Childhood Intra-Thoracic Tuberculosis Clinical Presentation Determines Yield of Laboratory Diagnostic Assays

Diagnosis of intra-thoracic tuberculosis (ITTB) in children is difficult due to the paucibacillary nature of the disease, the challenge in collecting appropriate specimens, and the low sensitivity of smear microscopy and culture. Culture and Xpert MTB/RIF provide higher diagnostic yield in presumptive TB in adults than in children. Current study was designed to understand poor yield of diagnostic assays in children. Children with presumptive ITTB were subjected to gastric aspirates and induced sputum twice. Samples were tested by Ziehl-Neelsen stain, Xpert MTB/RIF-assay, and MGIT-960 culture. Subjects were grouped as Confirmed, Unconfirmed, and Unlikely TB, and classified as progressive primary disease (PPD, lung parenchymal lesion), and primary pulmonary complex (PPC, hilar lymphadenopathy) on chest X-ray. Of children with culture-positive TB 51/394 (12.9%), culture-negative TB 305 (77.4%), and unlikely TB 38 (9.6%), 9 (2.3%) were smear positive, while 95 (24.1%) were Xpert-MTB/RIF positive. Xpert-MTB/RIF detected 40/51 culture confirmed cases (sensitivity 78.4% and NPV 96.3%). Culture was positive in more children presenting as PPD (p < 0.04). In culture-negative TB group, Xpert positivity was seen in 31% of those with PPD and 11.9% in those with PPC (p < 0.001).Conclusion: Xpert-MTB/RIF improved diagnosis by 2-fold and increased detection of MDR-TB. Both liquid culture and Xpert-MTB/RIF gave higher yield in children with lung parenchymal lesions. Children with hilar lymphadenopathy without active lung parenchymal lesions had poor diagnostic yield even with sensitive nucleic acid amplification tests, due to paucibacillary/localized disease, suggesting possible utility of invasively collected samples in early diagnosis and treatment.

Comparison of Granular Bone Grafts and Transverse Process Bone Grafts for Single-Segmental Thoracic Tuberculosis: A Retrospective Single-Center Comparative Study

Background: To compare the clinical efficacy of granular bone grafts and transverse process bone grafts for single-segmental thoracic tuberculosis (TB).Methods: The clinical records of 52 patients who were diagnosed with single-segmental thoracic TB and treated by one stage posterior debridement, bone graft fusion, and internal fixation in our department from 2015 to 2018 were retrospectively analyzed. Among them, 25 cases were in the granular bone graft group and 27 cases in the transverse processes bone graft group. Outcomes including the visual analog scale (VAS), erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), neurological function, operative time, operative blood loss, hospital stay, Cobb angle, bone graft fusion time, and postoperative complications were all recorded and analyzed.Results: There were no significant differences in operative time, operative blood loss, and hospital stay between the two groups (P > 0.05). With an average follow-up of 18–33 months, all patients in the two groups showed significant improvement in VAS score, ESR, CRP, and neurological function compared with preoperative measurements (P < 0.05), however, no significant differences were found for the last follow-up (P > 0.05). The two groups showed similar Cobb angle correction (P > 0.05), but the granular bone graft group had a larger Cobb angle loss than the transverse processes bone graft group (P < 0.05). The bone graft fusion time of the granular bone graft group was shorter than that of the transverse processes bone graft group (P < 0.05). No significant difference was found in the postoperative complications rate between the two groups (P > 0.05).Conclusion: Granular bone grafts and transverse process bone grafts may achieve comparable clinical efficacy for single-segmental thoracic TB, but the former method had a shorter bone fusion time.

The Efficacy of Intravenous Tanexamic Acid in One-stage Anterior Thoracic Tuberculosis Surgery

BackgroundSpinal Tuberculosis was the most affected region in bone tuberculosis. There were variant hemostatic medicines of different mechanisms reported in spinal surgery previously. The effect of Tanexamic Acid (TXA) in anterior spinal tuberculosis surgery is still obscure. The aim of current study is to elucidate the hemostatic effect of tranexamic acid in anterior thoracic tuberculosis surgery.MethodsRetrospective study was performed with 169 thoracic tuberculosis patients underwent one-stage anterior operation. Eighty patients were performed TXA peri-operation prescription. Forty patients (Pre-operation group, Pre-OP group) started TXA after corpectomy and other forty patients (Intra-operation group, Intra-OP group) were started with the induction of anesthesia. The second dose was 3 hours after the first dose. Pre-operation, 1 day post-operation, and 1 week post-operation blood routine test and blood coagulation test were recorded. Hemoglobin(HGB) variance was the difference value between pre-operation HGB and pos-operation HGB; Blood per level was the value of operation bleeding divided level. Health related quality of life parameters included Visual Analogue Scale score (VAS) and Oswestry Disability Index(ODI). Comparison study was performed among each groups. Correlation study was performed among each parameters in different groups. ResultsCompared to control group, TXA group showed significant decreased on Post-OP Bleeding, and increased on Post-OP HGB, Post-OP HCT and HGB variance. There were no significantly differences among all parameters between Pre-OP group and Intra-OP group. Significant correlation were shown between operation bleeding and post-operation bleeding in control group while the correlation were not significant in TXA group, Pre-OP group and Intra-OP group. Operation bleeding was significantly correlated with Operation Level, Operation Time and HGB variance in all groups. Post-OP Bleeding was significantly correlated with HGB variance in control group, TXA group and Pre-OP group, expect Intra-OP group. There were no significantly difference among all groups, although VAS and ODI showed reduction post-operation.ConclusionsTranexamic acid can effectively preserve surgical hemoglobin loss and reduce post-operation drainage in one-stage anterior thoracic tuberculosis surgery. But the effect of reducing intra-operation bleeding is not significant. Health related quality of life is not influenced by TXA.

