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Venugopal Menon K, Basu S, Oka G, Gohil K. Delphi-Based Survey for Surgical Indications in Biopsy Proven Active Adult Spinal Tuberculosis. Global Spine J 2025; 15:668-678. [PMID: 37776140 PMCID: PMC11877587 DOI: 10.1177/21925682231204157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/01/2023] Open
Abstract
STUDY DESIGN Delphi survey. OBJECTIVES To obtain an expert consensus on various dilemmas in the surgical treatment of adult spinal tuberculosis (TB) patients. METHODS Stage I included a literature review, stage II the identification of 40 Key Opinion leaders (KOLs) and a set of 46 questions, stage III included analysis of 3 rounds of the Delphi survey, and stage IV had final analysis and recommendations. For each question, the level of agreement needed to reach a consensus was set at greater than or equal to 70.0%. RESULTS The first and second Delphi survey rounds received 62 and 58 responses, respectively, with 16 questions having more than 70% and two questions having 100% agreement in the first stage. The second stage saw a 70% agreement on six questions. Thus, a consensus was obtained on 22 questions. The recommendations that emerged were as follows: neurodeficit with corresponding radiology and neurological deficit appearing/deteriorating while on anti-tubercular chemotherapy(ATT) are absolute indications for surgery, duration of ATT before neurological deterioration need not be considered, epidural abscess does not need decompression unless concordant clinical neurological findings are present, pain not responding to medical management is not a surgical indication, active pulmonary TB, drug-resistant TB, and tubercular sacroiliitis are not considered as surgical indications, and hemoglobin and other health markers have little contribution to surgical indications. CONCLUSION In order to resolve several conundrums in the surgical treatment of adult spinal TB, this Delphi survey is the first to achieve a national consensus from spine experts. The final recommendations cover the serological, radiographic, and clinical aspects of spinal TB.
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Affiliation(s)
- K. Venugopal Menon
- Department of Orthopedics, Bharati Vidyapeeth Medical College Hospital, Pune, India
| | - Saumyajit Basu
- Head of Department of Spine Surgery, Kothari Medical Centre, Kolkata, India
| | - Gauri Oka
- Research Consultant, Central Research and Publication Unit, Bharati Vidyapeeth Medical College and Hospital, Pune, India
| | - Kushal Gohil
- Department of Orthopedics, Grant Government Medical College and Sir JJ Group of Hospitals, Mumbai, India
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Yang X, Tian N, Zhang Y, Gao C, Hao D, Li J, Zhou C, Cui J. Deep learning radiomics model based on contrast-enhanced MRI for distinguishing between tuberculous spondylitis and pyogenic spondylitis. 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 2025:10.1007/s00586-025-08696-1. [PMID: 39920318 DOI: 10.1007/s00586-025-08696-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/30/2024] [Revised: 11/23/2024] [Accepted: 01/26/2025] [Indexed: 02/09/2025]
Abstract
PURPOSE This study aimed to develop and validate a deep learning radiomics nomogram (DLRN) to differentiate between tuberculous spondylitis (TS) and pyogenic spondylitis (PS) using contrast-enhanced MRI (CE-MRI). METHODS A retrospective approach was employed, enrolling patients diagnosed with TS or PS based on pathological examination at two centers. Clinical features were evaluated to establish a clinical model. Radiomics and deep learning (DL) features were extracted from contrast-enhanced T1-weighted images and subsequently fused. Following feature selection, radiomics, DL, combined DL-radiomics (DLR), and a deep learning radiomics nomogram (DLRN) were developed to differentiate TS from PS. Performance was assessed using metrics including the area under the curve (AUC), calibration curves, and decision curve analysis (DCA). RESULTS A total of 147 patients met the study criteria. Center 1 comprised the training cohort with 102 patients (52 TS and 50 PS), while Center 2 served as the external test cohort with 45 patients (17 TS and 28 PS). The DLRN model exhibited the highest diagnostic accuracy, achieving an AUC of 0.994 (95% CI: 0.983-1.000) in the training cohort and 0.859 (95% CI: 0.744-0.975) in the external test cohort. Calibration curves indicated good agreement for DLRN, and decision curve analysis (DCA) demonstrated it provided the greatest clinical benefit. CONCLUSION The CE-MRI-based DLRN showed robust diagnostic capability for distinguishing between TS and PS in clinical practice.
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Affiliation(s)
- Xiaonan Yang
- Department of Radiology, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, 266000, China
| | - Na Tian
- Department of Endocrinology and Metabolism, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, 266000, China
| | - Yuzhu Zhang
- Department of Abdominal Ultrasound, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, 266000, China
| | - Chuanping Gao
- Department of Radiology, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, 266000, China
| | - Dapeng Hao
- Department of Radiology, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, 266000, China
| | - Jie Li
- Department of Radiology, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, 266000, China
| | - Chuanli Zhou
- Minimally Invasive Spinal Surgery Center, The Affiliated Hospital of Qingdao University, Qingdao, 266000, Shandong, China
| | - Jiufa Cui
- Department of Radiology, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, 266000, China.
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Zou X, Li X, He K, Song Q, Yin R. Current knowledge of vertebral osteomyelitis: a review. Eur J Clin Microbiol Infect Dis 2025; 44:213-231. [PMID: 39589654 DOI: 10.1007/s10096-024-04983-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2024] [Accepted: 10/31/2024] [Indexed: 11/27/2024]
Abstract
PURPOSE As life expectancy increases worldwide, the elderly population in every country is growing in both the size and proportion. This review aims to provide a comprehensive overview of the microbiology, clinical presentation, diagnostic strategies, and therapeutic approaches to vertebral osteomyelitis, summarizing the latest evidence to guide effective treatment. METHODS A comprehensive literature search was conducted using the Medline and Embase databases to identify relevant studies on vertebral osteomyelitis. The search included the following keywords: "vertebral osteomyelitis," "spinal infection," "discitis," "spondylitis," " spondylodiscitis," and "spinal epidural abscess." Both retrospective and prospective studies, case series, and reviews were considered. RESULTS This condition is commonly caused by bacteria such as Staphylococcus aureus or gram-negative bacilli, but can also be caused by other pathogens like fungi and parasites. The onset of vertebral osteomyelitis is insidious, with low specificity in clinical manifestations, often making early diagnosis difficult. Delayed or inadequate treatment may lead to sepsis, permanent neurological damage, or even death. Treatment strategies emphasize the importance of identifying the causative pathogen to guide effective antimicrobial therapy. Current consensus does not advocate for empirical antibiotic treatment unless patients exhibit signs of neurological impairment or severe sepsis. Severe cases involving neurological paralysis, spinal instability, or sepsis may require surgical intervention. CONCLUSION Vertebral osteomyelitis requires prompt diagnosis and treatment for a good prognosis. Delayed diagnosis and treatment can lead to permanent neurological deficits or death. Identifying the causative organism is crucial for guiding appropriate antimicrobial therapy. In addition to conservative and surgical treatments, local drug delivery systems offer new approaches to managing spinal osteomyelitis.
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Affiliation(s)
- Xuanying Zou
- Department of Orthopedic Surgery, China-Japan Union Hospital, Jilin University, Jilin, 130033, China
| | - Xiaoyan Li
- Infection Control Department, Hospital of Stomatology, Jilin University, Jilin, 130033, China
| | - Kang He
- Rehabilitation Medicine Center and Institute of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Qiang Song
- Department of Orthopedic Surgery, China-Japan Union Hospital, Jilin University, Jilin, 130033, China
| | - Ruofeng Yin
- Department of Orthopedic Surgery, China-Japan Union Hospital, Jilin University, Jilin, 130033, China.
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Qiao YJ, Song XY, Zhang LD, Li F, Zhang HQ, Zhou SH. Comparative study of a rabbit model of spinal tuberculosis using different concentrations of Mycobacterium tuberculosis. World J Orthop 2025; 16:101424. [PMID: 39850038 PMCID: PMC11752485 DOI: 10.5312/wjo.v16.i1.101424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2024] [Revised: 11/03/2024] [Accepted: 12/19/2024] [Indexed: 01/13/2025] Open
Abstract
BACKGROUND Tuberculosis is among the most devastating infectious diseases worldwide. Spinal tuberculosis is not easy to detect at an early stage, which without effective treatment often leads to spinal deformity and spinal cord damage which in turn cause complications such as paraplegia and quadriplegia. In this study, we established a model using three concentrations of bacteria and carried out a comprehensive evaluation of the model by imaging, general observations, and histopathological and bacteriological studies. AIM To establish a rabbit model of spinal tuberculosis and examine the effect on the model's efficacy using different concentrations of Mycobacterium tuberculosis (M. tuberculosis) inoculum. METHODS New Zealand rabbits were randomly divided into experimental, control and blank groups. The experimental and control animals were sensitized with complete Freund's adjuvant, a hole was drilled beneath the upper endplate of the L6 vertebral body and filled with gelfoam sponge. The experimental group was divided into three subgroups (experimental 1, experimental 2, experimental 3) and infused with M. tuberculosis suspension at various concentrations. The control group was inoculated with saline and the blank group received no treatment. The 12-week post-operative survival rates were 100%, 80% and 30% in the experimental groups inoculated with concentrations of 106, 107 and 108 CFU/mL bacteria, respectively. RESULTS The survival rate of the control and blank groups was 100%. Vertebral body destruction at 8 weeks in the three experimental groups as determined by X-ray analysis was 33.3%, 62.5% and 66.7%, and by computed tomography (CT) and 3-dimensional CT 44.4%, 75% and 100%, respectively. At 12 weeks, the figures were 44.4%, 75% and 100% by X-ray analysis and 44.4%, 100% and 100% by CT and 3-dimensional CT, respectively. All surviving rabbits of the experimental groups had vertebral destruction. The positive bacterial culture rates were 22.2%, 75% and 66.7%, respectively, in the experimental groups. After being sensitized with complete Freund's adjuvant, large differences were observed in the extent of spinal tuberculosis after inoculation of the rabbits with different concentrations of H37RV standard M. tuberculosis. CONCLUSION The experimental 1 had a low success rate at establishing an infection. The experimental 3 resulted in high mortality and complication rates. The experimental 2 was optimum for establishing a spinal tuberculosis model based on the high level of symptoms observed and the low rabbit mortality.
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Affiliation(s)
- Yong-Jie Qiao
- Department of Joint Surgery, The Second Hospital & Clinical Medical School, Lanzhou University, Lanzhou 730050, Gansu Province, China
- Department of Orthopedics, The 940th Hospital of Joint Logistic Support Force of Chinese People’s Liberation Army, Lanzhou 730000, Gansu Province, China
| | - Xiao-Yang Song
- Department of Orthopedics, The 940th Hospital of Joint Logistic Support Force of Chinese People’s Liberation Army, Lanzhou 730000, Gansu Province, China
| | - Lv-Dan Zhang
- Department of Respiratory Medicine, The 940th Hospital of Joint Logistic Support Force of Chinese People’s Liberation Army, Lanzhou 730050, Gansu Province, China
| | - Feng Li
- Department of Orthopaedics, The 943rd Hospital of Joint Logistic Support Force of Chinese People’s Liberation Army, Wuwei 733099, Gansu Province, China
| | - Hao-Qiang Zhang
- Department of Orthopedics, The 940th Hospital of Joint Logistic Support Force of Chinese People’s Liberation Army, Lanzhou 730000, Gansu Province, China
| | - Sheng-Hu Zhou
- Department of Orthopedics, The 940th Hospital of Joint Logistic Support Force of Chinese People’s Liberation Army, Lanzhou 730000, Gansu Province, China
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Hu X, Xu D, Zhang H, Tang M, Gao Q. Comparative diagnostic accuracy of ChatGPT-4 and machine learning in differentiating spinal tuberculosis and spinal tumors. Spine J 2025:S1529-9430(25)00015-4. [PMID: 39805470 DOI: 10.1016/j.spinee.2024.12.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2024] [Revised: 12/02/2024] [Accepted: 12/30/2024] [Indexed: 01/16/2025]
Abstract
BACKGROUND In clinical practice, distinguishing between spinal tuberculosis (STB) and spinal tumors (ST) poses a significant diagnostic challenge. The application of AI-driven large language models (LLMs) shows great potential for improving the accuracy of this differential diagnosis. PURPOSE To evaluate the performance of various machine learning models and ChatGPT-4 in distinguishing between STB and ST. STUDY DESIGN A retrospective cohort study. PATIENT SAMPLE 143 STB cases and 153 ST cases admitted to Xiangya Hospital Central South University, from January 2016 to June 2023 were collected. OUTCOME MEASURES This study incorporates basic patient information, standard laboratory results, serum tumor markers, and comprehensive imaging records, including Magnetic Resonance Imaging (MRI) and Computed Tomography (CT), for individuals diagnosed with STB and ST. Machine learning techniques and ChatGPT-4 were utilized to distinguish between STB and ST separately. METHOD Six distinct machine learning models, along with ChatGPT-4, were employed to evaluate their differential diagnostic effectiveness. RESULT Among the 6 machine learning models, the Gradient Boosting Machine (GBM) algorithm model demonstrated the highest differential diagnostic efficiency. In the training cohort, the GBM model achieved a sensitivity of 98.84% and a specificity of 100.00% in distinguishing STB from ST. In the testing cohort, its sensitivity was 98.25%, and specificity was 91.80%. ChatGPT-4 exhibited a sensitivity of 70.37% and a specificity of 90.65% for differential diagnosis. In single-question cases, ChatGPT-4's sensitivity and specificity were 71.67% and 92.55%, respectively, while in re-questioning cases, they were 44.44% and 76.92%. CONCLUSION The GBM model demonstrates significant value in the differential diagnosis of STB and ST, whereas the diagnostic performance of ChatGPT-4 remains suboptimal.
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Affiliation(s)
- Xiaojiang Hu
- Department of Spine Surgery and Orthopaedics, Xiangya Hospital, Central South University, Changsha 410008, China; Department of Orthopedics, The Second Xiangya Hospital of Central South University, Changsha, 410011, Hunan, China
| | - Dongcheng Xu
- Department of Spine Surgery and Orthopaedics, Xiangya Hospital, Central South University, Changsha 410008, China; Department of Spine Surgery, The Third Xiangya Hospital, Central South University, Changsha, Hunan, 410013, China
| | - Hongqi Zhang
- Department of Spine Surgery and Orthopaedics, Xiangya Hospital, Central South University, Changsha 410008, China; National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha 410008, China
| | - Mingxing Tang
- Department of Spine Surgery and Orthopaedics, Xiangya Hospital, Central South University, Changsha 410008, China; National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha 410008, China.
| | - Qile Gao
- Department of Spine Surgery and Orthopaedics, Xiangya Hospital, Central South University, Changsha 410008, China; National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha 410008, China.
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Kalanjiyam GP, Ramachandran K, Rajasekaran S, Shetty AP, Kanna RM. Surgical Correction of Thoracic and Thoracolumbar TB Kyphosis by Posterior Only Approach Using Rajasekaran's Kyphosis Classification. Global Spine J 2024:21925682241310828. [PMID: 39713926 DOI: 10.1177/21925682241310828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2024] Open
Abstract
STUDY DESIGN Prospective analysis of retrospective data. OBJECTIVES To analyse the clinical and radiological outcomes of thoracic and thoracolumbar TB kyphosis by a posterior-only approach using kyphosis classification. METHODS Patients with thoracic and thoracolumbar spinal TB who underwent posterior-only surgical correction for kyphotic deformity >30° were categorized into Group: A (Active TB) and Group B (Healed TB). Demographic, clinical and radiological data were collected, and kyphotic deformity was classified according to Rajasekaran classification. RESULTS 52 patients with a minimum 2-year follow-up were included. Group A included 25 patients with mean preop kyphosis of 39.5° (31.2°-53.7°), and Group B included 27 patients with mean preop kyphosis of 85° (44.2°-125.2°). Among 25 patients in Group A, 19 were Type IIIA, and 6 were Type IIA kyphosis. In Group B, 18 patients were Type IIIB, 5 were Type III C, 3 were Type IIA, and 1 was IIIA kyphosis. All patients in group A underwent posterior column shortening by Smith-Peterson Osteotomy, with 14 patients requiring additional anterior column reconstruction. Patients in Group B required Closing-Opening Wedge Osteotomy (18), Halo followed by vertebral column resection (6), disc bone osteotomy (2) and pedicle subtraction osteotomy (1). Mean kyphosis at 2 years follow-up was 20.8° (11.2°-32.8°) in Group A and 53.5° (8.1°- 96.4°) in Group B. CONCLUSIONS Correction of kyphosis in spinal TB involves completely different strategies in active and healed disease. Hence, a posterior-only treatment approach using Rajasekaran's kyphosis classification can help surgeons in appropriate decision-making.
