Efficacy analysis of one-stage posterior-only surgical treatment for thoracic spinal tuberculosis in the T4–6 segments with minimum 5-year follow-up

In recent years, with the in-depth research on spinal tuberculosis, posterior surgery alone has been praised highly by more and more surgeons due to the better correction of kyphosis, better maintenance of spinal physiological curvature, smaller surgical trauma and fewer surgical complications. However, there is currently lack of relevant reports about the efficacy of posterior surgery alone in the treatment of tuberculosis in the T4–6 segments. This study aimed to evaluate the clinical study efficacy and feasibility of one-stage posterior-only surgical treatment for thoracic spinal tuberculosis in the T4–6 segments. 67 patients with tuberculosis in T4–6 segments who underwent one-stage posterior-only surgery were included in this study. The clinical efficacy was evaluated using statistical analysis based on the data about erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), Oswestry Dability Index (ODI) score, Visual Analogue Scale (VAS) score and Cobb angle before surgery, after surgery and at the last follow-up. All patients completed fusion during the follow-up period of 6–9 months. ESR and CRP were returned to normal for all patients at 6 months follow-up. In the meanwhile, among the 27 patients combined with neurological impairment, neurological functions of 22 cases (81.48%) recovered completely at the last follow-up (P < 0.05). Cobb angle of the kyphosis was improved from preoperative 34.8 ± 10.9° to postoperative 9.6 ± 2.8°, maintaining at 11.3 ± 3.2° at the last follow-up, The ODI and VAS scores were improved by 77.10% and 81.70%, respectively. This 5-year follow-up study shows that better clinical efficacy can be achieved for tuberculosis in T4–6 segments using one-stage posterior-only approach by costotransverse debridement in combination with bone graft and internal fixation. The posterior surgical method cannot only effectively accomplish debridement, obtain satisfactory clinical results, but also well correct kyphotic deformity and maintain it.

Study on the expression level of NF-κB and clinical evaluations in spinal tuberculosis patients

Spinal tuberculosis or tuberculous spondylitis is one of the most common types of skeletal tuberculosis. Complications of the spine and spinal cord tuberculosis include destruction of the vertebrae, deformity, and paraplegia. Since in some patients, the clinical manifestations of tuberculosis are unusual and timely diagnosis and treatment of this disease can prevent its serious consequences, so in the present study, some cases of rare manifestations of tuberculosis were investigated. The expression of the NF-κB gene in these patients was also evaluated. In this regard, 36 patients with spinal tuberculosis and 30 healthy individuals (as a control group) were assessed. Clinical symptoms, imaging, laboratory tests, pathology, and response to treatment related to patients with spinal tuberculosis and spinal cord tuberculosis were evaluated. NF-κB expression was also evaluated using the PCR technique in peripheral white blood cell samples. The obtained results were analyzed using SPSS ver. 16, χ2 and T-test statistical methods. Mann-Whitney U test and Kruskal–Wallis non-parametric tests were used to analyze non-parametric data. The results showed that out of 36 cases of spinal tuberculosis, 29 cases had spinal tuberculosis, five cases had tuberculous radiculomyelitis, one case had spinal intramedullary tuberculoma, and one case had syringomyelia. 52.78% of patients were male, and 70% of cases were observed between the ages of 35 and 55 years. Fever and back pain were seen in more than 80% of cases. The study of NF-κB expression in the control and case groups showed that the NF-κB expression in the case group increased compared to the control group. This increase was statistically significant (P = 0.0071). In general, in the present study, the methods of clinical diagnosis of spinal tuberculosis were evaluated. Also, the amount of NF-κB transcription factor was evaluated as an effective genetic factor in the diagnosis of this disease.

Tubercular Mycotic Aortic Aneurysm: Complication of Tubercular Spondylodiscitis due to Treatment Default

We have reported rare case of tubercular aortic aneurysm which has developed as complication of spinal tuberculosis. Imaging of patient is available prior to starting of antitubercular treatment which showed vertebral tuberculosis with absence of aortic aneurysm. However, patient defaulted on treatment after taking antitubercular chemotherapy only for 2 months. Patient again reported after 14 months with chest pain. At this stage, imaging showed progression of spinal tuberculosis with development of pseudoaneurysm in adjacent descending thoracic aorta. This contiguous spread of tuberculosis from spine to aorta may have been prevented if patient had completed complete course of antitubercular therapy with regular follow-ups. Patient of spinal tuberculosis need to be counselled and informed regarding its various complications, so that they remain adhered to antitubercular chemotherapy and timely follow-ups to prevent complications.

