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PubMed2002

[Differential diagnosis of tuberculous spondylitis under the conditions of a specialized sanatorium].

A total of 477 patients admitted to hospital for tuberculous spondylitis were examined. Further studies revealed that the process in the vertebral column was regarded as degenerative and dystrophic changes in 140 patients, nonspecific osteomyelitis in 94, and cancer in 22. The basis of diagnostic errors was the similarity of some clinical and X-ray manifestations and the pathomorphosis of tuberculous spondylitis, older patients, the wide use of antibiotics, which changes the clinical course of spinal tuberculosis. The causes of great difficulties in the differential diagnosis of tuberculous spondylitis lie in the insufficient diagnostic capacities of district tuberculosis dispensaries and in the clinical and X-ray manifestations of spinal tuberculosis which have changed today.

Adult↗

PubMed2003

Cervical tuberculosis in early childhood.

CASE HISTORY: We present a case of spinal tuberculosis in a 4-year-old girl that grounds severe vertebral destruction involving four cervical vertebrae and a large abscess with retropharyngeal expansion. Presenting symptoms were neck and right arm pain, torticollis and weakness of the right arm. We drained the abscess and removed the infected bone and reconstructed the cervical spine with a fibular allograft. The neurological deficits were recovered and the torticollis was straightened up. CONCLUSION: We emphasize the value of early diagnosis of spinal tuberculosis and early radical surgery with spinal reconstruction.

Abscess↗

PubMed2002

[Multiorgan tuberculosis: central peripheral hemodynamic features].

The paper deals with the study of central and peripheral hemodynamic features in patients with multiorgan tuberculosis. The study is based on the analysis of examination findings and treatment outcomes in 42 patients with concurrent tuberculosis of the lung and vertebral column. A control group consisted of 46 patents with spinal tuberculosis. The authors provide evidence that concurrent pulmonary and spinal tuberculosis substantially makes basic central and peripheral hemodynamic parameters worse in patients with tuberculosis spondylosis, aggravates their general condition, requires cardiotropic therapy on an individual basis, substantially prolongs preoperative preparation and postoperative rehabilitation.

Adult↗

PubMed2001

Tuberculosis of the thoracic spine. A classification based on the selection of surgical strategies.

In spinal tuberculosis MRI can clearly demonstrate combinations of anterior and posterior lesions as well as pedicular involvement. We propose a classification system, using information provided by MRI, to help to plan the appropriate surgical treatment for patients with thoracic spinal tuberculosis. We describe a series of 47 patients, divided into four groups, based on the surgical protocol used in the management. Group A consisted of patients with anterior lesions which were stable with no kyphotic deformity, and were treated with anterior debridement and strut grafting. Group B comprised patients with global lesions, kyphosis and instability who were treated with posterior instrumentation using a closed-loop rectangle with sublaminar wires, and by anterior strut grafting. Group C were patients with anterior or global lesions as in the previous groups, but who were at a high risk for transthoracic surgery because of medical and possible anaesthetic complications. These patients had a global decompression of the cord posteriorly, the anterior portion of the cord being approached through a transpedicular route. Posterior instrumentation was with a closed-loop rectangle held by sublaminar wires. Group D comprised patients with isolated posterior lesions which required posterior decompression only. An understanding of the extent of vertebral destruction can be obtained from MRI studies. This information can be used to plan appropriate surgery.

Adolescent↗

PubMed1998

Tuberculous lesions of the lumbosacral region. A 15-year follow-up of patients treated by ambulant chemotherapy.