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Gan J, Zhang C, Tang D, Du X. Surgical treatment of spinal tuberculosis: an updated review. Eur J Med Res 2024; 29:588. [PMID: 39695719 DOI: 10.1186/s40001-024-02198-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2024] [Accepted: 12/04/2024] [Indexed: 12/20/2024] Open
Abstract
Tuberculosis (TB) is a worldwide disease which seriously affects the global public health. Spinal TB is the most common extra-pulmonary TB and may cause vertebral bone destruction, collapse, kyphosis and even paralysis. Anti-TB chemotherapy is considered the cornerstone treatment of spinal TB and surgery is often required for patients with severe kyphosis, impaired neurological function or spinal instability. Debridement of TB lesions, bone grafting and internal fixation are the key procedures of spinal TB surgery. However, the selection of surgical approach, the extent of TB lesion debridement, the choice of bone graft materials, and the method and extent of internal fixation are all remain controversy. The aim of this updated review is to evaluate current literature for advances in management of spinal TB, with particular focus on surgical techniques.
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Affiliation(s)
- Jinjing Gan
- Department of Orthopedics, Chongqing Traditional Chinese Medicine Hospital, Chongqing, 400021, China
| | - Chuanzhi Zhang
- Department of Orthopedics, Chongqing Traditional Chinese Medicine Hospital, Chongqing, 400021, China
| | - Dagang Tang
- Department of Orthopedic Surgery, The First Affiliated Hospital of Chongqing Medical University, No.1 YouYi Road, Yuanjiagang, Yu Zhong District, Chongqing, 400016, China
- Chongqing Municipal Health Commission Key Laboratory of Musculoskeletal Regeneration and Translational Medicine, Chongqing, 400016, China
- Orthopaedic Research Laboratory of Chongqing Medical University, Chongqing, 400016, China
| | - Xing Du
- Department of Orthopedic Surgery, The First Affiliated Hospital of Chongqing Medical University, No.1 YouYi Road, Yuanjiagang, Yu Zhong District, Chongqing, 400016, China.
- Chongqing Municipal Health Commission Key Laboratory of Musculoskeletal Regeneration and Translational Medicine, Chongqing, 400016, China.
- Orthopaedic Research Laboratory of Chongqing Medical University, Chongqing, 400016, China.
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Lei S, Zhou J, Guo L, Guan X, Zhang M, Yue H, Kang X. Debridement and bone graft fusion via the lateral extracavitary approach combined with lateral and posterior screw-rod fixation in the treatment of thoracic spinal tuberculosis: A retrospective study of 38 cases. Heliyon 2024; 10:e39435. [PMID: 39698076 PMCID: PMC11652835 DOI: 10.1016/j.heliyon.2024.e39435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Revised: 09/28/2024] [Accepted: 10/14/2024] [Indexed: 12/20/2024] Open
Abstract
Objectives Thoracic spinal tuberculosis (TB) is still common, and surgical treatment can rapidly relieve pain, correct deformity, reduce bone loss and prevent further damage to neurological function. We have practiced an efficient and safe surgical method. Methods From January 2013 to April 2021, 38 patients with thoracic spinal TB were included in our study. Debridement and bone grafting were performed via the lateral extracavitary approach, combined with two different fixation methods. Data from these cases were analyzed retrospectively. Results For all cases, the C-reactive protein (CRP) level and erythrocyte sedimentation rate (ESR) of all the patients decreased to normal levels at the last follow-up. The average visual analog scale (VAS) score was 7.5 ± 1.6 preoperatively and 0.6 ± 0.8 at the last follow-up, showing a significant reduction. The average angle of kyphosis correction was 6.3 ± 4.7°, and the loss of correction was 1.4 ± 1.6°. Neurological function was significantly improved in all cases according to the American Spinal Injury Association (ASIA) classification. Solid fusion was observed in all cases at the last follow-up. Conclusions Debridement and bone graft fusion via the lateral extracavitary approach combined with two fixation methods can be very effective in the treatment of thoracic spinal TB.
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Affiliation(s)
- Shuanhu Lei
- Department of Orthopedics, The Second Hospital of Lanzhou University, Lanzhou, 730030, China
- Orthopaedics Key Laboratory of Gansu Province, The Second Hospital of Lanzhou University, Lanzhou, 730030, China
| | - Jianwei Zhou
- Department of Orthopedics, The Second Hospital of Lanzhou University, Lanzhou, 730030, China
- Orthopaedics Key Laboratory of Gansu Province, The Second Hospital of Lanzhou University, Lanzhou, 730030, China
| | - Li Guo
- Gansu Provincial Maternal and Child Health Care Hospital, Lanzhou, 730050, China
| | - Xiaoli Guan
- Department of Orthopedics, The Second Hospital of Lanzhou University, Lanzhou, 730030, China
- Orthopaedics Key Laboratory of Gansu Province, The Second Hospital of Lanzhou University, Lanzhou, 730030, China
| | - Mingtao Zhang
- Department of Orthopedics, The Second Hospital of Lanzhou University, Lanzhou, 730030, China
- Orthopaedics Key Laboratory of Gansu Province, The Second Hospital of Lanzhou University, Lanzhou, 730030, China
| | - Haiyuan Yue
- Department of Orthopedics, The Second Hospital of Lanzhou University, Lanzhou, 730030, China
- Orthopaedics Key Laboratory of Gansu Province, The Second Hospital of Lanzhou University, Lanzhou, 730030, China
| | - Xuewen Kang
- Department of Orthopedics, The Second Hospital of Lanzhou University, Lanzhou, 730030, China
- Orthopaedics Key Laboratory of Gansu Province, The Second Hospital of Lanzhou University, Lanzhou, 730030, China
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Greenwald MA, Edwards N, Eastlund DT, Gurevich I, Ho APZ, Khalife G, Lin-Torre J, Thompson HW, Wilkins RM, Alrabaa SF. The American Association of Tissue Banks tissue donor screening for Mycobacterium tuberculosis-Recommended criteria and literature review. Transpl Infect Dis 2024; 26 Suppl 1:e14294. [PMID: 38852068 DOI: 10.1111/tid.14294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Revised: 04/12/2024] [Accepted: 04/25/2024] [Indexed: 06/10/2024]
Abstract
After two multistate outbreaks of allograft tissue-transmitted tuberculosis (TB) due to viable bone, evidence-based donor screening criteria were developed to decrease the risk of transmission to recipients. Exclusionary criteria, commentary, and references supporting the criteria are provided, based on literature search and expert opinion. Both exposure and reactivation risk factors were considered, either for absolute exclusion or for exclusion in combination with multiple risk factors. A criteria subset was devised for tissues containing viable cells. Risk factors for consideration included exposure (e.g., geographic birth and residence, travel, homelessness, incarceration, healthcare, and workplace) and reactivation (e.g., kidney disease, liver disease, history of transplantation, immunosuppressive medications, and age). Additional donor considerations include the possibility of sepsis and chronic illness. Donor screening criteria represent minimal criteria for exclusion and do not completely exclude all possible donor TB risks. Additional measures to reduce transmission risk, such as donor and product testing, are discussed but not included in the recommendations. Careful donor evaluation is critical to tissue safety.
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Affiliation(s)
- Melissa A Greenwald
- American Association of Tissue Banks, McLean, Virginia, USA
- Uniformed Services University, Bethesda, Maryland, USA
- Donor Alliance, Denver, Colorado, USA
| | | | | | | | | | - Ghada Khalife
- Solvita, Dayton, Ohio, USA
- Wright State University, Dayton, Ohio, USA
| | - Janet Lin-Torre
- MTF Biologics, Edison, New Jersey, USA
- Department of Medicine, Cooperman Barnabas Medical Center, Livingston, New Jersey, USA
| | | | | | - Sally F Alrabaa
- University of South Florida, Morsani College of Medicine, Tampa, Florida, USA
- LifeLink Tissue Bank, Tampa, Florida, USA
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Li Q, Li M, Wang S, Geater AF, Dai J. Clinical Diagnostic Challenge in a Case of Disseminated Talaromyces marneffei Infection Misdiagnosed Initially as Pulmonary Tuberculosis: A Case Report and Literature Review. Infect Drug Resist 2024; 17:3751-3757. [PMID: 39224904 PMCID: PMC11368141 DOI: 10.2147/idr.s471938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2024] [Accepted: 08/19/2024] [Indexed: 09/04/2024] Open
Abstract
This case reports a middle-aged male patient who was HIV-negative and initially misdiagnosed as pulmonary tuberculosis but was eventually diagnosed with disseminated Talaromyces marneffei (T. marneffei) infection by next-generation sequencing. The patient presented with respiratory symptoms, recurrent bone pain, and subcutaneous masses as the main symptoms. After one year of antifungal treatment, the symptoms improved obviously, but the symptoms recurred after two weeks of drug withdrawal, and the symptoms were relieved after re-administration of antifungal drugs again. This report highlights the need for the rapid evaluation of fungal infections with metagenomic next-generation sequencing (mNGS) in patients with an inadequate diagnostic basis for tuberculosis infection or a poor response to antituberculosis drugs. In addition, long-term follow-up is needed to observe disease recurrence in patients with disseminated T. marneffei infection.
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Affiliation(s)
- Qiujing Li
- Department of Public Laboratory, The Third People’s Hospital of Kunming City, Infectious Disease Clinical Medical Center of Yunnan Province, Kunming, Yunnan, People’s Republic of China
| | - Mingwu Li
- Department of Tuberculosis, The Third People’s Hospital of Kunming City, Infectious Disease Clinical Medical Center of Yunnan Province, Kunming, Yunnan, People’s Republic of China
| | - Shuxian Wang
- Department of Tuberculosis, The Third People’s Hospital of Kunming City, Infectious Disease Clinical Medical Center of Yunnan Province, Kunming, Yunnan, People’s Republic of China
| | - Alan F Geater
- Department of Epidemiology, Faculty of Medicine, Prince of Songkla University, HatYai, Songkhla, Thailand
| | - Jingyi Dai
- Department of Public Laboratory, The Third People’s Hospital of Kunming City, Infectious Disease Clinical Medical Center of Yunnan Province, Kunming, Yunnan, People’s Republic of China
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Chen J, Liu Y, Huang S, Pang Z, Wei Q, Liu Y, Qin H, Chen Y. Spinal Infections? mNGS Combined with Microculture and Pathology for Answers. Infect Drug Resist 2024; 17:3025-3034. [PMID: 39050835 PMCID: PMC11268561 DOI: 10.2147/idr.s466738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2024] [Accepted: 07/05/2024] [Indexed: 07/27/2024] Open
Abstract
Introduction This study evaluates the efficacy of metagenomic next-generation sequencing (mNGS) in diagnosing spinal infections and developing therapeutic regimens that combine mNGS, microbiological cultures, and pathological investigations. Methods Data were collected from 108 patients with suspected spinal infections between January 2022 and December 2023. Lesion tissues were obtained via C-arm assisted puncture or open surgery for mNGS, conventional microbiological culture, and pathological analysis. Personalized antimicrobial therapies were tailored based on these findings, with follow-up evaluations 7 days postoperatively. The sensitivity and specificity of mNGS were assessed, along with its impact on treatment and prognosis. Results mNGS showed a significantly higher positive detection rate (61.20%) compared to conventional microbiological culture (30.80%) and PCT (28%). mNGS demonstrated greater sensitivity (79.41%) and negative predictive value (63.16%) than cultures (25% and 22.58%, respectively), with no significant difference in specificity and positive predictive value. Seven days post-surgery, a significant reduction in neutrophil percentage (NEUT%) was observed, though decreases in white blood cell count (WBC), erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP) were not statistically significant. At the last follow-up, significant improved in Visual Analogue Scale (VAS) scores, Oswestry Disability Index (ODI), and Japanese Orthopaedic Association (JOA) scores were noted. Conclusion mNGS outperforms traditional microbiological culture in pathogen detection, especially for rare and critical pathogens. Treatment protocols combining mNGS, microbiological cultures, and pathological examinations are effective and provide valuable clinical insights for treating spinal infections.
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Affiliation(s)
- Jiayi Chen
- Department of Spinal Orthopedics, The Second Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, People’s Republic of China
| | - Yonghong Liu
- Department of Preventive Health Care, The Second Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, People’s Republic of China
| | - Shengsheng Huang
- Department of Spinal Orthopedics, The Second Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, People’s Republic of China
| | - Zixiang Pang
- Department of Spinal Orthopedics, The Second Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, People’s Republic of China
| | - Qian Wei
- Department of Spinal Orthopedics, The Second Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, People’s Republic of China
| | - Yuzhen Liu
- Department of Spinal Orthopedics, The Second Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, People’s Republic of China
| | - Hongyuan Qin
- Department of Spinal Orthopedics, The Second Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, People’s Republic of China
| | - Yuanming Chen
- Department of Spinal Orthopedics, The Second Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, People’s Republic of China
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12
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Xiao ST, Zhang HQ, Wang YX. Isolated neural arch tuberculosis with tuberculomas: case report. Skeletal Radiol 2024; 53:1417-1421. [PMID: 37712982 DOI: 10.1007/s00256-023-04450-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 08/12/2023] [Accepted: 08/26/2023] [Indexed: 09/16/2023]
Abstract
We reported a case of atypical spinal tuberculosis on the posterior elements of lumbar spine in a 52-year-old female. It was easy to be misdiagnosed as spinal tumor due to its imaging characteristics. We performed puncture biopsy to initially consider tuberculosis, and then the patient was accepted surgical treatment. The intraoperative removed specimen was sent to pathological examination, microbial culture, Xpert MTB/RIF and metagenomic next-generation sequencing (mNGS) and then the diagnosis of neural arch tuberculosis was confirmed. After operation, the patient obtained stable effect by anti-tuberculosis drug treatment. In a word, the uncommon case had an important reference significance for the diagnosis of atypical spine tuberculosis and differentiation from spinal tumors. It is critical to make right preliminary diagnosis by appropriate examination as it determined the next diagnosis and treatment in special and rare clinical cases.
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Affiliation(s)
- Shun-Tian Xiao
- Department of Spine Surgery and Orthopaedics, Xiangya Spinal Surgery Center, Xiangya Hospital of Central South University, Xiang Ya Road 87, Changsha, 410008, Hunan Province, China
- National Clinical Research Center for Geriatric Disorder, Xiangya Hospital of Central South University, Changsha, 410008, Hunan Province, China
| | - Hong-Qi Zhang
- Department of Spine Surgery and Orthopaedics, Xiangya Spinal Surgery Center, Xiangya Hospital of Central South University, Xiang Ya Road 87, Changsha, 410008, Hunan Province, China
- National Clinical Research Center for Geriatric Disorder, Xiangya Hospital of Central South University, Changsha, 410008, Hunan Province, China
| | - Yu-Xiang Wang
- Department of Spine Surgery and Orthopaedics, Xiangya Spinal Surgery Center, Xiangya Hospital of Central South University, Xiang Ya Road 87, Changsha, 410008, Hunan Province, China.
- National Clinical Research Center for Geriatric Disorder, Xiangya Hospital of Central South University, Changsha, 410008, Hunan Province, China.
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13
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Lv H, Liao S, Shi Z, Guo Y, Zhou J, Chen H, Luo F, Xu J, Zhang Z, Zhang Z. Application of metagenomic next-generation sequencing for rapid molecular identification in spinal infection diagnosis. Front Cell Infect Microbiol 2024; 14:1382635. [PMID: 39011516 PMCID: PMC11247381 DOI: 10.3389/fcimb.2024.1382635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Accepted: 06/10/2024] [Indexed: 07/17/2024] Open
Abstract
Objective This study aimed to determine the sensitivity and specificity of metagenomic next-generation sequencing (mNGS) for detecting pathogens in spinal infections and to identify the differences in the diagnostic performance between mNGS and targeted next-generation sequencing (tNGS). Methods A total of 76 consecutive patients with suspected spinal infections who underwent mNGS, culture, and histopathological examinations were retrospectively studied. The final diagnosis of the patient was determined by combining the clinical treatment results, pathological examinations, imaging changes and laboratory indicators. The sensitivity and specificity of mNGS and culture were determined. Results The difference between the two detection rates was statistically significant (p < 0.001), with mNGS exhibiting a significantly higher detection rate (77.6% versus 18.4%). The average diagnosis time of mNGS was significantly shorter than that of bacterial culture (p < 0.001, 1.65 versus 3.07 days). The sensitivity and accuracy of mNGS were significantly higher than that of the culture group (p < 0.001, 82.3% versus 17.5%; 75% versus 27.6%), whereas the specificity of mNGS (42.9%) was lower than that of the culture group (p > 0.05, 42.9% versus 76.9%). The sensitivity, specificity, accuracy, and positive predictive value (PPV) of pus were higher than those of tissue samples for mNGS, whereas for culture, the sensitivity, specificity, accuracy, and PPV of tissue samples were higher than those of pus. tNGS demonstrated higher sensitivity and accuracy in diagnosing tuberculosis (TB) than mNGS (80% versus 50%; 87.5% versus 68.8%). Conclusion mNGS for spinal infection demonstrated better diagnostic value in developing an antibiotic regimen earlier, and it is recommended to prioritize pus samples for testing through mNGS. Moreover, tNGS outperformed other methods for diagnosing spinal TB and identifying antibiotic-resistance genes in drug-resistant TB.
