral disc space with an epidural filling defect at the ventral aspect of the vertebral canal on epidurography. On magnetic resonance imaging (MRI), findings were similar to those described for human diskospondylitis including altered signal intensity and nonuniform contrast enhancement of the L7-S1 intervertebral disc, adjacent vertebral end plates and epidural and sublumbar soft tissues. Although skeletal radiography is usually sufficient to reach a diagnosis of discospondylitis, MRI of this patient made it possible to reach a presumptive diagnosis of discospondylitis prior to development of definitive radiographic abnormalities.
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Affiliation(s)
- S L Kraft
- Department of Clinical Sciences, College of Veterinary Medicine, Kansas State University, Manhattan 66506, USA
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Abstract
STUDY DESIGN This case report describes a middle-aged woman with concomitant tuberculosis and pyogenic infection of the cervical spine. OBJECTIVE To describe an unusual case of concomitant tuberculosis and pyogenic infection of the cervical spine. SUMMARY OF BACKGROUND DATA Neither tuberculosis nor pyogenic spondylitis of the cervical spine is a common disorder. This case report describes a concomitant infection of C3-C4 in an otherwise healthy patient. To the authors' knowledge, such a case has never been reported. METHODS This 52-year-old woman had spontaneous neck pain and myelopathy. Radiologic examination revealed the presence of an epidural abscess with destruction of C3-C4 vertebral bodies. RESULTS Anterior decompression and fusion were performed, followed by therapy with antituberculosis drugs and antibiotics. The patient completely recovered. A follow-up radiograph revealed that solid fusion had been achieved. CONCLUSION A case of concomitant tuberculosis and pyogenic infection of the cervical spine is presented. The possibility of this differential diagnosis should be considered, especially in areas of endemic tuberculosis. Examination of biopsy samples for histologic and bacteriologic findings is important to confirm this diagnosis. Radical debridement and combination therapy are strongly recommended to treat patients with this combination of infections.
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Affiliation(s)
- W K Fu
- Department of Orthopaedics and Traumatology, Pamela Youde Nethersole Eastern Hospital, Chai Wan, Hong Kong
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Colmenero JD, Jiménez-Mejías ME, Sánchez-Lora FJ, Reguera JM, Palomino-Nicás J, Martos F, García de las Heras J, Pachón J. Pyogenic, tuberculous, and brucellar vertebral osteomyelitis: a descriptive and comparative study of 219 cases. Ann Rheum Dis 1997; 56:709-15. [PMID: 9496149 PMCID: PMC1752312 DOI: 10.1136/ard.56.12.709] [Citation(s) in RCA: 217] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVES To describe a large series of patients with vertebral osteomyelitis (VO), and to compare the clinical, biological, radiological, and prognostic features of pyogenic (PVO), tuberculous (TVO), and brucellar vertebral osteomyelitis (BVO). METHODS A retrospective multicentre study, which included 219 adult patients with VO with confirmed aetiology, who were diagnosed between 1983 and 1995 in two tertiary care centres. Of these patients, 105 (48%) had BVO, 72 (33%) PVO, and 42 (19%) TVO. RESULTS One hundred and forty eight (67.6%) patients were male and 71 (32.4%) female. The mean (SD) age was 50.4 (16.4) years (range 14-84) and the mean (SD) duration of symptoms before the diagnosis was 14 (16.8) weeks. In 127 patients (57.9%) the vertebral level involved was lumbar, in 70 (31.9%) thoracic, and in 16 (7.3%) cervical. One hundred and nineteen patients (54.4%) received only medical treatment and 100 (45.6%) required both medical and surgical treatment. The presence of diabetes mellitus, intravenous drug abuse, underlying chronic debilitating diseases or immunosuppression, previous infections, preceding bacteraemia, recent vertebral surgery, leucocytosis, neutrophilia, and increased erythrocyte sedimentation rate (ESR) were significantly associated to PVO. A prolonged clinical course, thoracic segment involvement, absence of fever, presence of spinal deformity, neurological deficit, and paravertebral or epidural masses, were significantly more frequent in the group of TVO. The need for surgical treatment and the presence of severe functional sequelae were more frequent in the groups of PVO and TVO. CONCLUSION There are significant clinical, biological, radiological, and prognostic differences between BVO, PVO, and TVO. These differences can point to the causal agent and orient the initial empirical medical treatment while awaiting a final microbiological diagnosis.
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Affiliation(s)
- J D Colmenero
- Unit of Infectious Diseases, University Regional Hospital Carlos Haya, Málaga, Spain
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