STUDY DESIGN: A 15-year clinical follow-up of tuberculous lesions of the lumbosacral region. OBJECTIVES: To verify the hypothesis that the lumbar lordosis and the specific biomechanics of the lumbosacral region influence and alter the healing pattern and progress of the disease when compared with their effects in other regions of the spine. SUMMARY OF BACKGROUND DATA: An estimated 2 million or more patients have active spinal tuberculosis, and the global incidence of the disease is increasing. The involvement of the lower lumbar region and the lumbosacral junction is relatively rare, with few reports in English literature. METHODS: Of a total of 304 patients forming a part of a controlled clinical trial comparing two forms of therapy in spinal tuberculosis, 53 patients had involvement of L3 and below. The following data were studied in these patients: age at start of treatment, number of vertebra involved, vertebral body loss, progress of the angle of kyphosis, and anterior and posterior growth of the involved segment during a period of 15 years. Student's t test for independent samples was used for statistical analysis. RESULTS: The fourth lumbar vertebra was the most common vertebral segment involved, and the lumbosacral junction was affected in 12 patients. The average pretreatment kyphosis was 6.4 degrees and increased to 10.2 degrees at the end of 15 years. The average kyphotio angle per vertebral body loss was 4.9 degrees, far less than in the dorsolumbar region in which kyphotic angles of 27-30 degrees have been reported. Children younger than 10 years old differed in clinical appearance and progress compared with those older than 17 years. They not only showed more extensive involvement but also had more deformity with the same vertebral loss. Twelve patients less than 10 years old had an average involvement of 3.1 vertebral bodies and an average vertebral loss of 2.2 bodies. In comparison, the average number of vertebrae involved was 1.9 (P < 0.01) and the vertebral body loss was only 0.87 (P < 0.01) in patients older than 17 years. Also, the average kyphosis was 6.4 degrees compared with only 4.2 degrees (P < 0.01) in adults. In patients older than 17 years, there was no change after 2 years, by which time the collapse was complete. Four of 12 patients less than 10 years old, showed progressive kyphosis caused by continued growth of posterior parts of the body (i.e., sequestrated hemivertebrae). CONCLUSIONS: In tuberculosis of the lumbosacral region, the development of kyphosis is minimal in patients older than 17 years, when growth has already stopped, and deformity is expressed more as foreshortening of the trunk. Children younger than 10 years old have more severe involvement with increased tendency toward greater kyphosis. They are also prone to progressive deformity through the years when the anterior growth plates are destroyed. Surgery is indicated in this group to prevent greater deformity.

Adolescent↗

PubMed2005

Anterior instrumentation for cervical spine tuberculosis: an analysis of surgical experience with 61 cases.

OBJECTIVE: To evaluate the efficacy of anterior instrumentation in patients with subaxial and cervicodorsal spinal tuberculosis in reconstruction of the spine, providing pain relief, neurological recovery and prevention of deformity. MATERIALS AND METHODS: The records of 61 consecutive patients, of surgically treated spinal tuberculosis affecting C3 to D2 region, in our neuro and spinal surgery unit over a five-year period were retrospectively reviewed. Patients with involvement of the C3-C6 vertebrae underwent excision of the involved vertebrae and intervertebral discs followed by reconstruction with titanium implants by anterior approach. A transclavicular approach was used for patients with involvement of the C7-D2 vertebrae. A five-drug antituberculous regimen was administered for a period of one year. The follow-up ranged from 24 to 84 months (mean 38 months). Clinical and radiological assessment using flexion and extension radiographs was performed at 24 months for all cases. RESULTS: The neck pain score based on a visual analog scale (1-10) changed from a pre-operative average of 7 to 2 at follow-up after 4 months. Fifty-two patients (85%) had complete relief of pain while 16 patients who had Grade III to IV muscle strength regained complete power. The asymmetric wasting in patients with involvement of the cervicodorsal region did not recover completely. Flexion-extension radiographs at 24 months did not show any evidence of instability or nonunion. CONCLUSIONS: Anterior reconstruction using titanium plates and locking screws for stabilization of the subaxial and cervicodorsal region tuberculosis is a useful adjunct in preventing kyphotic deformity. A satisfactory segmental stability and fusion is achieved by this technique.

Adolescent↗

PubMed1975

[Stenosis of the spinal canal after spondylodesis (iatrogenic stenosis of the spinal canal) (author's transl)].

Authors experience based on 15 cases of iatrogenic stenosis of spinal canal in thoracic and lumbar region. The stenosis was the sequelae of spondylodesis made for spinal tuberculosis, spondylolisthesis traumatic and idiopathic, spinal fractures and assimilation faults. The onset of signs of stenosis appeared from 1 to 7 years after the first operation. The treatment was operative in 8 cases, conservative in 7. The first gave the best results. Observation time was up to 14 years after the second operation.

Adolescent↗

PubMed1998

A 15-year assessment of controlled trials of the management of tuberculosis of the spine in Korea and Hong Kong. Thirteenth Report of the Medical Research Council Working Party on Tuberculosis of the Spine.

The final results up to 15 years are reported of clinical trials of the management of tuberculosis of the spine in Korea and Hong Kong. In Korea, 350 patients with active spinal tuberculosis were randomised to ambulatory chemotherapy or bed rest in hospital (in Masan) or a plaster-of-Paris jacket for nine months (in Pusan). Patients in both centres were also randomised to either PAS plus isoniazid for 18 months or to the same drugs plus streptomycin for the first three months. In Hong Kong, all 150 patients were treated with the three-drug regime and randomised to either radical excision of the spinal lesion with bone graft or open debridement. On average, the disease was more extensive in Korea, but at 15 years (or 13 or 14 years in a proportion of the patients in Korea) the great majority of patients in both countries achieved a favourable status, no evidence of CNS involvement, no radiological evidence of disease, no sinus or clinically evident abscess, and no restriction of normal physical activity. Most patients had already achieved a favourable status much earlier. The earlier results of these trials are confirmed by the long-term follow-up with no late relapse or late-onset paraplegia. The results of chemotherapy on an outpatient basis were not improved by bed rest or a plaster jacket and the only advantage of the radical operation was less late deformity compared with debridement. A second series of studies has shown that short-course regimes based on isoniazid and rifampicin are as effective as the 18-month regimes: ambulatory chemotherapy with these regimes should now be the main management of uncomplicated spinal tuberculosis.