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Affiliation(s)
- Hui Lv
- Department of Spine Surgery, Jiangbei Branch of Southwest Hospital, 958th Hospital of the PLA Army, Chongqing, China
- Department of Orthopaedic, Southwest Hospital, The First Affiliated Hospital of Army Medical University, Chongqing, China
| | - Sheng Liao
- Department of Spine Surgery, Jiangbei Branch of Southwest Hospital, 958th Hospital of the PLA Army, Chongqing, China
| | - Zhenzhen Shi
- Department of Medecine, Dinfectome Inc., Nanjing, Jiangsu, China
| | - Yuan Guo
- Department of Spine Surgery, Jiangbei Branch of Southwest Hospital, 958th Hospital of the PLA Army, Chongqing, China
| | - JianHong Zhou
- Department of Spine Surgery, Jiangbei Branch of Southwest Hospital, 958th Hospital of the PLA Army, Chongqing, China
| | - Hui Chen
- Department of Spine Surgery, Jiangbei Branch of Southwest Hospital, 958th Hospital of the PLA Army, Chongqing, China
| | - Fei Luo
- Department of Spine Surgery, Jiangbei Branch of Southwest Hospital, 958th Hospital of the PLA Army, Chongqing, China
- Department of Orthopaedic, Southwest Hospital, The First Affiliated Hospital of Army Medical University, Chongqing, China
| | - JianZhong Xu
- Department of Spine Surgery, Jiangbei Branch of Southwest Hospital, 958th Hospital of the PLA Army, Chongqing, China
- Department of Orthopaedic, Southwest Hospital, The First Affiliated Hospital of Army Medical University, Chongqing, China
| | - ZhongRong Zhang
- Department of Spine Surgery, Jiangbei Branch of Southwest Hospital, 958th Hospital of the PLA Army, Chongqing, China
- Department of Orthopaedic, Southwest Hospital, The First Affiliated Hospital of Army Medical University, Chongqing, China
| | - ZeHua Zhang
- Department of Spine Surgery, Jiangbei Branch of Southwest Hospital, 958th Hospital of the PLA Army, Chongqing, China
- Department of Orthopaedic, Southwest Hospital, The First Affiliated Hospital of Army Medical University, Chongqing, China
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Jain AK, Jain P, Jaggi K, Suresh A, Yadav M, Gain A, Gupta H. Drug-Resistant Bone, Joint and Spine Tuberculosis: Evolution of Diagnosis and Treatment. Indian J Orthop 2024; 58:661-668. [PMID: 38812873 PMCID: PMC11130086 DOI: 10.1007/s43465-024-01138-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Accepted: 03/17/2024] [Indexed: 05/31/2024]
Abstract
Background Drug resistant (DR) osteoarticular TB (OATB) is a challenge in view of it being deep seated lesion and paucibacillary disease. Case definition, investigation protocol, treatment of proven DR and those cases where DR could not be demonstrated lacks clarity and evidence. Hence, a series of studies were conducted to develop an algorithm to investigate and treat therapeutically refractory disease (TRD) or presumptive drug resistance (PDR) cases of OATB. Patients and methods 6 studies were conducted. Study one and two evaluated criteria to label TRD/PDR. Three subsequent studies were conducted where TDR/PDR or fresh cases of OATB cases were investigated by AFB smear, Bactec/liquid culture, histology and genotypic DST by CBNAAT & LPA. Sixth study was a retrospective evaluation of all DR cases treated for proven or clinical drug resistance (CDR). Results Patient of bone/spine TB on ATT for 5 months or more show poor clinico-radiological treatment response as worsening of lesion, increased spinal deformity, persistent discharging sinus/ulcer, appearance of fresh lesion, recurrence of previous lesion, wound dehiscence of post-operative surgical scar cab labelled as PDR cases. These cases on histology ascertained TB and were proven DR on genotypic and phenotypic DST and are treated successfully. The patients of histologically ascertained TB and no/indeterminate phenotypic and genotypic DST were successfully treated as clinical drug resistance on MDR protocol. Conclusions We described an algorithm. We must suspect PDR(TRD) based on criteria described. The tissue must be procured and submitted for AFB smear, histology and phenotypic and genotypic DST for diagnosis of TB. Genotypic and phenotypic DST will be useful to prove (90% instances) type of drug resistance. Remaining on strong clinical suspicion of DR and yet inconclusive on phenotypic/genotypic DST (<10%), may be treated as CDR as MDR. The adverse drug reactions and hepatic side-effects should be monitored diligently and these cases to be treated till healed status is demonstrated.
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Affiliation(s)
- Anil K. Jain
- University College of Medical Sciences, University of Delhi, A10 Part B, Ashok Nagar, Ghaziabad, 201002 India
| | - Pragya Jain
- University College of Medical Sciences, University of Delhi, A10 Part B, Ashok Nagar, Ghaziabad, 201002 India
| | - Karan Jaggi
- University College of Medical Sciences, University of Delhi, A10 Part B, Ashok Nagar, Ghaziabad, 201002 India
| | - Abhimanyu Suresh
- University College of Medical Sciences, University of Delhi, A10 Part B, Ashok Nagar, Ghaziabad, 201002 India
| | - Manish Yadav
- University College of Medical Sciences, University of Delhi, A10 Part B, Ashok Nagar, Ghaziabad, 201002 India
| | - Amartya Gain
- University College of Medical Sciences, University of Delhi, A10 Part B, Ashok Nagar, Ghaziabad, 201002 India
| | - Himanshu Gupta
- University College of Medical Sciences, University of Delhi, A10 Part B, Ashok Nagar, Ghaziabad, 201002 India
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Sahu A, Bansal T, Borkar SA. Case of cervicodorsal tuberculosis involving seven contiguous vertebrae in a young child. BMJ Case Rep 2024; 17:e259560. [PMID: 38802257 DOI: 10.1136/bcr-2023-259560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2024] Open
Abstract
We present a rare case of a male child in middle childhood who presented to the emergency department with neck pain, neck deformity, low-grade fever, breathing difficulty and swallowing difficulty. The patient had a significant history of weight loss and loss of appetite. On examination, neurological deficits were observed, including mildly increased tone in bilateral lower limbs, reduced power in both lower limbs, exaggerated knee and ankle jerks, and upgoing plantar reflexes. Radiographs and MRI revealed a kyphotic deformity with apex at the T1 vertebra, lytic lesions in seven contiguous vertebrae and a large prevertebral abscess extending from C2 to T5. The patient underwent a posterior-only surgical approach with decompression, abscess drainage and stabilisation, resulting in successful cord decompression and correction of the kyphotic deformity. At 18 months follow-up, the patient is doing well with improvement to normal neurology and full return of a child to normal activities.
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Affiliation(s)
- Arpit Sahu
- Department of Orthopaedics, All India Institute of Medical Sciences, New Delhi, India
| | - Tungish Bansal
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Sachin A Borkar
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
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16
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Jia J, Zhang M, Cao Z, Hu X, Lei S, Zhang Y, Kang X. The rabbit model for spinal tuberculosis: An overview. J Orthop Surg (Hong Kong) 2024; 32:10225536241266703. [PMID: 39033332 DOI: 10.1177/10225536241266703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/23/2024] Open
Abstract
Mycobacterium tuberculosis infection has emerged as a global public health issue, predominantly manifesting as pulmonary tuberculosis. Bone and joint tuberculosis, with spinal tuberculosis accounting for approximately 50%, represents a significant form of extrapulmonary tuberculosis. Over the past years, there has been a rise in the incidence of spinal tuberculosis, and research concerning this area has gained significant attention. At present, animal models provide a means to investigate the pathogenesis, drug resistance, and novel treatment approaches for spinal tuberculosis. New Zealand rabbits, possessing a comparable anatomical structure to humans and capable of reproducing typical pathological features of human tuberculosis, are extensively employed in spinal tuberculosis research using animal models. This article comprehensively evaluates the strengths, considerations in strain selection, various modelling approaches, and practical applications of the rabbit model in studying spinal tuberculosis based on pertinent literature to guide fundamental research in this field by providing valuable insights into appropriate animal model selection.
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Affiliation(s)
- Jingwen Jia
- Department of Orthopaedics, Lanzhou University Second Hospital, Lanzhou, P.R. China
| | - Mingtao Zhang
- Department of Orthopaedics, Lanzhou University Second Hospital, Lanzhou, P.R. China
| | - Zhenyu Cao
- Department of Orthopaedics, Lanzhou University Second Hospital, Lanzhou, P.R. China
| | - Xuchang Hu
- Department of Orthopaedics, Lanzhou University Second Hospital, Lanzhou, P.R. China
| | - Shuanhu Lei
- Department of Orthopaedics, Lanzhou University Second Hospital, Lanzhou, P.R. China
| | - Yizhi Zhang
- Department of Orthopaedics, Lanzhou University Second Hospital, Lanzhou, P.R. China
| | - Xuewen Kang
- Department of Orthopaedics, Lanzhou University Second Hospital, Lanzhou, P.R. China
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Wang C, Lou C, Yang Z, Shi J, Niu N. Plasma metabolomic analysis reveals the metabolic characteristics and potential diagnostic biomarkers of spinal tuberculosis. Heliyon 2024; 10:e27940. [PMID: 38571585 PMCID: PMC10987919 DOI: 10.1016/j.heliyon.2024.e27940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 02/16/2024] [Accepted: 03/08/2024] [Indexed: 04/05/2024] Open
Abstract
Objectives This study aimed to conduct a non-targeted metabolomic analysis of plasma from patients with spinal tuberculosis (STB) to systematically elucidate the metabolomic alterations associated with STB, and explore potential diagnostic biomarkers for STB. Methods From January 2020 to January 2022, 30 patients with spinal tuberculosis (STBs) clinically diagnosed at the General Hospital of Ningxia Medical University and 30 age- and sex-matched healthy controls (HCs) were selected for this study. Using ultra-high performance liquid chromatography coupled with quadrupole time-of-flight mass spectrometry (UPLC-QTOF/MS) based metabolomics, we analyzed the metabolic profiles of 60 plasma samples. Statistical analyses, pathway enrichment, and receiver operating characteristic (ROC) analyses were performed to screen and evaluate potential diagnostic biomarkers. Results Metabolomic profiling revealed distinct alterations between the STBs and HCs cohorts. A total of 1635 differential metabolites were screened, functionally clustered, and annotated. The results showed that the differential metabolites were enriched in sphingolipid metabolism, tuberculosis, cutin, suberine and wax biosynthesis, beta-alanine metabolism, methane metabolism, and other pathways. Through the random forest algorithm, LysoPE (18:1(11Z)/0:0), 8-Demethyl-8-formylriboflavin 5'-phosphate, Glutaminyl-Gamma-glutamate, (2R)-O-Phospho-3-sulfolactate, and LysoPE (P-16:0/0:0) were determined to have high independent diagnostic value. Conclusions STBs exhibited significantly altered metabolite profiles compared with HCs. Here, we provide a global metabolomic profile and identify potential diagnostic biomarkers of STB. Five potential independent diagnostic biomarkers with high diagnostic value were screened. This study provides novel insights into the pathogenesis, diagnosis, and treatment strategies of STB.
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Affiliation(s)
- Chaoran Wang
- Department of Orthopedics, General Hospital of Ningxia Medical University, Yinchuan 750004, Ningxia, China
- School of Clinical Medicine, Ningxia Medical University, Yinchuan 750004, Ningxia, China
| | - Caili Lou
- School of Clinical Medicine, Ningxia Medical University, Yinchuan 750004, Ningxia, China
| | - Zongqiang Yang
- Department of Orthopedics, General Hospital of Ningxia Medical University, Yinchuan 750004, Ningxia, China
| | - Jiandang Shi
- Department of Orthopedics, General Hospital of Ningxia Medical University, Yinchuan 750004, Ningxia, China
| | - Ningkui Niu
- Department of Orthopedics, General Hospital of Ningxia Medical University, Yinchuan 750004, Ningxia, China
- Research Center for Prevention and Control of Bone and Joint Tuberculosis, General Hospital of Ningxia Medical University, Yinchuan 750004, Ningxia, China
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Feng S, Wang S, Liu C, Wu S, Zhang B, Lu C, Huang C, Chen T, Zhou C, Zhu J, Chen J, Xue J, Wei W, Zhan X. Prediction model for spinal cord injury in spinal tuberculosis patients using multiple machine learning algorithms: a multicentric study. Sci Rep 2024; 14:7691. [PMID: 38565845 PMCID: PMC10987632 DOI: 10.1038/s41598-024-56711-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Accepted: 03/09/2024] [Indexed: 04/04/2024] Open
Abstract
Spinal cord injury (SCI) is a prevalent and serious complication among patients with spinal tuberculosis (STB) that can lead to motor and sensory impairment and potentially paraplegia. This research aims to identify factors associated with SCI in STB patients and to develop a clinically significant predictive model. Clinical data from STB patients at a single hospital were collected and divided into training and validation sets. Univariate analysis was employed to screen clinical indicators in the training set. Multiple machine learning (ML) algorithms were utilized to establish predictive models. Model performance was evaluated and compared using receiver operating characteristic (ROC) curves, area under the curve (AUC), calibration curve analysis, decision curve analysis (DCA), and precision-recall (PR) curves. The optimal model was determined, and a prospective cohort from two other hospitals served as a testing set to assess its accuracy. Model interpretation and variable importance ranking were conducted using the DALEX R package. The model was deployed on the web by using the Shiny app. Ten clinical characteristics were utilized for the model. The random forest (RF) model emerged as the optimal choice based on the AUC, PRs, calibration curve analysis, and DCA, achieving a test set AUC of 0.816. Additionally, MONO was identified as the primary predictor of SCI in STB patients through variable importance ranking. The RF predictive model provides an efficient and swift approach for predicting SCI in STB patients.
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Affiliation(s)
- Sitan Feng
- Department of Spine and Osteopathy Ward, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, People's Republic of China
| | - Shujiang Wang
- Department of Outpatient, General Hospital of Eastern Theater Command, Nanjing, Jiangsu, People's Republic of China
| | - Chong Liu
- Department of Spine and Osteopathy Ward, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, People's Republic of China
| | - Shaofeng Wu
- Department of Spine and Osteopathy Ward, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, People's Republic of China
| | - Bin Zhang
- Department of Spine and Osteopathy Ward, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, People's Republic of China
- Department of Spine Ward, Bei Jing Ji Shui Tan Hospital Gui Zhou Hospital, Guiyang, Guizhou, People's Republic of China
| | - Chunxian Lu
- Department of Spine and Osteopathy Ward, Bai Se People's Hospital, Baise, Guangxi, People's Republic of China
| | - Chengqian Huang
- Department of Spine and Osteopathy Ward, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, People's Republic of China
| | - Tianyou Chen
- Department of Spine and Osteopathy Ward, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, People's Republic of China
| | - Chenxing Zhou
- Department of Spine and Osteopathy Ward, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, People's Republic of China
| | - Jichong Zhu
- Department of Spine and Osteopathy Ward, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, People's Republic of China
| | - Jiarui Chen
- Department of Spine and Osteopathy Ward, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, People's Republic of China
| | - Jiang Xue
- Department of Spine and Osteopathy Ward, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, People's Republic of China
| | - Wendi Wei
- Department of Spine and Osteopathy Ward, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, People's Republic of China
| | - Xinli Zhan
- Department of Spine and Osteopathy Ward, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, People's Republic of China.