One-stage anterior focus debridement, interbody graft using titamium mesh cages, and anterior instrumentation and fusion in the surgical treatment of short segment thoracic tuberculosis

Study design:This is a retrospective studyObjective:The purpose of this study was to evaluate the clinical efficacy of primary anterior debridement, bone graft fusion and internal fixation in the treatment of short segmental thoracic tuberculosis. MethodsWe performed a retrospective analysis of 16 adult patients with short segment thoracic spinal TB who underwent surgery between September 2013 to March 2017. All the 16 patients were treated using a single primary anterior debridement, bone graft fusion and internal fixation. Clinical manifestations, laboratory, neurological symptoms,bone fusion and imaging results were subjected to statistical analysis.ResultsAll patients underwent operation successfully. The symptoms of chest and back pain were alleviated and disappeared at 1–6 months postoperatively.Patients were followed up for 24–48months (average, 35.6 ±9.6 months). Among 16 patients, no recurrence, and all the patients got bony spinal fusion within 4 to 8 months after surgery judging by spinal x-ray film.The preoperative ESR and CRP level of all patients were 72.6 ± 27.5 mm/h and 75.7 ± 25.9 mg/L, which decreased to 15.9 ± 4.6 mm/h and 4.7 ± 2.0 mg/L at the final follow-up, respectively. The preoperative thoracic kyphosis angle were 18.2± 4.1°respectively. The corresponding postoperative angles were ameliorated significantly to 9.1 ±1.9°. During the follow-up, spinal paraplegia was significantly improved in all patients. Neurologic status of the 16 patients with preoperative neurologic defcit was 3 with grade A recovered to normal; 4 with grade B recovered to normal; 4 with grade C recovered to normal; 3 with grade A recovered to grade D; 1 with grade B recovered to grade D;1 with grade C recovered to D.ConclusionThe clinical results of primary anterior debridement, bone graft fusion and internal fixation in the treatment of short segmental thoracic tuberculosis with paraplegia or incomplete paralysis can be an effective and feasible treatment method.

Extreme lateral interbody fusion and percutaneous pedicle screw fixation in the minimally invasive treatment of thoracic tuberculosis

Objective As a minimally invasive intervertebral fusion technique popularized in recent years, extreme lateral interbody fusion (XLIF) has various advantages. In this study, we describe the application and efficacy of XLIF for the treatment of thoracic tuberculosis (TB), as this may be an emerging treatment option for thoracic TB in the future. Methods We present the case of a 75-year-old man who had suffered from chest and back pain for 1 month. Imaging studies showed destruction of the T12 and L1 vertebral bodies and the T12–L1 intervertebral disc, accompanied by formation of a paravertebral abscess. After 2 weeks of standard anti-TB treatment, the patient underwent debridement of the lesions, XLIF, and percutaneous pedicle screw fixation. Results The patient’s chest and back pain were significantly alleviated after the operation. The patient recovered well, and as of the most recent follow-up had no obvious limitation in thoracolumbar spine function. Conclusions XLIF combined with percutaneous pedicle screw fixation for the treatment of thoracic TB can allow for TB lesion debridement, discectomy, and interbody fusion under direct visualization, and can effectively improve patient prognosis.

One-stage anterior focus debridement, interbody graft using titamium mesh cages, and anterior instrumentation and fusion in the surgical treatment of short segment thoracic tuberculosis with paraplegia

Purpose The purpose of this study was to evaluate the clinical efficacy of primary anterior debridement, bone graft fusion and internal fixation in the treatment of short segmental thoracic tuberculosis with paraplegia.Methods We performed a retrospective analysis of 16 adult patients with short segment thoracic spinal TB with paraplegia who underwent surgery between September 2013 to March 2017. All the 16 patients were treated using a single primary anterior debridement, bone graft fusion and internal fixation. Clinical manifestations, laboratory, neurological symptoms,bone fusion and imaging results were subjected to statistical analysis.Results All patients underwent operation successfully. The preoperative ESR and CRP level of all patients were 72.6 ± 27.5 mm/h and 75.7 ± 25.9 mg/L, which decreased to 15.9 ± 4.6 mm/h and 4.7 ± 2.0 mg/L at the final follow-up, respectively. The preoperative thoracic kyphosis angle were 30.7 ± 7.1°respectively. The corresponding postoperative angles were ameliorated significantly to 9.1 ±1.9°. During the follow-up, spinal paraplegia was significantly improved in all patients.The symptoms of chest and back pain were alleviated and disappeared at 1–6 months postoperatively.Patients were followed up for 24–48months (average, 35.6 ±9.6 months). Among 16 patients, no recurrence, and bone fusion was achieved at the final follow-up.Conclusion The clinical results of primary anterior debridement, bone graft fusion and internal fixation in the treatment of segmental thoracic tuberculosis with paraplegia were satisfactory.