Adolescent↗

PubMedDate not supplied

[Tuberculous spondylitis with syndesmophytes and paraspinal ossification. Two case reports].

The authors described 2 patients with spinal tuberculosis. The first one was presented with multiple anterior marginal involvement of vertebral bodies, centrosomatic spondylitis of L3, associated with a syndesmophytic showing spinal ossification. In the second case, spinal tuberculosis involved the vertebral arc of L2 and L4. A paravertebral ossification on both sides of L4 was seen. The nature of these vertebral and paravertebral ossifications was discussed.

Adolescent↗

PubMed1986

Hepatic toxicity in South Indian patients during treatment of tuberculosis with short-course regimens containing isoniazid, rifampicin and pyrazinamide.

Results are presented of the incidence of hepatitis, nearly always with jaundice, among 1686 patients in clinical trials of the treatment of spinal tuberculosis, of tuberculosis meningitis and of pulmonary tuberculosis with short-course regimens containing rifampicin, isoniazid, streptomycin and pyrazinamide. The incidence was high in patients treated with daily regimens of isoniazid and rifampicin: 16-39% in children with tuberculous meningitis, 10% in patients with spinal tuberculosis (non-surgical cases), and 2-8% in those with pulmonary tuberculosis. Hepatitis, in those receiving rifampicin occurred more often in slow than in rapid acetylators of isoniazid, the proportions amongst those whose acetylator phenotype had been determined being 11% of 317 slow acetylators and 1% of 244 rapid acetylators. In children with tuberculous meningitis, the risk of hepatitis with isoniazid 20 mg/kg (39%) was higher than that with 12 mg/kg (16%), and appreciably lower in patients given rifampicin twice-weekly (5%) rather than daily (21%). There was no indication that pyrazinamide contributed to the hepatic toxicity.

Adolescent↗

PubMed1999

Short-course chemotherapy for tuberculosis of the spine. A comparison between ambulant treatment and radical surgery--ten-year report.

We performed a randomised, controlled clinical trial to compare ambulant short-course chemotherapy with anterior spinal fusion plus short-course chemotherapy for spinal tuberculosis without paraplegia. Patients with active disease of vertebral bodies were randomly allocated to one of three regimens: a) radical anterior resection with bone grafting plus six months of daily isoniazid plus rifampicin (Rad6); b) ambulant chemotherapy for six months with daily isoniazid plus rifampicin (Amb6); or c) similar to b) but with chemotherapy for nine months (Amb9). Ten years from the onset of treatment, 90% of 78 Rad6, 94% of 78 Amb6 and 99% of 79 Amb9 patients had a favourable status. Ambulant chemotherapy for a period of six months with daily isoniazid plus rifampicin (Amb6) was an effective treatment for spinal tuberculosis except in patients aged less than 15 years with an initial angle of kyphosis of more than 30 degrees whose kyphosis increased substantially.

Adolescent↗

PubMed2002

[Spinal and pulmonary tuberculosis].

The paper presents the results of a study of the clinical course of tuberculous spondylitis of combined pulmonary tuberculosis in 86 patients admitted from different areas of the Republic of Uzbekistan. Patients with tuberculosis of the spine and lung have been shown to have a more unfavourable course of a specific process in the bony tissue and lung. The tuberculous process is accompanied by severe intoxication, pain syndromes. The severity of the process is aggravated if there are extensive suppurative processes around an osseous focus. These patients have varying severe cerebrospinal disorders. Moreover, patients with combined forms of the process more frequently exhibit concomitant nonspecific visceral diseases.

Adult↗

PubMed1998

Teleradiology in KwaZulu-Natal. A pilot project.

OBJECTIVE: This was a pilot teleradiology project connecting two secondary KwaZulu-Natal hospitals' radiography departments to a central Durban teaching hospital. The purpose of the study was to assess the usefulness of same-day teleradiology reports to the medical staff and whether such a service changed patient management. DESIGN: After 1 month's service at each hospital, the first 200 teleradiology reports, original radiographs and patients' case notes were reviewed to determine whether any errors in interpretation of the radiographs had been made and whether the reports had changed patient management. RESULTS: The service changed patient management in 10% of cases. Undetected pathology was recognised by the radiologist in 20 patients--pulmonary tuberculosis in 10, spinal tuberculosis in 3, miliary tuberculosis in 2 and fractures in 5. Problems were encountered with transmission of data using the current telephone network, loss of data at the receiving station and the increased workload of the radiographer transmitting the data. CONCLUSIONS: Teleradiology services do make a positive impact on patient management in rural hospitals. However, there are many technical pitfalls that must be avoided in order to establish an effective service.