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Sharma K, Sharma M, Sharma A, Dhillon MS. Diagnosing osteoarticular tuberculosis and detecting rifampicin resistance: A comparative analysis of Truenat MTB Plus vs GeneXpert Ultra. Tuberculosis (Edinb) 2024; 145:102483. [PMID: 38310759 DOI: 10.1016/j.tube.2024.102483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 01/25/2024] [Accepted: 01/30/2024] [Indexed: 02/06/2024]
Abstract
SETTING Diagnosing osteoarticular tuberculosis (OATB) and detecting drug resistance is a challenge in an endemic country like India. OBJECTIVE Truenat MTB Plus assay (TruPlus), a chip-based portable machine, was compared with GeneXpert Ultra (GxUltra) for diagnosing drug-resistant OATB. DESIGN 115 synovial fluid and pus specimens [22 culture-positive confirmed, 58 culture-negative clinically-suspected, 35 non-TB controls] processed between 2017 and 2023 were subjected to TruPlus, GxUltra and multiplex-PCR for diagnosing OATB. They were further screened for rifampicin resistance using TruRif chip. The performance was evaluated against composite reference standard, phenotypic drug susceptibility testing and rpoB gene sequencing. RESULTS TruPlus, GxUltra and MPCR detected 77.5 %, 71.25 %, and 83.75 %, cases of OATB, respectively. TruPlus detected five additional cases missed by GxUltra. The performance of TruPlus was comparable to GxUltra (p = 0.074) and to MPCR (p = 0.074), while performance of GxUltra was significantly inferior to MPCR (p = 0.004). The overall agreement with reference standard was substantial for TruPlus and MPCR and moderate for GxUltra. Both TruRif and GxUltra reported 4 cases as rifampicin resistant. CONCLUSION TruPlus along with TruRif offers better sensitivity than GxUltra. Its compact and portable platform allows wider application in peripheral settings, thus making it a pragmatic solution for diagnosing OATB and its drug resistance.
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Affiliation(s)
- Kusum Sharma
- Department of Medical Microbiology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India.
| | - Megha Sharma
- Department of Microbiology, All India Institute of Medical Sciences (AIIMS), Bilaspur, Himachal Pradesh, 174001, India
| | - Aman Sharma
- Department of Internal Medicine, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India
| | - Mandeep Singh Dhillon
- Department of Orthopedics, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India
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Borde MD, Menon VK, Kanade UP, Rajale SS, Mane AV, Varma H. Drug eluting bioactive glass ceramics for fusion in spondylodiscitis: a pilot study. Neurosurg Rev 2024; 47:80. [PMID: 38355838 DOI: 10.1007/s10143-024-02317-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Revised: 01/31/2024] [Accepted: 02/06/2024] [Indexed: 02/16/2024]
Abstract
Retrospective observational study. To determine the efficacy and safety of bioactive glass ceramics mixed with autograft in the treatment of spondylodiscitis. Thirty-four patients with spondylodiscitis underwent surgery using autologous bone graft augmented by antibiotic loaded bioactive glass ceramic granules. Twenty-five patients aging 6 to 77, completed 1-year follow-up. The lumbosacral junction was affected in 3, lumbar spine in 13, one each in the dorso-lumbar junction and sacrum, and 7 dorsal spines. The organism isolated was Mycobacterium tuberculosis in 15, Methicillin sensitive Staphylococcus aureus (MSSA) in 4, Pseudomonas aeruginosa in 4, Klebsiella pneumoniae in one, Burkholderia pseudomallei in 1, and mixed infections in 2. All patients had appropriate antibiotic therapy based on culture and sensitivity. Clinical and radiological evaluation of all the patients was done at 6 weeks, 3 months, 6 months, and 12 months after the surgery. Twenty-three patients improved clinically and showed radiographic fusion between 6 and 9 months. The patient with Burkholderia infection died due to fulminant septicemia with multi organ failure while another patient died at 9 months due to an unrelated cardiac event. The mean Visual Analogue Score (VAS) at the end of 1-year was 2 with radiological evidence of fusion in all patients. There were no re-infections or discharging wounds, and the 30-day re-admission rate was 0. Bioactive glass ceramics is a safe and effective graft expander in cases of spondylodiscitis. The absorption of antibiotics into the ceramic appears to help the elimination of infection.
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Affiliation(s)
- Mandar D Borde
- Department of Spine Surgery, Bharati Vidyapeeth Medical College Hospital, Pune, India.
| | - Venugopal K Menon
- Department of Spine Surgery, Bharati Vidyapeeth Medical College Hospital, Pune, India
| | - Umesh P Kanade
- Department of Orthopaedics, Bharati Vidyapeeth Medical College Hospital, Pune, India
| | - Sangram S Rajale
- Department of Orthopaedics, Bharati Vidyapeeth Medical College Hospital, Pune, India
| | - Akash V Mane
- Department of Orthopaedics, Bharati Vidyapeeth Medical College Hospital, Pune, India
| | - Harikrishna Varma
- Sree Chitra Tirunal Institute of Medical Sciences and Technology, Trivandrum, Kerala, India
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Liu Y, Liu Q, Duan X, Wang W, Pu L, Luo B, He D. One-stage posterior transpedicular debridement, hemi-interbody and unilateral-posterior bone grafting, and instrumentation for the treatment of thoracic spinal tuberculosis: a retrospective study. Acta Neurochir (Wien) 2024; 166:65. [PMID: 38315247 DOI: 10.1007/s00701-024-05966-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 01/06/2024] [Indexed: 02/07/2024]
Abstract
PURPOSE To investigate the clinical efficacy and feasibility of the surgical treatment of thoracic spinal tuberculosis using one-stage posterior instrumentation, transpedicular debridement, and hemi-interbody and unilateral posterior bone grafting. METHODS Fifty-six patients with thoracic spinal tuberculosis who underwent surgery performed by a single surgeon between September 2009 and August 2020 were enrolled in this study. Based on data from the erythrocyte sedimentation rate (ESR), Visual Analog Scale (VAS), and Cobb angle before surgery, after surgery, and at the most recent follow-up, clinical effectiveness was assessed using statistical analysis. The variables investigated included operating time, blood loss, complications, neurological function, and hemi-interbody fusion. RESULTS None of the patients experienced significant surgery-associated complications. At the last follow-up, 23 of the 25 patients (92%) with neurological impairment showed improvement. The thoracic kyphotic angle was significantly decreased from 24.1 ± 9.9° to 13.4 ± 8.6° after operation (P < 0.05), and the angle was 14.44 ± 8.8° at final follow-up (P < 0.05). The Visual Analog Scale significantly decreased from 6.7 ± 1.4 preoperatively to 2.3 ± 0.8 postoperatively (P < 0.05) and finally to 1.2 ± 0.7 at the last follow-up (P < 0.05). Bone fusion was confirmed in 56 patients at 3-6 months postoperatively. CONCLUSIONS One-stage posterior transpedicular debridement, hemi-interbody and unilateral posterior bone grafting, and instrumentation are effective and feasible treatment methods for thoracic spinal tuberculosis.
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Affiliation(s)
- Yan Liu
- Department of Orthopedics, Shanghai Changhai Hospital, 168 Changhai Road, Shanghai, 200433, People's Republic of China
| | - Qingshan Liu
- Department of Orthopedics, Shanghai Changhai Hospital, 168 Changhai Road, Shanghai, 200433, People's Republic of China
| | - Xuzhou Duan
- Department of Orthopedics, Shanghai Changhai Hospital, 168 Changhai Road, Shanghai, 200433, People's Republic of China
| | - Wentao Wang
- Department of Orthopedics, Shanghai Changhai Hospital, 168 Changhai Road, Shanghai, 200433, People's Republic of China
| | - Lianjie Pu
- Department of Orthopedics, Shanghai Changhai Hospital, 168 Changhai Road, Shanghai, 200433, People's Republic of China
| | - Beier Luo
- Department of Orthopedics, Shanghai Changhai Hospital, 168 Changhai Road, Shanghai, 200433, People's Republic of China
| | - Dawei He
- Department of Orthopedics, Shanghai Changhai Hospital, 168 Changhai Road, Shanghai, 200433, People's Republic of China.
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Luo Y, Chen H, Chen H, Xiu P, Zeng J, Song Y, Li T. Recent Advances in Nanotechnology-Based Strategies for Bone Tuberculosis Management. Pharmaceuticals (Basel) 2024; 17:170. [PMID: 38399384 PMCID: PMC10893314 DOI: 10.3390/ph17020170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Revised: 01/26/2024] [Accepted: 01/26/2024] [Indexed: 02/25/2024] Open
Abstract
Bone tuberculosis, an extrapulmonary manifestation of tuberculosis, presents unique treatment challenges, including its insidious onset and complex pathology. While advancements in anti-tubercular therapy have been made, the efficacy is often limited by difficulties in achieving targeted drug concentrations and avoiding systemic toxicity. The intricate bone structure and presence of granulomas further impede effective drug delivery. Nano-drug delivery systems have emerged as a promising alternative, offering the enhanced targeting of anti-tubercular drugs. These systems, characterized by their minute size and adaptable surface properties, can be tailored to improve drug solubility, stability, and bioavailability, while also responding to specific stimuli within the bone TB microenvironment for controlled drug release. Nano-drug delivery systems can encapsulate drugs for precise delivery to the infection site. A significant innovation is their integration with prosthetics or biomaterials, which aids in both drug delivery and bone reconstruction, addressing the infection and its osteological consequences. This review provides a comprehensive overview of the pathophysiology of bone tuberculosis and its current treatments, emphasizing their limitations. It then delves into the advancements in nano-drug delivery systems, discussing their design, functionality, and role in bone TB therapy. The review assesses their potential in preclinical research, particularly in targeted drug delivery, treatment efficacy, and a reduction of side effects. Finally, it highlights the transformative promise of nanotechnology in bone TB treatments and suggests future research directions in this evolving field.
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Affiliation(s)
| | | | | | | | | | | | - Tao Li
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu 610041, China; (Y.L.); (H.C.); (H.C.); (P.X.); (J.Z.); (Y.S.)
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Gao S, Abulizi Y, Mamat F, Mamat M, Liang W, Guo H, Xun C, Sheng W. Posterior fixation, anterior debridement and bone grafting in the treatment of thoracic and lumbar tuberculosis in children younger than 3 years of age. Acta Neurochir (Wien) 2024; 166:25. [PMID: 38252149 DOI: 10.1007/s00701-024-05928-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 11/15/2023] [Indexed: 01/23/2024]
Abstract
PURPOSE This study aimed to investigate the clinical outcomes of posterior fixation, combined with one- or two-stage anterior debridement and bone grafting in treating children younger than 3 years of age with thoracic and lumbar tuberculosis. METHODS This was a retrospective study involving 16 young children with thoracic or lumbar tuberculosis. Surgical data were recorded. Frankel Grade was used to assess neurological function. The regional kyphosis angle was measured to evaluate the deformity correction. Erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) levels were detected to assess the activity of tuberculosis. Bony fusion and complications were also recorded. RESULTS The mean operation time was 204.4 ± 41.8 min. The mean estimated blood loss was 126.3 ± 94.4 ml. Preoperative Frankel Grade results indicated five patients with Grade C, six with Grade D, and five with Grade E. At the final follow-up, all patients were in Grade E. Twelve patients were brought back to normal spinal alignment and the rest four patients remained kyphotic. There was an improvement of 29.3° ± 18.3° in regional kyphotic angle postoperatively. And the deformity correction was 27.4° ± 19.1° at the final follow-up. ESR and CRP decreased to a normal range at three months follow-up. Bony fusion was achieved in all patients. None of the cases developed fixation failure, pseudoarthrosis, or tuberculosis recurrence. CONCLUSION Posterior fixation, combined with one- or two-stage anterior debridement and bone grafting, is a safe and effective surgical strategy for treating young children with thoracic and lumbar tuberculosis.
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Affiliation(s)
- Shutao Gao
- Department of Spine Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, 830054, Xinjiang, China
| | - Yakefu Abulizi
- Department of Spine Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, 830054, Xinjiang, China
| | - Fulati Mamat
- Department of Spine Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, 830054, Xinjiang, China
| | - Mardan Mamat
- Department of Spine Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, 830054, Xinjiang, China
| | - Weidong Liang
- Department of Spine Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, 830054, Xinjiang, China
| | - Hailong Guo
- Department of Spine Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, 830054, Xinjiang, China
| | - Chuanhui Xun
- Department of Spine Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, 830054, Xinjiang, China
| | - Weibin Sheng
- Department of Spine Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, 830054, Xinjiang, China.
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Li K, Liu B, Zhang Q. Recurrent Spinal Tuberculosis with HIV Infection After Surgery: A Rare Case of Recurrence and Drug Resistance. Infect Drug Resist 2023; 16:7827-7833. [PMID: 38162320 PMCID: PMC10757785 DOI: 10.2147/idr.s438184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 12/21/2023] [Indexed: 01/03/2024] Open
Abstract
Tuberculosis (TB) and acquired immunodeficiency syndrome (AIDS) are prevalent infectious diseases that continue to pose a significant global health burden. The co-infection of mycobacterium tuberculosis and human immunodeficiency virus (HIV) represents a substantial public health challenge, particularly in developing nations. In this study, we present an exceptional case of spinal tuberculosis complicated by HIV infection, which exhibited relapse post-surgery necessitating reoperation, along with the emergence of drug resistance. The first operation was lumbar lesion removal, decompression, internal fixation, and bone graft fusion assisted by lumbar discioscopy. The second operation was ultrasound-guided puncture and drainage of right psoas major abscess. The management of patients with HIV/TB co-infection demands specific considerations regarding medication regimens, surgical interventions, and nursing care. However, limited experience exists in treating such individuals, thus further research is imperative to enhance our understanding of HIV/TB co-infection.
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Affiliation(s)
- Kangpeng Li
- National Center for Infectious Diseases, Beijing Ditan Hospital, Capital Medical University, Beijing, 100015, People’s Republic of China
| | - Bo Liu
- National Center for Infectious Diseases, Beijing Ditan Hospital, Capital Medical University, Beijing, 100015, People’s Republic of China
| | - Qiang Zhang
- National Center for Infectious Diseases, Beijing Ditan Hospital, Capital Medical University, Beijing, 100015, People’s Republic of China
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Kuo CH, Tu TH. Commentary on "Simultaneous Single-Position Oblique Lateral Interbody Fusion Combined With Unilateral Percutaneous Pedicle Screw Fixation for Single-Level Lumbar Tuberculosis: A 3-Year Retrospective Comparative Study". Neurospine 2023; 20:1319-1320. [PMID: 38171299 PMCID: PMC10762404 DOI: 10.14245/ns.2347288.644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2024] Open
Affiliation(s)
- Chao-Hung Kuo
- Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Department of Biomedical Engineering, School of Biomedical Science and Engineering, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Tsung-Hsi Tu
- Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
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Luo Y, Chen H, Xiu P, Zeng J, Song Y, Li T. Comparative evaluation of multi-fold rib and structural iliac bone grafts in single-segment thoracic and thoracolumbar spinal tuberculosis: clinical and radiological outcomes. J Orthop Surg Res 2023; 18:917. [PMID: 38041140 PMCID: PMC10693100 DOI: 10.1186/s13018-023-04416-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2023] [Accepted: 11/27/2023] [Indexed: 12/03/2023] Open
Abstract
OBJECTIVE To compare clinical and radiological outcomes of multi-fold rib and structural iliac bone grafts, the primary autologous graft techniques in anterolateral-only surgery for single-segment thoracic and thoracolumbar spinal tuberculosis. METHODS This retrospective study included 99 patients treated from January 2014 to March 2022, categorized into 64 with multi-fold rib grafts (group A) and 35 with structural iliac bone grafts (group B). Outcomes assessed included hospital stay, operation time, intraoperative blood loss, postoperative drainage, complications, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), the Visual Analog Scale (VAS) for pain, the Oswestry Disability Index (ODI), bone fusion time, and the American Spinal Injury Association (ASIA) impairment scale grade. Segmental kyphotic angle and intervertebral height were measured radiologically before surgery and follow-up. RESULTS The mean follow-up was 63.50 ± 26.05 months for group A and 64.97 ± 26.43 months for group B (P > 0.05). All patients had achieved a clinical cure. Group A had a shorter operation time (P = 0.004). Within one week post-surgery, group B reported higher VAS scores (P < 0.0001). Neurological performance and quality of life significantly improved in both groups. No significant differences were observed in segmental kyphotic angle and intervertebral height between the groups pre- and postoperatively (P > 0.05). However, group A showed a greater segmental kyphotic angle at the final follow-up, while group B had better maintenance of kyphotic angle correction and intervertebral height (P < 0.05). Bone fusion was achieved in all patients without differences in fusion time (P > 0.05). CONCLUSIONS Multi-fold rib grafts resulted in shorter operation times and less postoperative pain, while structural iliac bone grafts provided better long-term maintenance of spinal alignment and stability, suggesting their use in cases where long-term outcomes are critical.