A rare case report of psoas abscess in pregnancy in a tertiary centre

A psoas abscess in pregnancy is a relatively uncommon condition with nonspecific signs and symptoms. It may lead to serious complications if not diagnosed and treated promptly. Although spinal tuberculosis affects nearly half of skeletal tuberculosis patients, psoas abscess develops in only 5% of spinal tuberculosis cases. A clinical history and examination are used to make a diagnosis, which is then confirmed by microbiology and radiological findings. Here is an interesting case report on psoas abscess in pregnancy managed by pigtail catheter insertion and drainage.

Treatment of Severe Bone Destruction in L5-S1 Spinal Tuberculosis With Anterior Combined Posterior Approach

Background: There are many studies on the surgical treatment of lumbosacral tuberculosis, but both the anterior and posterior approaches present some shortcomings. This study aimed to evaluate the therapeutic efficacy of anterior debridement and bone graft, posterior fixation and fusion with navigation for L5-S1 tuberculosis with severe bone destruction. Methods: This was a retrospective study of 24 patients with severe tuberculosis in L5-S1 who underwent anterior interbody arthrodesis and posterior pedicle screw internal fixation by open approach under computer navigation between February 2011 and Novenmber 2016. The erythrocyte sedimentation rate(ESR), C-reactive protein level(CRP),visual analogue scale(VAS), and lumbosacral angle were compared between before surgery, after surgery, and at the final follow-up. The fusion status of bone graft was evaluated with computed tomography(CT).Results: The mean operation time was 244.58 minutes. The mean intraoperative blood loss was 413.75ml. The accuracy of screw placement was 96.43%. The mean follow-up period was 26.17 months. The average ESR, CRP, VAS, and lumbosacral angles were 65.96 mm/h, 52.93 mg/L, 4.96 points ,and 107.94°, respectively,at preoperative, 34.17 mm/h, 16.47 mg/L, 1.58 points, and 116.12°, respectively, after surgery, and 14.08 mm/h, 6.20 mg/L, 0.58 points, and 115.97°, respectively, at the final follow-up period. The differences of ESR, CRP, VAS are statistically significant (p < 0.05). The difference of lumbosacral angles before and after surgery is statistically significant (p < 0.05)，but there is no statistically significant difference between after surgery and the final follow-up period (p＞0.05). Nine patients with ASIA Grade D before surgery returned to Grade E by the final follow-up period. All patients achieved bone fusion.There was no recurrence of the disease. Conclusions: Anterior debridement and bone graft fusion combined with navigated posterior pedicle screw fixation is a safe and effective treatment option for patients with severe bone destruction in L5-S1 spinal tuberculosis.

Analysis of Clinical Characteristics of 556 Spinal Tuberculosis Patients in Two Tertiary Teaching Hospitals in Guangxi Province

Spinal tuberculosis (STB), which accounts for half of musculoskeletal tuberculosis, is among the leading causes of extrapulmonary tuberculosis. Guangxi Province, located in southern China, is among the most severely affected provinces in China. In this study, we collected and analyzed data from 2 Class-A tertiary teaching hospitals in Nanning City, Guangxi Province, from 2011 to 2019, with the aim of providing reference points for the prevention, diagnosis, treatment, and prognosis analysis of STB, using the epidemiological characteristics of 556 STB cases. Our results revealed that males had a slightly higher incidence (50.17%) compared to females (49.83%), with 64.93% of cases falling between the ages of 18 and 45 years. Cases from rural communities accounted for 63.49% of the reviewed cases. The average time between onset of symptoms and hospitalization was 18.0 months (range: 1 day-220 months). The most commonly reported symptoms were lower back pain (78.60%), radicular pain (51.98%), and systemic toxemia (43.53%). Additionally, 53.98% of the reviewed cases had varying degrees of neurological impairment. The main pathological lesion locations were the lumbar spine (43.53%) and thoracic spine (32.55%). Among them, 72.66% of cases involved at least 2 vertebral segments, and 62.77% of cases presented with paravertebral abscesses. Among the cases reviewed, 90.65% underwent antituberculosis chemotherapy prior to surgery. Following treatment, the cure rate was 78.41%, while 3.78% of patients had postoperative relapse. There were cases of concomitant illnesses among the cases reviewed, 40.65% of patients also had pulmonary tuberculosis, 15.29% had hepatitis B, 13.30% had diabetes, and 7.91% had hypertension. Our results still demonstrate that spinal tuberculosis remains a serious public health problem in Guangxi Province. Thus, preventive measures should be directed towards rural residents with comorbidities such as the elderly and diabetic.