A modern approach to the diagnosis of tuberculous spondylitis (literature review)

Objective — provide a systematic analysis of the scientific literature on the current state of diagnosis of patients with tuberculous spondylitis (TS), and identify prospects for improving the diagnosis of this disease. Materials and methods. To carry out this work, we analyzed 118 literature sources from the Pub Med database on the records of Diagnosis of extrapulmonary tuberculosis. Diagnosis of tuberculous spondylitis, and 26 of them tacked for detailed study. Results and discussion. It was found that TS is the most severe clinical form of osteoarticular tuberculosis (OATB), which is a serious medical and social problem. The percentage of diagnostic errors in TS is very high and its level in recent decades has a clear tendency to increase. The diagnostic pause in this disease usually lasts at least three months. Clinico-radiological examinations are the most accessible and widely used in the world, being the basis for the diagnosis of OATB. From the standpoint of evidence-based medicine, a verified (proven) diagnosis of OATB should be based on data from bacteriological and histological examination of pathological material. Quite often the course of the TS is accompanied by the phenomena of pathomorphosis, which significantly complicates the differential diagnosis. In scientific publications, insufficient attention is paid to the issue of etiological diagnosis of the disease, but traditional methods of clinical and radiological studies have a significant percentage of diagnostic errors. Conclusions. Diagnosis of TS in modern conditions in the vast majority of cases occurs at a later stage (in the advanced form), which causes significant difficulties in the treatment this category of patients.It is important to improve the methods of etiological diagnosis of TS with the following studies sensitivity of the pathogen to antibacterial drugs, which is one of the main conditions for successful treatment.

Operative methods of fixation of the spine. Shamov (Nov. Chir. Archives, 1922)

Currently, surgical methods of spinal fixation in tuberculous spondylitis are quite numerous. Based on a review of the literature and 50 own clinical cases, the author considers the following to be the most appropriate among them.

Operative method of treatment of tuberculous spondylitis

After in the 90s of the XVIII century. the pathology of bone tuberculosis became known, it was found that the rest of the diseased joint is an essential factor in the fight against tuberculosis.

Tuberculous spondylitis

Tuberculous spondylitis in the Orthopedic Department of the Charit Surgical Polyclinic in Berlin, according to the study of Bergmann'a (Arch. F. Orthop. U. Unf-Chir., 1923, XXII), during the time from 1912 to 1922 was established 342 times, which is 23% in relation to all bone-tuberculosis patients.

Diagnosis of tuberculous spondylitis

Diagnosis of tuberculous spondylitis in adults, especially in the absence of kyphosis and a characteristic response to the load of the spine, is often very difficult. Barr (Bulk md., No. 10, 1923) advises in such cases to pay special attention to various "neuralgic" phenomena, unilateral increase in tendon reflexes and Babinsk'oro symptom, as well as to limited rigidity of the spinal muscles.

A Case of Tuberculous Spondylitis in Child with Undernourish

Tuberculous spondylitis accounts for around 2% of all cases of Tuberculosis (TB) and around 15% of extrapulmonary TB cases. It has been reported that a 17 years old boy with a complaint of a bump on the lumbar region and felt low back pain since two years before admission with a history of back trauma. There was a decrease of body weight. There was no paraesthesia nor paralysis. Defecation and micturition were normal. Basic immunization was incomplete. On physical examination found palpable lymph nodes 0,5x0,5x0,5 cm, multiple et regio colli. There was no BCG scar. Impression nutritional status was undernourished. There was fixed palpable mass at back size about 5x4x5 cm, hard, no fluctuations, no rebound tenderness. Lung examination was normal. Tuberculin test showed induration sized 20 mm. Gene Xpert result Micobacterium Tuberculosis (MTB) not detected. On chest X-ray examination found L1-2 corpus destruction. MRI Spine was suggestive of compressive fractures and suggestive of a bilateral psoas abscess. Decompression and lumbar stabilization surgery were performed. The histopathology examination results were consistent to spondylitis TB characteristics. The patient was discharged on 6th hospitalization and given anti-tuberculous drug.Keywords: bump, extrapulmonary, fracture, spondylitis, tuberculosis

Immediate and postponed results of surgery of tuberculosis in patients with HIV infection

The objective: to evaluate immediate and postponed results of surgical treatment of tuberculosis (TB) in patients with TB/HIV co-infection.Subjects and methods. 106 patients underwent surgery: 64 patients suffering from pulmonary tuberculosis (81.2% had resections, and 18.8% – thoracoplasty), 36 patients – tuberculous spondylitis (vertebral body resection in combination with anterior spondylodesis), and 6 patients – cerebral TB (removal of tuberculous lesions under neuronavigation). Development of complications in the postoperative period and tuberculosis relapses in the long-term period was assessed.Results. No severe and suppurative complications were observed in the postoperative period in patients with HIV/pulmonary TB and HIV/cerebral TB. In patients with HIV/TB spondylitis, complications were registered in 4/36 (11.1%) cases: in 2/4 – postoperative wound suppuration and in 2/4 – ligature fistulas. No relapse of tuberculosis was reported after lung resection in 45 out of 45 patients availabe for follow-up, after thoracoplasty in 10 out of 12 patients, after surgery due to tuberculous spondylitis – in 25 out of 27 patients, and cerebral tuberculosis – in 5 out of 6.

Intravoxel Incoherent Motion for Differentiating Spinal Metastasis: A Pilot Study

Background: To investigate the value of an intravoxel incoherent motion (IVIM) MRI for discriminating spinal metastasis from tuberculous spondylitis.Methods: This study included 50 patients with spinal metastasis (32 lung cancer, 7 breast cancer, 11 renal cancer), and 20 tuberculous spondylitis. All patients underwent IVIM MRI at 3.0T before treatment. The IVIM parameters including single-index model ( Apparent diffusion coefficient (ADC)-stand), double exponential model (ADCslow，ADCfast and f) and stretched-exponential model parameters (distributed diffusion coefficient (DDC) and α) were acquired. Two radiologists separately measured these parameters for each lesion through drawing region of interest. Receiver operating characteristic (ROC) and the area under the ROC curve analysis was used to evaluate the diagnostic performance. Each parameter was substituted into the Logistic regression model to determine the meaningful parameters, and the combined diagnostic performance was evaluated.Results: The ADCfast and f showed significant differences between spinal metastasis and tuberculous spondylitis. (for all, p < 0.05). The Logistic regression model results showed that ADCfast and f were independent factors affecting the conclusion (P<0.05). The AUC values of ADCfast and f were 0.823 (95%CI:0.719 to 0.927) and 0.876 (95%CI: 0.782 to 0.969), respectively. ADCfast combined with f showed the highest AUC value of 0.925 (95%CI: 0.858 to 0.992). Additional significant differences were found in ADCstand, ADCslow, DDC and α among different metastasis type.Conclusions: IVIM MR imaging may be helpful for differentiating spinal metastasis from tuberculous spondylitis and may be used to detect the origin tumor for those patients who could not identify primary tumors, and provide help for clinical treatment.