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Affiliation(s)
- Yuanrui Luo
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, No. 37 Guo Xue Rd, Chengdu, China
| | - Hua Chen
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, No. 37 Guo Xue Rd, Chengdu, China
| | - Peng Xiu
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, No. 37 Guo Xue Rd, Chengdu, China
| | - Jiancheng Zeng
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, No. 37 Guo Xue Rd, Chengdu, China
| | - Yueming Song
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, No. 37 Guo Xue Rd, Chengdu, China
| | - Tao Li
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, No. 37 Guo Xue Rd, Chengdu, China.
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Yadav M, Jain AK, Singhal R, Chadha M, Arora VK, Bhargava A. Incidence and Patterns of Drug Resistance in Patients with Spinal Tuberculosis: a Prospective, Single-Center Study from a Tuberculosis-Endemic Country. Indian J Orthop 2023; 57:1833-1841. [PMID: 37881297 PMCID: PMC10593722 DOI: 10.1007/s43465-023-00986-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Accepted: 08/20/2023] [Indexed: 10/27/2023]
Abstract
Background There is paucity of data on incidence and pattern of drug resistance in spinal TB. This prospective observational study was conducted to document the incidence and drug-resistance pattern among primary and presumptive resistant cases. Methods 59 consecutive cases diagnosed clinico-radiologically (imaging) were grouped into Group A (n = 51, primary cases) and Group B (n = 8, presumptive resistant cases) based on pre-defined criteria (INDEX-TB guidelines). Tissue samples obtained percutaneously (37.29%, 22/59) and on surgery (62.71%, 37/59) were subjected to genotypic DST (CBNAAT, LPA) and phenotypic DST (BACTEC MGIT 960 culture and sensitivity using fixed critical concentration of drugs). Results Etiological diagnosis was ascertained in all. 13/51 (25.49%) in Group A, while 3/8 (37.5%) in Group B and 16/59 (27.12%) overall demonstrated drug resistance. 12/16 (75%) had no prior history of ATT intake. 4 demonstrated INH (Isoniazid) mono-resistance. 12 polydrug resistance demonstrated: 5MDR, 3pre-XDR, while RIF + FQ (fluoroquinolones), FQ + Lz (linezolid), only SLID (second-line injectable drugs), and only FQ resistance observed in 1 case each. Isolated RIF (Rifampicin) resistance and XDR pattern were not observed. Overall frequency of RIF resistance was 16.4% (9/55) and INH was 25% (12/48) with low-(n-2) and high-level INH resistance (n-10). Among second-line drugs, FQ resistance was more than SLID resistance and within FQ, levofloxacin resistance was more frequent than moxifloxacin. MGIT demonstrated positive growth in 16/59 samples, out of which 1 sample was positive for nontuberculous mycobacteria (M. chelonae) but on genotypic testing demonstrated MTB resistant to RIF and FQ. Conclusion This is the first report on incidence and drug-resistant pattern in culture-positive/negative cases. High (25.49%) primary drug resistance is worrisome. This being the first study in spinal TB cases which document prevalent drug-resistant pattern as evaluated for consecutive culture-positive/negative cases. The tissue obtained must be submitted for AFB culture and molecular tests to ascertain drug resistance in culture-positive/negative cases. However, in the presence of insufficient tissue sample histology and CBNAAT can ascertain etiological diagnosis in 100% cases. INH resistance is more than RIF with isolated RIF resistance unreported.
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Affiliation(s)
- Manish Yadav
- Department of Orthopaedics, University College of Medical Sciences and Guru Teg Bahadur Hospital, Dilshad Garden, Delhi, 110095 India
| | - Anil K. Jain
- Department of Orthopaedics, University College of Medical Sciences and Guru Teg Bahadur Hospital, Dilshad Garden, Delhi, 110095 India
| | - Ritu Singhal
- National Reference Laboratory & Center of Excellence (TB) WHO, Department of Microbiology, National Institute of Tuberculosis & Respiratory Diseases, New Delhi, Delhi 110030 India
| | - Manish Chadha
- Department of Orthopaedics, University College of Medical Sciences and Guru Teg Bahadur Hospital, Dilshad Garden, Delhi, 110095 India
| | - Vinod Kumar Arora
- Department of Pathology, University College of Medical Sciences and Guru Teg Bahadur Hospital, Dilshad Garden, Delhi, 110095 India
| | - Aayush Bhargava
- Department of Orthopaedics, University College of Medical Sciences and Guru Teg Bahadur Hospital, Dilshad Garden, Delhi, 110095 India
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Rajasekaran S, Soundararajan DCR, Reddy GJ, Shetty AP, Kanna RM. A Validated Score for Evaluating Spinal Instability to Assess Surgical Candidacy in Active Spinal Tuberculosis-An Evidence Based Approach and Multinational Expert Consensus Study. Global Spine J 2023; 13:2296-2309. [PMID: 35220789 PMCID: PMC10538347 DOI: 10.1177/21925682221080102] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
STUDY DESIGN Modified Delphi Consensus and Observational Study. OBJECTIVE Instability in spinal tuberculosis (STB) leads to disabling spinal deformity and neurodeficit. Identifying and estimating instability remains subjective, mainly based on experience. This study aims to develop an objective scoring system to determine instability in STB. MATERIALS AND METHODS The study included 4 phases. (1) A panel of 10 experienced spine surgeons developed a questionnaire based on literature. (2) 68 spine surgeons from 12 countries opined on the importance of each factor in a survey. Five factors deemed important by >70% of participants were further analyzed (3) 60 representative cases of STB were analyzed for instability. A preliminary scoring system was developed, a threshold score for determining instability was derived, and (4) Results were validated. RESULTS All the 5 factors ("Spine at risk" signs, severity of vertebral body loss, Cervicothoracic/Thoracolumbar junction involvement, age ≤15, and kyphotic deformity ≥30°) considered important by >70% of participants were associated with instability and included in scoring: age ≤15 years (P-value, 0.05), cervicothoracic/thoracolumbar junction involvement (P-value, 0.028), sagittal deformity angle ratio (DAR) ≥ 15° (P-value, <.001), vertebral body loss-segmental ratio ≥.5 (P-value, <.001), and presence of spine at risk signs (P-value, <.001). A total score of ≥3/09 indicated definite instability with good sensitivity (77%) and excellent specificity (100%). Repeatability assessment showed a good agreement (.9625), and Cohen's kappa coefficient was strong (.809). CONCLUSION A simple objective scoring system for predicting instability in STB has been developed using 5 main factors; young age, junctional involvement, severity of the deformity, vertebral body loss, and presence of spine at risk signs.
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Affiliation(s)
| | | | | | - Ajoy P. Shetty
- Department of Spine Surgery, Ganga Hospital, Coimbatore, India
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Xia P, Tao P, Zhao X, Peng X, Chen S, Ma X, Fan L, Feng J, Pu F. Anterior debridement combined with autogenous iliac bone graft fusion for the treatment of lower cervical tuberculosis: a multicenter retrospective study. J Orthop Traumatol 2023; 24:48. [PMID: 37709959 PMCID: PMC10501986 DOI: 10.1186/s10195-023-00730-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 08/15/2023] [Indexed: 09/16/2023] Open
Abstract
BACKGROUND This study aimed to analyze the clinical efficacy of one-stage anterior debridement of lower cervical tuberculosis using iliac crest bone graft fusion and internal fixation. MATERIALS AND METHODS A retrospective analysis was performed on 48 patients with lower cervical tuberculosis admitted to multiple medical centers from June 2018 to June 2021. Among them, 36 patients had lesions involving two vertebrae and 12 patients had lesions involving more than three vertebrae. All patients were treated with quadruple antituberculosis drugs for more than 2 weeks before the operation, and then treated with one-stage anterior debridement and autogenous iliac bone graft fusion combined with titanium plate internal fixation. After the operation, antituberculosis drugs were continued for 12-18 months. The patients were followed-up to observe the improvement in clinical symptoms, bone graft fusion, Cobb angle, visual analog score (VAS), erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), wound healing, and neurological function. RESULTS The patients were followed-up for 13-43 months, with an average of 21.46 ± 1.52 months. The clinical symptoms significantly improved after the operation. The bone graft was completely fused in all patients, and the bone fusion time was 3-6 months, with an average of 4.16 ± 0.47 months. At the last follow-up, the Cobb angle, VAS, ESR, and CRP level were significantly lower than those before surgery (P < 0.05). None of the patients had loosening, detachment, or rupture of the internal fixation, and no recurrence occurred. All surgical incisions healed in one stage without infection or sinus formation. The preoperative Frankel neurological function classification was grade B in 7 cases, grade C in 13, grade D in 18, and grade E in 10. At the last follow-up, 8 cases recovered to grade D and 40 recovered to grade E. CONCLUSIONS For patients with lower cervical tuberculosis, based on oral treatment with quadruple antituberculosis drugs, direct decompression through anterior debridement, followed by autologous iliac bone graft fusion combined with internal fixation can completely remove tuberculosis foci, rebuild the stability of the cervical spine, and obtain good clinical efficacy. Level of evidence Level 3.
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Affiliation(s)
- Ping Xia
- Department of Orthopaedics, Wuhan Fourth Hospital (Puai Hospital), Wuhan, China
| | - Pengfei Tao
- Department of Orthopedics, Traditional Chinese and Western Medicine Hospital of Wuhan (Wuhan No.1 Hospital), Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xiaolong Zhao
- Department of Orthopedics, Traditional Chinese and Western Medicine Hospital of Wuhan (Wuhan No.1 Hospital), Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xianglin Peng
- Department of Orthopedics, Traditional Chinese and Western Medicine Hospital of Wuhan (Wuhan No.1 Hospital), Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Songfeng Chen
- Department of Orthopaedic Surgery, The First Affiliated Hospital, Zhengzhou University, Zhengzhou, China
| | - Xiucai Ma
- Department of Bone and Soft Tissue Oncology, Gansu Provincial People's Hospital, Lanzhou, China
| | - Lei Fan
- Department of Orthopedics, The Second Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Jing Feng
- Department of Orthopedics, Traditional Chinese and Western Medicine Hospital of Wuhan (Wuhan No.1 Hospital), Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
| | - Feifei Pu
- Department of Orthopedics, Traditional Chinese and Western Medicine Hospital of Wuhan (Wuhan No.1 Hospital), Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
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Gao S, Hu Y, Mamat F, Liang W, Mamat M, Xun C, Zhang J, Sheng W. Application of cement-augmented pedicle screws in elderly patients with spinal tuberculosis and severe osteoporosis: a preliminary study. J Orthop Surg Res 2023; 18:624. [PMID: 37626361 PMCID: PMC10463792 DOI: 10.1186/s13018-023-04099-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 08/14/2023] [Indexed: 08/27/2023] Open
Abstract
OBJECTIVE Surgical management of elderly patients with spinal tuberculosis and severe osteoporosis is challenging. Cement-augmented pedicle screws (CAPS) have been specifically designed for elderly patients with osteoporotic spines. Herein, we investigated the feasibility of CAPS applied in elderly patients with spinal tuberculosis and severe osteoporosis. METHODS We retrospectively analyzed data of patients with spinal tuberculosis and severe osteoporosis between January 2017 and January 2021. Surgical data, including surgical duration and intraoperative blood loss, were recorded. Radiological parameters, such as correction of regional kyphotic angle and screw loosening, were also evaluated. Additionally, visual analog scores (VAS) and Oswestry disability index (ODI) were used to evaluate back pain and functional recovery, respectively. Erythrocyte sedimentation (ESR) and C-reactive protein (CRP) concentrations were detected to assess tuberculosis activity. The presence of complications and fusion rate was also assessed. RESULTS A total of 15 patients were included in this study. The surgical duration was 263.0 ± 56.2 min, with an average blood loss of 378.7 ± 237.0 ml. The correction of regional kyphotic angle was 12.4° ± 15.0°, and it was well maintained until the final follow-up. The mean VAS decreased from 6.0 ± 1.2 points to 0.5 ± 0.6 points, and ODI reduced from 37.8% ± 7.6% to 8.3% ± 2.8% (P < 0.01). At the final follow-up, ESR and CRP levels were within normal range. Bony fusion occurred in all patients, with an average fusion duration of 8.8 ± 1.5 months. No cases of pedicle screw pullout, screw loosening, or pseudoarthrosis occurred. Tuberculosis recurrence and dissemination were not observed during the follow-ups. CONCLUSIONS CAPS fixation is an effective and safe technique to achieve solid fixation and favorable clinical outcomes in elderly patients with spinal tuberculosis and severe osteoporosis.
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Affiliation(s)
- Shutao Gao
- Department of Spine Surgery, The First Affiliated Hospital of Xinjiang Medical University, 137 Liyushan Avenue, Xinshi District, Ürümqi, 830054 Xinjiang China
| | - Yukun Hu
- Department of Spine Surgery, The First Affiliated Hospital of Xinjiang Medical University, 137 Liyushan Avenue, Xinshi District, Ürümqi, 830054 Xinjiang China
| | - Fulati Mamat
- Department of Spine Surgery, The First Affiliated Hospital of Xinjiang Medical University, 137 Liyushan Avenue, Xinshi District, Ürümqi, 830054 Xinjiang China
| | - Weidong Liang
- Department of Spine Surgery, The First Affiliated Hospital of Xinjiang Medical University, 137 Liyushan Avenue, Xinshi District, Ürümqi, 830054 Xinjiang China
| | - Mardan Mamat
- Department of Spine Surgery, The First Affiliated Hospital of Xinjiang Medical University, 137 Liyushan Avenue, Xinshi District, Ürümqi, 830054 Xinjiang China
| | - Chuanhui Xun
- Department of Spine Surgery, The First Affiliated Hospital of Xinjiang Medical University, 137 Liyushan Avenue, Xinshi District, Ürümqi, 830054 Xinjiang China
| | - Jian Zhang
- Department of Spine Surgery, The First Affiliated Hospital of Xinjiang Medical University, 137 Liyushan Avenue, Xinshi District, Ürümqi, 830054 Xinjiang China
| | - Weibin Sheng
- Department of Spine Surgery, The First Affiliated Hospital of Xinjiang Medical University, 137 Liyushan Avenue, Xinshi District, Ürümqi, 830054 Xinjiang China
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Duan S, Dong W, Hua Y, Zheng Y, Ren Z, Cao G, Wu F, Rong T, Liu B. Accurate Differentiation of Spinal Tuberculosis and Spinal Metastases Using MR-Based Deep Learning Algorithms. Infect Drug Resist 2023; 16:4325-4334. [PMID: 37424672 PMCID: PMC10329448 DOI: 10.2147/idr.s417663] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 06/28/2023] [Indexed: 07/11/2023] Open
Abstract
Purpose To explore the application of deep learning (DL) methods based on T2 sagittal MR images for discriminating between spinal tuberculosis (STB) and spinal metastases (SM). Patients and Methods A total of 121 patients with histologically confirmed STB and SM across four institutions were retrospectively analyzed. Data from two institutions were used for developing deep learning models and internal validation, while the remaining institutions' data were used for external testing. Utilizing MVITV2, EfficientNet-B3, ResNet101, and ResNet34 as backbone networks, we developed four distinct DL models and evaluated their diagnostic performance based on metrics such as accuracy (ACC), area under the receiver operating characteristic curve (AUC), F1 score, and confusion matrix. Furthermore, the external test images were blindly evaluated by two spine surgeons with different levels of experience. We also used Gradient-Class Activation Maps to visualize the high-dimensional features of different DL models. Results For the internal validation set, MVITV2 outperformed other models with an accuracy of 98.7%, F1 score of 98.6%, and AUC of 0.98. Other models followed in this order: EfficientNet-B3 (ACC: 96.1%, F1 score: 95.9%, AUC: 0.99), ResNet101 (ACC: 85.5%, F1 score: 84.8%, AUC: 0.90), and ResNet34 (ACC: 81.6%, F1 score: 80.7%, AUC: 0.85). For the external test set, MVITV2 again performed excellently with an accuracy of 91.9%, F1 score of 91.5%, and an AUC of 0.95. EfficientNet-B3 came second (ACC: 85.9, F1 score: 91.5%, AUC: 0.91), followed by ResNet101 (ACC:80.8, F1 score: 80.0%, AUC: 0.87) and ResNet34 (ACC: 78.8, F1 score: 77.9%, AUC: 0.86). Additionally, the diagnostic accuracy of the less experienced spine surgeon was 73.7%, while that of the more experienced surgeon was 88.9%. Conclusion Deep learning based on T2WI sagittal images can help discriminate between STB and SM, and can achieve a level of diagnostic performance comparable with that produced by experienced spine surgeons.
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Affiliation(s)
- Shuo Duan
- Department of Orthopaedic Surgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Weijie Dong
- Department of Orthopedics, Beijing Chest Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Yichun Hua
- Department of Medical Oncology, Beijing Tiantan Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Yali Zheng
- Department of Respiratory, Critical Care, and Sleep Medicine, Xiang’an Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, People’s Republic of China
| | - Zengsuonan Ren
- Department of Orthopaedic Surgery, People’s Hospital of Hainan Tibetan Autonomous Prefecture, Hainan Tibetan Autonomous Prefecture, Qinghai Province, People’s Republic of China
| | - Guanmei Cao
- Department of Radiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Fangfang Wu
- Department of Respiratory, Critical Care, and Sleep Medicine, Xiang’an Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, People’s Republic of China
| | - Tianhua Rong
- Department of Orthopaedic Surgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Baoge Liu
- Department of Orthopaedic Surgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, People’s Republic of China
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Du R, Feng Y, Mao H. Case report: Diagnosis of Talaromyces marneffei infection in an HIV-negative patient with septic shock and high-titer anti-interferon gamma autoantibodies by metagenomic next-generation sequencing. Front Cell Infect Microbiol 2023; 13:1163846. [PMID: 37469600 PMCID: PMC10352806 DOI: 10.3389/fcimb.2023.1163846] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Accepted: 06/19/2023] [Indexed: 07/21/2023] Open
Abstract
Background Sepsis is a life-threatening condition caused by a dysfunctional response to infection from the host. Septic shock, a subset of sepsis, caused by Talaromyces marneffei infection (talaromycosis) has rarely been reported. Owing to its slow culture and low yield, talaromycosis is typically misdiagnosed in HIV-negative patients as other infections, such as tuberculosis, bacterial pneumonia, and lung cancer, especially in non-endemic regions. Early and accurate diagnosis as well as efficient treatment options are required to improve prognosis. Method A 30-year-old HIV-negative Chinese woman from a non-endemic area of T. marneffei was initially misdiagnosed with tuberculosis. She had a poor response to anti-tuberculosis treatment. On July 16, 2022, she was admitted to our hospital; the patient developed septic shock on the third day after hospitalization and was ultimately diagnosed with talaromycosis via metagenomic next-generation sequencing (mNGS). Result The condition of the patient improved after appropriate treatment with amphotericin B. Furthermore, enzyme-linked immunosorbent assay results confirmed that the patient had a high-titer of anti-interferon gamma (IFN-γ) autoantibodies. Conclusion HIV-negative individuals with anti-IFN-γ autoantibodies typically have relapsing, refractory, and fatal infections, such as talaromycosis, which is typically misdiagnosed in the initial course of the disease. This can lead to septic shock. Clinicians should be aware that they may encounter HIV-negative patients with T. marneffei infection in non-endemic areas. Thus, mNGS is an effective technology for detecting T. marneffei infection. Additionally, the detection of anti-IFN-γ autoantibodies in these patients would aid in knowing their susceptibility to fatal infections.
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Affiliation(s)
- Rao Du
- Department of Pulmonary and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan
| | - Yinhe Feng
- Department of Respiratory and Critical Care Medicine, People’s Hospital of Deyang City, Affiliated Hospital of Chengdu College of Medicine, Deyang, Sichuan, China
| | - Hui Mao
- Department of Pulmonary and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan
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Carabalí-Isajar ML, Rodríguez-Bejarano OH, Amado T, Patarroyo MA, Izquierdo MA, Lutz JR, Ocampo M. Clinical manifestations and immune response to tuberculosis. World J Microbiol Biotechnol 2023; 39:206. [PMID: 37221438 DOI: 10.1007/s11274-023-03636-x] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 04/29/2023] [Indexed: 05/25/2023]
Abstract
Tuberculosis is a far-reaching, high-impact disease. It is among the top ten causes of death worldwide caused by a single infectious agent; 1.6 million tuberculosis-related deaths were reported in 2021 and it has been estimated that a third of the world's population are carriers of the tuberculosis bacillus but do not develop active disease. Several authors have attributed this to hosts' differential immune response in which cellular and humoral components are involved, along with cytokines and chemokines. Ascertaining the relationship between TB development's clinical manifestations and an immune response should increase understanding of tuberculosis pathophysiological and immunological mechanisms and correlating such material with protection against Mycobacterium tuberculosis. Tuberculosis continues to be a major public health problem globally. Mortality rates have not decreased significantly; rather, they are increasing. This review has thus been aimed at deepening knowledge regarding tuberculosis by examining published material related to an immune response against Mycobacterium tuberculosis, mycobacterial evasion mechanisms regarding such response and the relationship between pulmonary and extrapulmonary clinical manifestations induced by this bacterium which are related to inflammation associated with tuberculosis dissemination through different routes.
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Grants
- a Fundación Instituto de Inmunología de Colombia (FIDIC), Carrera 50#26-20, Bogotá 111321, Colombia
- a Fundación Instituto de Inmunología de Colombia (FIDIC), Carrera 50#26-20, Bogotá 111321, Colombia
- a Fundación Instituto de Inmunología de Colombia (FIDIC), Carrera 50#26-20, Bogotá 111321, Colombia
- a Fundación Instituto de Inmunología de Colombia (FIDIC), Carrera 50#26-20, Bogotá 111321, Colombia
- b PhD Program in Biomedical and Biological Sciences, Universidad del Rosario, Carrera 24#63C-69, Bogotá 111221, Colombia
- c Health Sciences Faculty, Universidad de Ciencias Aplicadas y Ambientales (UDCA), Calle 222#55-37, Bogotá 111166, Colombia
- d Faculty of Medicine, Universidad Nacional de Colombia, Carrera 45#26-85, Bogotá 111321, Colombia
- e Medicine Department, Hospital Universitario Mayor Mederi, Calle 24 # 29-45, Bogotá 111411. Colombia
- e Medicine Department, Hospital Universitario Mayor Mederi, Calle 24 # 29-45, Bogotá 111411. Colombia
- f Universidad Distrital Francisco José de Caldas, Carrera 3#26A-40, Bogotá 110311, Colombia
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Affiliation(s)
- Mary Lilián Carabalí-Isajar
- Fundación Instituto de Inmunología de Colombia (FIDIC), Carrera 50#26-20, 111321, Bogotá, Colombia
- Biomedical and Biological Sciences Programme, Universidad del Rosario, Carrera 24#63C-69, 111221, Bogotá, Colombia
| | | | - Tatiana Amado
- Fundación Instituto de Inmunología de Colombia (FIDIC), Carrera 50#26-20, 111321, Bogotá, Colombia
| | - Manuel Alfonso Patarroyo
- Fundación Instituto de Inmunología de Colombia (FIDIC), Carrera 50#26-20, 111321, Bogotá, Colombia
- Faculty of Medicine, Universidad Nacional de Colombia, Carrera 45#26-85, 111321, Bogotá, Colombia
| | - María Alejandra Izquierdo
- Medicine Department, Hospital Universitario Mayor Mederi, Calle 24 # 29-45, 111411, Bogotá, Colombia
| | - Juan Ricardo Lutz
- Medicine Department, Hospital Universitario Mayor Mederi, Calle 24 # 29-45, 111411, Bogotá, Colombia.
| | - Marisol Ocampo
- Fundación Instituto de Inmunología de Colombia (FIDIC), Carrera 50#26-20, 111321, Bogotá, Colombia.
- Universidad Distrital Francisco José de Caldas, Carrera 3#26A-40, 110311, Bogotá, Colombia.
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Leowattana W, Leowattana P, Leowattana T. Tuberculosis of the spine. World J Orthop 2023; 14:275-293. [PMID: 37304201 PMCID: PMC10251269 DOI: 10.5312/wjo.v14.i5.275] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 02/24/2023] [Accepted: 04/12/2023] [Indexed: 05/18/2023] Open
Abstract
Pott's spine, commonly known as spinal tuberculosis (TB), is an extrapulmonary form of TB caused by Mycobacterium TB. Pott's paraplegia occurs when the spine is involved. Spinal TB is usually caused by the hematogenous spread of infection from a central focus, which can be in the lungs or another location. Spinal TB is distinguished by intervertebral disc involvement caused by the same segmental arterial supply, which can result in severe morbidity even after years of approved therapy. Neurological impairments and spine deformities are caused by progressive damage to the anterior vertebral body. The clinical, radiographic, microbiological, and histological data are used to make the diagnosis of spinal TB. In Pott's spine, combination multidrug antitubercular therapy is the basis of treatment. The recent appearance of multidrug-resistant/extremely drug-resistant TB and the growth of human immunodeficiency virus infection have presented significant challenges in the battle against TB infection. Patients who come with significant kyphosis or neurological impairments are the only ones who require surgical care. Debridement, fusion stabilization, and correction of spinal deformity are the cornerstones of surgical treatment. Clinical results for the treatment of spinal TB are generally quite good with adequate and prompt care.
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Affiliation(s)
- Wattana Leowattana
- Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, Rachatawee 10400, Bangkok, Thailand
| | - Pathomthep Leowattana
- Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, Rachatawee 10400, Bangkok, Thailand
| | - Tawithep Leowattana
- Department of Medicine, Faculty of Medicine, Srinakarinwirot University, Wattana 10110, Bangkok, Thailand
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Yang K, Feng C, Zheng B, Hui H, Kong L, Yan L, Hao D, He B. Single-Posterior Revision Surgery for Recurrent Thoracic/Thoracolumbar Spinal Tuberculosis With Kyphosis. Oper Neurosurg (Hagerstown) 2023:01787389-990000000-00694. [PMID: 37083590 DOI: 10.1227/ons.0000000000000702] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 02/02/2023] [Indexed: 04/22/2023] Open
Abstract
BACKGROUND AND OBJECTIVES The treatment of thoracic/thoracolumbar spinal tuberculosis (STB) remains challenging. The spinal deformity, long disease history, heterogeneous lesion, and poor drug response make the treatment of recurrent and kyphosis cases even more difficult. This study aims to investigate the efficacy and safety of single-posterior revision surgery in patients with recurrent thoracic/thoracolumbar STB and kyphosis. METHODS Patients with recurrent thoracic/thoracolumbar STB with kyphosis and treated with single-posterior debridement, osteotomy, correction, bone graft, and fusion in our center from 2009 to 2019 were enrolled. The clinical data, radiographs, and erythrocyte sedimentation rate (ESR) at different stages were collected. ESR, kyphotic angle, Visual Analog Scale, and neurological functions were analyzed. RESULTS A total of 27 patients (16 male, 11 female) with an average age of 48.4 ± 13.0 years were included. The average surgery time was 320.6 ± 46.4 minutes, and the average estimated blood loss was 1470.6 ± 367.4 mL. From admittance to the latest follow-up, the average Visual Analog Scale significantly reduced from 5.6 ± 1.3 to 0.5 ± 0.7, the average ESR was improved from 69.4 ± 15.8 mm/h to normal, and the average kyphotic angle was corrected from 66.6° ± 11.7° to 34.5° ± 6.6°. For patients with preoperative neurological deficits, their neurological functions were improved to normal. In drug susceptibility tests, 70.5% (11/17) of specimens had bacteria resistant to at least 1 first-line drug. CONCLUSION Single-posterior debridement, osteotomy, correction, bone graft, and fusion are effective and safe in the treatment of recurrent thoracic/thoracolumbar spinal tuberculosis with kyphosis. The drug treatment of recurrent spinal tuberculosis should be carefully tailored.
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Affiliation(s)
- Kai Yang
- Department of Spine Surgery, Honghui Hospital, Xi'an Jiaotong University, Xi'an, China
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Sharma K, Sharma M, Sharma A, Dhillon MS. Diagnosing osteo-articular tuberculosis and multidrug resistance using real-time polymerase chain reaction and high-resolution melt-curve analysis. J Orthop Res 2023; 41:891-896. [PMID: 35780389 DOI: 10.1002/jor.25410] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 06/21/2022] [Accepted: 06/29/2022] [Indexed: 02/04/2023]
Abstract
The study evaluated real-time quantitative polymerase chain reaction (qPCR) and high-resolution melt-curve analysis (HRM) for simultaneous diagnosis of osteo-articular tuberculosis (OATB) and drug resistance. Two hundred and fifty synovial fluid and pus specimens (20 confirmed OATB by culture, 130 suspected OATB, and 100 controls) processed in the Department of Medical Microbiology, PGIMER were subjected to qPCR using rpoB, MPB64, and IS6110 genes. All OATB positive specimens were subjected to HRM for detecting resistance to rifampicin and isoniazid. qPCR detected 129/150 OATB cases with a sensitivity of 86% (95% for confirmed and 84.6% for suspected OATB cases) and specificity of 100%. rpoB and MPB64 genes had higher sensitivity than IS6110 (86% vs. 74.6%). HRM reported eight multidrug resistant (MDR), two mono-rifampicin, and five mono-isoniazid resistant cases, all were concordant with gene sequencing. qPCR followed by HRM analysis offer a simple, accurate, and rapid platform for simultaneous detection of OATB and MDR.
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Affiliation(s)
- Kusum Sharma
- Department of Medical Microbiology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Megha Sharma
- Department of Microbiology, All India Institute of Medical Sciences (AIIMS), Bilaspur, Himachal Pradesh, India
| | - Aman Sharma
- Department of Internal Medicine, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Mandeep Singh Dhillon
- Department of Orthopaedics, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
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McVeigh LG, Zaazoue MA, Lane BC, Voorhies JM, Bradbury J. Management and outcomes of surgical site tuberculosis infection due to infected bone graft in spine surgery: a single-institution experience and 1-year postoperative follow-up. J Neurosurg Spine 2023; 38:281-292. [PMID: 36272124 DOI: 10.3171/2022.7.spine22534] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 07/06/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE In 2021, several patients across the United States received bone allograft contaminated with Mycobacterium tuberculosis (TB). TB is typically a pulmonary infection with many possible extrapulmonary manifestations, including skeletal tuberculosis. However, TB is a rare causative organism of postoperative surgical site infection. Iatrogenic skeletal TB infections are not widely reported in the medical literature; therefore, treatment and associated outcomes are relatively unknown. In this series, the authors report 6 cases of patients who received a mesenchymal stem cell-enhanced bone graft infected with TB at their institution, including the clinical courses, imaging findings, management plans, and outcomes at 1 year postoperatively. METHODS A retrospective review was performed of 6 consecutive patients who underwent spinal fusion surgery at the authors' institution and received bone graft from a lot contaminated with TB. Collected data included patient demographic characteristics, indications for surgery, surgical procedures performed, timing of contamination discovery, medical treatment, and follow-up information including reoperation, healing progress, and imaging findings. RESULTS Five of 6 patients (83.3%) eventually tested positive for TB via interferon-gamma release assay or wound culture. They experienced significant complications, including surgical site infections with neck swelling, pain, dysphagia, and wound dehiscence. Extensive soft-tissue infection was common; however, significant bony involvement was not observed. Surgical wound debridement was required in 4 patients, and all patients received medical management with standard RIPE (rifampin, isoniazid pyrazinamide, pyridoxine, and ethambutol) therapy for 8 weeks with extension of rifampin and isoniazid for scheduled 12 months. All patients (excluding 1 patient who died of COVID-19) showed signs of improvement with adequately healing wounds at the most recent follow-up at a median (range) of 12 (6-13) months postoperatively. To date, no patients have developed pulmonary TB. CONCLUSIONS Direct inoculation with TB via contaminated bone grafts resulted in a high rate of severe soft-tissue infection, although extensive skeletal and pulmonary involvement has not been observed at 1 year postoperatively; this review includes the longest reported follow-up period for this TB outbreak. Medical management remains the mainstay of therapy for these patients, with most patients showing recovery with oral antibiotic therapy. The severity of these infections arising from mesenchymal stem cell-containing bone allografts that undergo an alternative sterilization process than standard allografts raises concerns regarding the added risks of infection, which should be weighed against the expected benefits of these grafts.
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Pathogenesis, Diagnostic Challenges, and Risk Factors of Pott's Disease. Clin Pract 2023; 13:155-165. [PMID: 36826156 PMCID: PMC9955044 DOI: 10.3390/clinpract13010014] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 01/14/2023] [Accepted: 01/17/2023] [Indexed: 01/27/2023] Open
Abstract
Tuberculosis (TB) prevalence is increasing in developed nations and continuing to cause significant mortality in low- and middle-income countries. As a result of the uptick in cases, there also exists an increased prevalence of extrapulmonary TB. TB is caused by Mycobacterium tuberculosis (M. tb). When M. tb disseminates to the vertebral column, it is called Pott's disease or spinal TB. The frequency, symptoms, and severity of the disease range by the location of the spine and the region of the affected vertebrae. While the current literature shows that timely diagnosis is crucial to reduce the morbidity and mortality from Pott's disease, there is a lack of specific clinical diagnostic criteria for Pott's disease, and the symptoms may be very non-specific. Studies have shown that novel molecular diagnostic methods are effective and timely choices. Research has implicated the risk factors for the susceptibility and severity of Pott's disease, such as HIV and immunosuppression, poverty, and malnutrition. Based on the current literature available, our group aims to summarize the pathogenesis, clinical features, diagnostic challenges, as well as the known risk factors for Pott's disease within this literature review.
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Miyamoto K, Imada H, Yoshida S, Oka H, Iida S, Saita K, Ogihara S. Atypical clinical and radiological presentations of lumbar spinal tuberculosis mimicking a spinal tumor: A case report. Medicine (Baltimore) 2023; 102:e32730. [PMID: 36701731 PMCID: PMC9857248 DOI: 10.1097/md.0000000000032730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
INTRODUCTION Tuberculosis (TB) is an important infectious disease worldwide. Classical spinal TB has specific radiological findings involving adjacent vertebral bodies with destruction of the intervertebral disc and involvement of paravertebral soft tissues with cold abscess formation. However, a few cases not exhibiting the radiological characteristics of TB spondylitis have been reported. We report a rare case of lumbar spinal TB with atypical clinical and radiological presentations that was difficult to differentiate from a malignant spinal tumor. PATIENT CONCERNS A 21-year-old man, who had immigrated to Japan from the Philippines 5 years ago, without a significant medical history, presented with back pain lasting 1 month and progression of gait disturbance 2 weeks prior to presentation. DIAGNOSIS Laboratory tests showed normal blood cell counts and normal value of C-reactive protein levels. Preoperative imaging studies indicated a possible spinal tumor. However, histopathologic findings of the epidural soft tissues at the first surgery led to the diagnosis of spinal mycobacterial infection. The diagnosis of spinal TB was confirmed by a positive culture of Mycobacterium tuberculosis obtained at the second surgery. INTERVENTIONS Given the progressive nature of neurologic deterioration, instead of needle biopsy, we proceeded with surgical intervention 8 days after admission; simultaneous neural decompression and open biopsy. Histological findings of the excised epidural soft tissues led to the diagnosis of spinal mycobacterial infection. We performed the second surgery involving additional resection of epidural soft tissues for further dural decompression and to obtain specimens for mycobacterial culture. Immediately after the second surgery, the patient commenced combination therapy with anti-tuberculous drugs. OUTCOMES The patient demonstrated significant recovery of motor function in the lower extremities, and was able to run at 2 months after the second surgery. The epidural granulomas completely disappeared on magnetic resonance imaging 3 months postoperatively. CONCLUSION Atypical clinical and radiological presentations of spinal TB present a challenge for appropriate diagnosis and early treatment. Even in developed countries where there are very few spinal TB patients, clinicians should be aware that spinal TB is an important differential diagnosis, especially in elderly patients or patients coming from countries with a middle-high prevalence of TB.
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Affiliation(s)
- Kodai Miyamoto
- Department of Orthopaedic Surgery, Saitama Medical Center, Saitama Medical University, Saitama, Japan
| | - Hiroki Imada
- Department of Pathology, Saitama Medical Center, Saitama Medical University, Kawagoe, Saitama, Japan
| | - Shinsuke Yoshida
- Department of Neurosurgery, Saitama Medical Center, Saitama Medical University, Saitama, Japan
| | - Hideaki Oka
- Department of General Medicine, Saitama Medical Center, Saitama Medical University, Saitama, Japan
| | - Shunpei Iida
- Department of Orthopaedic Surgery, Saitama Medical Center, Saitama Medical University, Saitama, Japan
| | - Kazuo Saita
- Department of Orthopaedic Surgery, Saitama Medical Center, Saitama Medical University, Saitama, Japan
| | - Satoshi Ogihara
- Department of Orthopaedic Surgery, Saitama Medical Center, Saitama Medical University, Saitama, Japan
- * Correspondence: Satoshi Ogihara, Department of Orthopaedic Surgery, Saitama Medical Center, Saitama Medical University, 1981 Kamoda, Kawagoe, Saitama 350-8550, Japan (e-mail: )
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Muacevic A, Adler JR. An Unusual Presentation of Tuberculosis With Dysphagia. Cureus 2022; 14:e30174. [PMID: 36397918 PMCID: PMC9648149 DOI: 10.7759/cureus.30174] [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: 10/10/2022] [Indexed: 11/26/2022] Open
Abstract
About a quarter of the world's population is infected with tuberculosis (TB). It is one of the leading causes of death worldwide. However, the prevalence of TB in the United States is rare. Pulmonary TB is the commonest form of TB. Most patients with TB present with pulmonary symptoms. Extrapulmonary TB usually presents with symptoms related to the organ system involved and can present with very unusual symptoms. TB presenting with dysphagia is uncommon, and spinal TB presenting with dysphagia is very unusual. A 57-year-old woman presented to the emergency department with a four-month history of dysphagia and chest pain. She was undergoing an outpatient workup of her symptoms that included esophagogastroduodenoscopy, gastric emptying study, and computed tomography (CT) scan of the chest, which showed incidental findings of a focus in the thoracic spine. It was followed by a bone scan, and the results were concerning for malignancy. She was awaiting an oncology appointment when she presented to us. A basic workup after her presentation that includes complete blood count, comprehensive metabolic panel, troponin, chest x-ray, and electrocardiogram was unrevealing. Magnetic resonance imaging (MRI) of the thoracic spine showed findings suggestive of tuberculous spondylitis, tuberculous paraspinal, and prevertebral abscesses. Chest CT was repeated, which showed mass effect and erosion on the posterior esophageal wall with anterior displacement of the esophagus. Tissue biopsy revealed acid-fast bacilli (AFB) on AFB stain, and the culture grew Mycobacterium tuberculosis. She was successfully treated with the antitubercular regimen of rifampin, isoniazid, ethambutol, and pyrazinamide. TB can present with a myriad of symptoms, and although rare, it can present with symptoms like dysphagia. In patients with a history of travel to or immigration from an endemic region, previous infection, and immunosuppression, TB should be considered as one of the differential diagnoses even for unusual symptoms like dysphagia.
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Chen Y, Sheng B, Li J, Lv F. Tuberculous Thoracic Aortic Pseudoaneurysm Associated With Spinal Tuberculosis: A Case Report and Literature Review. Front Med (Lausanne) 2022; 9:882697. [PMID: 35721076 PMCID: PMC9198831 DOI: 10.3389/fmed.2022.882697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 05/09/2022] [Indexed: 11/13/2022] Open
Abstract
Background Thoracic aortic pseudoaneurysm associated with spinal tuberculosis is a rare but fatal condition. The risk of pseudoaneurysm rupture is extremely high and this disease needs greater awareness. The present study reported a case of thoracic aortic pseudoaneurysm caused by paravertebral cold abscess with spinal tuberculosis. Case presentation A 35-year-old woman with back pain was diagnosed with thoracic aortic pseudoaneurysm with spinal tuberculosis, and endovascular aneurysm repair (EVAR) was performed. The patient's symptoms disappeared after EVAR, following which she was discharged. Conclusions The case highlighted that in cases where non-enhanced computed tomography (CT) revealed that the aortic vessel was surrounded by a paravertebral abscess, magnetic resonance imaging (MRI) should be performed to confirm whether the presence of a pseudoaneurysm. Upon diagnosis of pseudoaneurysm, surgery should be performed immediately. In recent times, EVAR has emerged as a promising alternative to open surgery.
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Affiliation(s)
- Yurou Chen
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Bo Sheng
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Jia Li
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Furong Lv
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
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Guo Y, Xu M, Li L, Gu B, Zhang Z, Diao W. Comparative efficacy of traditional conservative treatment and CT-guided local chemotherapy for mild spinal tuberculosis. BMC Musculoskelet Disord 2022; 23:589. [PMID: 35717153 PMCID: PMC9206356 DOI: 10.1186/s12891-022-05545-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 06/09/2022] [Indexed: 03/27/2025] Open
Abstract
Background There are considerable differences in the treatment strategy for spinal tuberculosis, including conservative or surgical procedures. Conservative treatment is always suitable for most patients. This study aimed to compare the clinical efficacy of traditional conservative treatment with CT-guided local chemotherapy strategy of mild spinal tuberculosis. Methods This research retrospectively analysed 120 patients with spinal tuberculosis between January 2005 and January 2016 according to the diagnostic criteria of mild spinal tuberculosis. In total, 89 patients underwent traditional conservative treatment, 31 underwent CT-guided local chemotherapy. Clinical outcome, laboratory indexes, and radiological results were analysed to provide a clinical basis for the choice of mild spinal tuberculosis treatment. Results All cases achieved a clinical cure with 24 to 50 months followed up. Cobb angle of the two groups spinal tuberculosis segments was 6.25 ± 3.1100B0, 5.69 ± 2.5800B0 before treatment and 12.36 ± 6.3100B0, 14.87 ± 7.2600B0 after treatment, respectively. The VAS scores were significantly decreased post-treatment. At the 1 month follow-up, the VAS scores and erythrocyte sedimentation rate (ESR) were significantly differences between the two groups. The efficacy in the CT-guided local chemotherapy (Group B) was better than the traditional conservative treatment (Group A). But from the 3 months follow-up to the last follow-up, the VAS scores and ESR was no significant differences between the two groups and the average ESR decreased to normal. There was no evident kyphosis, symptoms or neurological deficits at the final follow-up. The paravertebral abscesses had disappeared, with no significant progression of local kyphosis, significant absorption and clear lesion edges, pain relief and normal ESR in the two groups. Conclusions For mild spinal tuberculosis, traditional conservative treatment can achieve satisfactory results. The strategy combined with CT-guided local chemotherapy treatment is minimally invasive, beneficial for the drainage of paravertebral abscesses and pain relief.
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Affiliation(s)
- Yangyang Guo
- Department of Orthopaedics, Zhoukou Orthopedic Hospital, Eastern Taihao Road, Zhoukou City, Henan Province, China
| | - Meitao Xu
- Department of Orthopaedics, Southwest Hospital, Third Military Medical University, Chongqing, China
| | - Lei Li
- Department of Orthopaedics, Zhoukou Orthopedic Hospital, Eastern Taihao Road, Zhoukou City, Henan Province, China
| | - Bin Gu
- Department of Orthopaedics, Zhoukou Orthopedic Hospital, Eastern Taihao Road, Zhoukou City, Henan Province, China
| | - Zehua Zhang
- Department of Orthopaedics, Southwest Hospital, Third Military Medical University, Chongqing, China.
| | - Wenbo Diao
- Department of Orthopaedics, Zhoukou Orthopedic Hospital, Eastern Taihao Road, Zhoukou City, Henan Province, China.
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Benammou A, Elloumi A, Kamoun C, Bellil M, Balti W, Ben Dhia S, Mahmoud I, Abdelmoula L, Hadhri K, Kooli M, Ben Salah M. Fortuitous discovery of isolated tuberculosis of the tenth and eleventh costotransverse joints: A case report. Radiol Case Rep 2022; 17:1897-1900. [PMID: 35401892 PMCID: PMC8991227 DOI: 10.1016/j.radcr.2022.03.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 02/25/2022] [Accepted: 03/02/2022] [Indexed: 11/18/2022] Open
Affiliation(s)
- Adnene Benammou
- Orthopedic surgery department, Charles Nicolle's Hospital. Boulevard 9 avril. Tunis, Tunisia
- Corresponding author.
| | - Ahmed Elloumi
- Orthopedic surgery department, Charles Nicolle's Hospital. Boulevard 9 avril. Tunis, Tunisia
| | - Chrif Kamoun
- Orthopedic surgery department, Charles Nicolle's Hospital. Boulevard 9 avril. Tunis, Tunisia
| | - Mehdi Bellil
- Orthopedic surgery department, Charles Nicolle's Hospital. Boulevard 9 avril. Tunis, Tunisia
| | - Walid Balti
- Orthopedic surgery department, Charles Nicolle's Hospital. Boulevard 9 avril. Tunis, Tunisia
| | - Siwar Ben Dhia
- Rheumatology department, Charles Nicolle's Hospital, Boulevard 9 avril, Tunis, Tunisia
| | - Ines Mahmoud
- Rheumatology department, Charles Nicolle's Hospital, Boulevard 9 avril, Tunis, Tunisia
| | - Leila Abdelmoula
- Rheumatology department, Charles Nicolle's Hospital, Boulevard 9 avril, Tunis, Tunisia
| | - Khaled Hadhri
- Orthopedic surgery department, Charles Nicolle's Hospital. Boulevard 9 avril. Tunis, Tunisia
| | - Mondher Kooli
- Orthopedic surgery department, Charles Nicolle's Hospital. Boulevard 9 avril. Tunis, Tunisia
| | - Mohamed Ben Salah
- Orthopedic surgery department, Charles Nicolle's Hospital. Boulevard 9 avril. Tunis, Tunisia
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Qiu J, Peng Y, Qiu X, Gao W, Liang T, Zhu Y, Chen T, Hu W, Gao B, Deng Z, Liang A, Huang D. Comparison of anterior or posterior approach in surgical treatment of thoracic and lumbar tuberculosis: a retrospective case-control study. BMC Surg 2022; 22:161. [PMID: 35538532 PMCID: PMC9092713 DOI: 10.1186/s12893-022-01611-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Accepted: 04/19/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND With the widespread use of the posterior surgery, more and more surgeons chose posterior surgery to treat thoracic and lumbar tuberculosis. But others still believed that the anterior surgery is more conducive to eradicating the lesions, and easier to place larger bone pieces for bone graft fusion. We compared the clinical and radiological outcomes of anterior and posterior surgical approaches and presented our views. METHODS This study included 52 thoracic and lumbar tuberculosis patients at Sun Yat-sen Memorial Hospital from January 2010 to June 2018. All cases underwent radical debridement, nerve decompression, intervertebral bone graft fusion and internal fixation. Cases were divided into anterior group (24 cases) and posterior group (28 cases). Statistical analysis was used to compare the clinical effectiveness, radiological outcomes, complications and other related information. RESULTS Patients in the anterior group and the posterior group were followed up for an average of 27.4 and 22.3 months, respectively. There were no statistically significant differences between groups in the preoperative, postoperative and last follow-up VAS score, ASIA grade and Cobb angle of local kyphosis. Moreover, there were no statistically significant differences in the improvement of neurological function, loss of kyphotic correction, total incidence of complications, operative time, intraoperative blood loss and hospital stay between the two groups (P > 0.05). But there was greater correction of kyphosis, earlier bone fusion, lower incidence of poor wound healing, less interference with the normal spine and less internal fixation consumables and medical cost in the anterior group (P < 0.05). CONCLUSIONS Both anterior and posterior approaches are feasible for thoracic and lumbar tuberculosis. While for thoracic and lumbar tuberculosis patients with a single lesion limited in the anterior and middle columns of the spine without severe kyphosis, the anterior approach surgery may have greater advantages in kyphosis correction, bone fusion, wound healing, protection of the normal spine, and medical consumables and cost.
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Affiliation(s)
- Jincheng Qiu
- Department of Orthopedics, Sun Yat-Sen Memorial Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Yan Peng
- Department of Orthopedics, Sun Yat-Sen Memorial Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Xianjian Qiu
- Department of Orthopedics, Sun Yat-Sen Memorial Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Wenjie Gao
- Department of Orthopedics, Sun Yat-Sen Memorial Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Tongzhou Liang
- Musculoskeletal Research Laboratory, Department of Orthopaedics and Traumatology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Yuanxin Zhu
- Department of Orthopedics, Sun Yat-Sen Memorial Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Taiqiu Chen
- Department of Orthopedics, Sun Yat-Sen Memorial Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Wenjun Hu
- Department of Orthopedics, Sun Yat-Sen Memorial Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Bo Gao
- Department of Orthopedics, Sun Yat-Sen Memorial Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Zhihuai Deng
- Department of Orthopedics, Sun Yat-Sen Memorial Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Anjing Liang
- Department of Orthopedics, Sun Yat-Sen Memorial Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, China.
| | - Dongsheng Huang
- Department of Orthopedics, Sun Yat-Sen Memorial Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, China.
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Leos-Leija AK, Padilla-Medina JR, Reyes-Fernández PM, Peña-Martínez VM, Montes-Tapia FF, Castillo-Bejarano JI. Vertebral destruction in an 11-month-old child with spinal tuberculosis: a case report and review of literature. ANNALS OF PEDIATRIC SURGERY 2022. [DOI: 10.1186/s43159-022-00160-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
The incidence of tuberculosis is increasing especially in endemic countries. Spinal tuberculosis represents nearly the 50% of reported cases of skeletal tuberculosis. This is the youngest case of spinal tubercular disease that has been reported. The objective of this report is to describe a spinal tuberculosis case in an infant in thoracic spine, in order to show the importance of early diagnosis in this population, to limit the progression of this highly destructive disease and reduce the severe sequelae that this disease is associated.
Case presentation
An 11-month-old infant previously healthy born in the northeast Mexico. Physical examination revealed a mass lesion in the dorsal region, fixed to deep planes, indurated. Neurological examination found Frankel C paraparesis showing muscle strength 2/5 on the Lovett scale in both lower extremities, anal reflex present, and preserved sensitivity.
In the magnetic resonance of the spine, hyperintensities in the vertebral bodies of D6-D9 were observed in the T2 with destruction of the D7 and D8 bodies. A thoracotomy was performed with total mass resection with corpectomy of vertebrae D7 and D8, medullary decompression, and placement of fibula allograft between vertebrae D6 and D9. In the histopathological sample, a chronic granulomatous inflammatory process associated with acid-fast bacilli was observed, in addition to presenting a positive result in quantitative real-time PCR GeneXpert MTB/RIF sensitive to rifampicin. Twelve months later, he presented 5/5 muscular strength, without alterations in sensitivity, in addition to presenting ambulation onset at 18 months of age.
Conclusion
The spinal tuberculosis is a disease that occurs in endemic countries. A prompt diagnosis is necessary to limit the progression of a highly destructive disease. In addition, the fact of presenting at an early age produces hard making decisions for the adequate treatment of the disease and reduces the adverse effects of these procedures.
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Zhang H, Xiao L, Tang M, Yang G. Spinous Process Combined With a Titanium Mesh Cage as a Bone Graft in the Stability Reconstruction of Lumbar or Lumbosacral Spinal Tuberculosis. Front Surg 2022; 9:818926. [PMID: 35445070 PMCID: PMC9013749 DOI: 10.3389/fsurg.2022.818926] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Accepted: 03/10/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundAutogenous bone grafts, such as iliac bone or rib struts, have been used in the anterior reconstruction of spinal tuberculosis (STB) and have their own benefits and limitations. Here, we introduced a new method, the spinous process (SP), combined with a titanium mesh cage (TMC) as a bone graft in the stability reconstruction of lumbar or lumbosacral STBs. By retrospectively comparing patients who received SP+TMC to traditional TMC bone grafts or allogeneic bone grafts in terms of safety, efficacy and cost-effectiveness, we aimed to evaluate whether SP+TMC could be a possible alternative method.MethodsFrom 2010 to 2018, 69 patients who underwent one-stage posterior debridement with grafts and internal fixation within a single lumbar or lumbosacral segment were included in this study. Twelve patients who received SP combined with a TMC (SP+TMC, group A), 30 patients who received a TMC only (group B), and 27 patients who received allografts (group C) were included. Measurements including operative time, blood loss, length of hospital stay, visual analog scale (VAS) score, Oswestry Disability Index (ODI), erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), American Spinal Injury Association Impairment (ASIA) grade, final follow-up (FFU) duration and postoperative complications were recorded. Radiological measurements, including the number of segments fixated, the number of pedicle screws used, the Cobb angle, pelvic parameters, and the bony fusion time, were reviewed. All outcomes were analyzed using SPSS 25.ResultsWe found that the SP+TMC group had fewer fixation segments, fewer pedicle screws implanted, a shorter operative time, reduced blood loss, and a considerably lower hospital cost than allografts. In addition, the TMC group had a comparable clinical outcome with the TMC group regarding lower economic cost.ConclusionOur study demonstrates that compared to a TMC or allograft, the use of SP combined with a TMC as a bone graft is an effective and reliable approach for the surgical management of one-level lumbar or lumbosacral spinal tuberculosis, leading to effective restoration of spinal stability. Furthermore, this approach is a cost-effective structural bone grafting method, especially for patients in developing countries.
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Affiliation(s)
- Hongqi Zhang
- Department of Spine Surgery and Orthopaedics, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Lige Xiao
- Department of Spine Surgery and Orthopaedics, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Mingxing Tang
- Department of Spine Surgery and Orthopaedics, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Guanteng Yang
- Department of Spine Surgery and Orthopaedics, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
- *Correspondence: Guanteng Yang
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Qi Y, Liu Z, Liu X, Fang Z, Liu Y, Li F. Tuberculosis-Specific Antigen/Phytohemagglutinin Ratio Combined With GeneXpert MTB/RIF for Early Diagnosis of Spinal Tuberculosis: A Prospective Cohort Study. Front Cell Infect Microbiol 2022; 12:781315. [PMID: 35174105 PMCID: PMC8842995 DOI: 10.3389/fcimb.2022.781315] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Accepted: 01/10/2022] [Indexed: 12/27/2022] Open
Abstract
Spinal tuberculosis (TB), the most common form of musculoskeletal tuberculosis, is an infection-related disease globally, with paraplegia occurring in severe cases. Therefore, identification of spinal TB at an early stage is important for early intervention and eventual therapy. In this study, we conducted a prospective cohort study in routine clinical practice to investigate the diagnosis of different TB tests. A total of 519 patients were recruited based on the radiology of spinal TB. The diagnostic model was computed by regression analysis and was determined by receiver operating characteristic (ROC) curve analysis. Specificity, sensitivity, predictive value, likelihood ratio, and accuracy were also computed and compared. GeneXpert MTB/RIF showed a higher positive rate compared to that in the acid-fast bacilli smear and Mycobacterium culture. The results also showed that the Mycobacterium tuberculosis-specific antigen/phytohemagglutinin ratio in the T-SPOT assay had a good performance in the preoperative diagnosis and prediction of spinal TB. The diagnostic model based on the ratio of tuberculosis-specific antigen/phytohemagglutinin combined with GeneXpert MTB/RIF showed better efficiency for spinal TB diagnosis. In summary, the tuberculosis-specific antigen/phytohemagglutinin ratio combined with GeneXpert MTB/RIF could provide an early diagnosis of spinal TB.
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Affiliation(s)
- Yiwei Qi
- Department of Neurosurgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Laboratory Sino-German Neuro-Oncology Molecular, Department of Neurosurgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Zhiwei Liu
- Department of Orthopedic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xiaojin Liu
- Department of Neurosurgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Laboratory Sino-German Neuro-Oncology Molecular, Department of Neurosurgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Zhong Fang
- Department of Orthopedic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yanchao Liu
- Department of Neurosurgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Laboratory Sino-German Neuro-Oncology Molecular, Department of Neurosurgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- *Correspondence: Feng Li, ; Yanchao Liu,
| | - Feng Li
- Department of Orthopedic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- *Correspondence: Feng Li, ; Yanchao Liu,
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Wang L, Yang Z, Wang C, Zhu X, Shi J, Niu N. Isolated tuberculosis of the lumbar facet joint: A case report. Medicine (Baltimore) 2021; 100:e28268. [PMID: 34941107 PMCID: PMC8701758 DOI: 10.1097/md.0000000000028268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 11/25/2021] [Indexed: 01/05/2023] Open
Abstract
RATIONALE Spinal tuberculosis (TB) is the most common in bone and joint TB, of which vertebral TB is more common, while accessory TB is rare. The incidence of isolated adnexal lesions in spinal TB is 2% to 3%. It is difficult to distinguish the imaging changes of spinal adnexal TB from other types of spinal infections and spinal tumors, and the pathological diagnosis of spinal TB is often atypical. Here, we report a case of isolated lumbar facet joint TB. PATIENT CONCERNS A 64-year-old female patient had an 8-month history of low back pain, decreased pinprick sensation in the left anterior middle thigh area, weakening of the patellar tendon reflex of the left lower limb, and enhanced MRI of the lumbar vertebrae showed bone destruction at the left superior and inferior articular process of the lumbar 2 to 3 and the encapsulated calcification containing the lesion around the articular process. The enhanced scan showed solid part and septal enhancement, and the lesion protruded to the left and posterior side of the spinal canal, and the left posterior edge of the dural sac was compressed at the same level. Conservative treatment for 8 months was ineffective. DIAGNOSES L2-3 vertebral lamina, facet joint, and intraspinal space-occupying Lamina TB. INTERVENTIONS The diagnostic treatment scheme for anti-TB drugs was routinely administered before the operation. Isoniazid (300 mg), rifampicin (450 mg), ethambutol (750 mg), and pyrazinamide (1500 mg) were administered orally once daily after breakfast for 1 month, as anti-TB treatment for 1 month. Posterior lumbar total laminectomy and decompression, pedicle screw internal fixation, TB focus debridement, lumbar intertransverse process bone graft fusion was performed 1 month later. OUTCOMES The patient was relieved of symptoms after surgical treatment and anti-tubercular medication. LESSONS We present a case of isolated TB of the lumbar facet joint, which was initially diagnosed as L2-3 vertebral lamina, facet joint, and intraspinal space-occupying osteochondroma. For patients with long-term low back pain, it is suggested to follow-up with lumbar computed tomography and lumbar magnetic resonance imaging when conventional X-ray examination does not show any lesion. Despite its rarity, isolated TB of the lumbar facet joint should be highly suspected in elderly patients with pulmonary TB, low-grade fever, and waist pain.
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Affiliation(s)
- Linan Wang
- Clinical Medical College of Ningxia Medical University, Yinchuan, China
| | - Zongqiang Yang
- Department of Spine Surgery, General Hospital of Ningxia Medical University, Yinchuan, China
| | - Chaoran Wang
- Clinical Medical College of Ningxia Medical University, Yinchuan, China
| | - Xi Zhu
- Clinical Medical College of Ningxia Medical University, Yinchuan, China
- Department of Spine Surgery, General Hospital of Ningxia Medical University, Yinchuan, China
| | - Jiandang Shi
- Department of Spine Surgery, General Hospital of Ningxia Medical University, Yinchuan, China
| | - Ningkui Niu
- Department of Spine Surgery, General Hospital of Ningxia Medical University, Yinchuan, China
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Pinto D, Dhawale A, Shah I, Rokade S, Shah A, Chaudhary K, Aroojis A, Mehta R, Nene A. Tuberculosis of the spine in children - does drug resistance affect surgical outcomes? Spine J 2021; 21:1973-1984. [PMID: 34116216 DOI: 10.1016/j.spinee.2021.06.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 05/09/2021] [Accepted: 06/01/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT The emergence of drug resistance has complicated the management of spinal tuberculosis (TB). While it is well known that the medical management of drug-resistant spinal TB is more difficult, the surgical outcomes of the same have not been studied sufficiently, particularly in children. PURPOSE To analyze the surgical outcomes in a cohort of children treated for spinal TB, and to thus assess whether drug resistant (DR) disease is associated with poorer surgical outcomes. STUDY DESIGN/SETTING Retrospective observational study. PATIENT SAMPLE All children diagnosed and treated for tuberculous spondylodiscitis at a single center between January 2014 and June 2017. OUTCOME MEASURES Surgical outcomes in terms of neurological status and kyphosis angle at final follow-up, and complication rates. METHODS Radiographic and clinical data of children treated for spinal TB with minimum two-year follow-up were retrospectively analyzed. Data gathered included age, gender, level of spine affected, number of vertebrae involved, neurology (Frankel grade), microbiological reports, duration and type of anti-tuberculous therapy (ATT), details of Orthopaedic management and complications during treatment. In DR cases, the time from presentation to starting of second-line ATT was also assessed. Radiographs were reviewed to note the pre- and post-operative degree of kyphosis as well as the angle at final follow-up. Patients that developed major complications were compared statistically with those that did not. RESULTS Forty-one consecutive children (mean age 8.5 ± 4.2 years, 20 boys, 21 girls) were treated for spinal TB with a mean follow-up of 31.2 ± 6.4 months. Fifteen were managed conservatively, of which only one had DR-TB. Of the 26 managed surgically, 13 were managed with first-line ATT and 13 required second-line ATT. Of this latter group, eight had microbiologically proven drug resistance, whereas five were switched to second-line therapy presumptively because of failure to show an adequate response to first-line regimen. At last follow-up, all children had completed the prescribed course of ATT and had been declared cured. Neurological improvement was seen in all but one patient; and at last follow-up, 18 children were Frankel E, seven were Frankel D, and one was Frankel B. 1The immediate post-operative Kyphosis angle averaged 24.38° ± 15.21°. However, six children showed a subsequent worsening of kyphosis, and the Kyphosis angle at last follow-up averaged 30.96° ± 23.92°. Five children had major complications requiring revision surgery; complications included wound dehiscence, vertebral collapse, screw pull-out and implant breakage. Significantly higher number of patients in the group with complications had required second-line ATT (p < .05). CONCLUSIONS In a cohort of children treated surgically for spinal tuberculosis, a higher complication rate, and thus poor surgical outcomes, were found to be associated with drug resistant disease.
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Affiliation(s)
- Deepika Pinto
- Department of Orthopaedics, Bai Jerbai Wadia Hospital for Children, Parel, Mumbai 400012, India
| | - Arjun Dhawale
- Department of Orthopaedics, Bai Jerbai Wadia Hospital for Children, Parel, Mumbai 400012, India; Department of Orthopaedics, Sir H.N. Reliance Foundation Hospital, Girgaon, Mumbai 400004, India.
| | - Ira Shah
- Paediatric TB Clinic, Bai Jerbai Wadia Hospital for Children, Parel, Mumbai 400012, India
| | - Sarang Rokade
- Department of Orthopaedics, Bai Jerbai Wadia Hospital for Children, Parel, Mumbai 400012, India
| | - Avi Shah
- Department of Orthopaedics, Bai Jerbai Wadia Hospital for Children, Parel, Mumbai 400012, India
| | - Kshitij Chaudhary
- Department of Orthopaedics, Sir H.N. Reliance Foundation Hospital, Girgaon, Mumbai 400004, India
| | - Alaric Aroojis
- Department of Orthopaedics, Bai Jerbai Wadia Hospital for Children, Parel, Mumbai 400012, India
| | - Rujuta Mehta
- Department of Orthopaedics, Bai Jerbai Wadia Hospital for Children, Parel, Mumbai 400012, India
| | - Abhay Nene
- Department of Orthopaedics, Bai Jerbai Wadia Hospital for Children, Parel, Mumbai 400012, India
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Single-stage posterior resection of the transversal process combined with an intervertebral foraminal approach for debridement, interbody fusion, internal fixation for the treatment of lumbar tuberculosis and psoas major abscess. INTERNATIONAL ORTHOPAEDICS 2021; 46:331-339. [PMID: 34693463 DOI: 10.1007/s00264-021-05244-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 10/08/2021] [Indexed: 12/19/2022]
Abstract
PURPOSES To investigate the feasibility and clinical efficacy of the treatment for lumbar tuberculosis with psoas major abscess with single-stage posterior resection of the transversal process combined with an intervertebral foraminal approach for debridement, interbody fusion, internal fixation. METHODS This retrospective study evaluated the clinical data of 24 patients (14 males and 10 females) with lumbar tuberculosis and psoas major abscess admitted to the Comprehensive Surgery from June 2016 to June 2019. All patients were treated with the single-stage posterior approach to remove the transverse process combined with the intervertebral foramina approach for debridement, interbody fusion, internal fixation. The quadruple anti-tuberculosis drug therapy was given both pre-operatively and post-operatively. Clinical symptoms and complications were investigated and recorded. The visual analogue scale (VAS), American Spinal Injury Association (ASIA), degree of lesion fusion C-reactive protein (CRP) levels, and erythrocyte sedimentation rate (ESR) were evaluated. RESULTS The average follow-up period was 16. 5 months (from 12 to 36 months). The average VAS score at three months post-operation was significantly declined than the pre-operative VAS score [(2.17 ± 0.87) points vs (5.46 ± 1.22) points, t = - 11.534, P < 0.01)]. At the last follow-up, the neurological function of 20 patients recovered to grade E, whereas four patients were still in grade D. The ESR and CRP returned to normal levels in all patients. Bone fusion was achieved in nine cases at six months, 11 cases at nine months, and four cases at 12 months. The incisions of 23 patients had healed nicely without chronic sinus. Poor incision healing only happened in one case at the day 12 post-operation. The bone grafts among the lesions obtained bony fusion. Besides, there was no recurrence of tuberculosis, loosening or fracture of internal fixation during the follow-up. CONCLUSION Single-stage posterior resection of the transversal process combined with an intervertebral foramina approach for debridement, interbody fusion, internal fixation is probably an effective and safe approach of the treatment for lumbar tuberculosis combined with psoas major abscess, producing few complications. This technique provides an alternative method for the surgical treatment of lumbar tuberculosis combined with psoas major abscess.
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