Hospitals, Rural↗

PubMed1992

Neurotuberculosis: a review.

Tuberculosis is still a major cause of serious illness in many parts of the world. CNS involvement has frequently been found secondary to tuberculosis elsewhere in the body, particularly the lungs. The disease manifests itself as meningitis, tuberculoma and/or spinal tuberculosis. The presence of tuberculosis elsewhere in the body favors the diagnosis although its absence does not exclude it. While tuberculous meningitis is a disease of childhood, tuberculomas and spinal tuberculosis are invariably an adult manifestation. The great majority of patients with neurotuberculosis are diagnosed and treated early because of characteristic clinical, imaging, and CSF findings. Clinical response to antituberculous therapy in all forms of neurotuberculosis is excellent if the diagnosis is made early before irreversible neurological deficit is established.

Antitubercular Agents↗

PubMed1998

[Clinical value of a rapid immunochromatographic assay in diagnosis and differential diagnosis of bone and joint tuberculosis].

OBJECTIVE: To evaluate the clinical value of a rapid immunochromatographic assay in diagnosis and differential diagnosis of bone and joint tuberculosis. METHOD: Antibodies in sera from 75 patients with active bone and joint tuberculosis, 69 patients with non-tuberculous bone and joint diseases and 72 healthy individuals were detected by the rapid immunochromatographic assay using ICT-TB kit. RESULT: The positive rate was found to be 80% in the patients with active bone and joint tuberculosis, while 90% in the group with spinal tuberculosis, 53% in the extra-spinal articular tuberculosis. The false positive rates were 4% and 3% respectively in those with other bone and joint diseases and healthy individuals. CONCLUSION: The assay is a rapid, sensitive and specific supplementary tool for the diagnosis of the bone and joint tuberculosis.

Antibodies, Bacterial↗

PubMed1994

[Epidural computed electroneurography and electrostimulation of the spinal cord in the reconstructive surgery of the spine in tuberculous spondylitis].

The study deals with the development of new diagnostic and therapeutical methods for deep spinal marrow diseases in spinal tuberculosis and its sequelae. The human spinal marrow has been first electroneurophysiologically studied during compression of the spine and ofter its anterolateral decompression. A comprehensive diagnostic technique--computed electrospinoneurography has been proposed; objective criteria for prediction and evaluation of therapeutical efficiency have been defined. The proposed epidural electrostimulation following a surgery for anterolateral decompression of the spine accelerates regression of neurological symptoms and increases the extent of its regression in 89.2% of cases in the early postoperative period and enhances the efficacy of prior operations up to 83.9% in the long-term period. The high efficiency of the method is 87.1%, which allows it to be recommended for introduction into clinical practice.

Adolescent↗

PubMed1980

Tuberculosis of the spine: a review.

Spinal tuberculosis remains common in the "Third World" and is commoner in Britain and "developed" countries than many other disorders that receive much more attention. Though little new has been added to knowledge of its morbid anatomy, the observation that it is associated with a low bacterial population is emphasised. Controlled clinical trials in Korea, Hong Kong and Bulawayo have demonstrated the excellent results of outpatient ambulant chemotherapy, which are unimproved by other additional measures with the one exception of the skilled performance of radical resection of the focus with anterior spinal fusion (the Kong Kong operation). The management of paraplegia is discussed, as are recent attempts to correct fixed residual kyphosis.

Antitubercular Agents↗

PubMed2006

[Research on complications of thoracoscopic assisted thoracic spine surgery].

OBJECTIVE: To analyze occurrence, prevention and treatment of the complications of thoracoscopic assisted spine surgery. METHODS: Retrospective review of 182 patients who underwent standard thoracoscopic technique or video-assisted thoracic surgical procedure from October 1998 to August 2004. The treatment of thoracic diseases included debridement, decompression with (or) reconstruction. The total number of complications were recorded, and its mechanism, prevention and treatment were analyzed. RESULTS: Complications occurred in 16 patients, 12 cases of perioperative complications included 3 patients suffered from pneumonia, 3 pulmonary atelectasis, 2 patients' lung injured by trocar, 1 patient obtained transient monoplegia, 2 suffered from transient intercostal nerve pain and 1 had superficial incision infection. Long-term complications occurred in 4 cases: spinal tuberculosis relapsed 2 cases (one who had diabetes obtained relapse in 8 months of post-operation and another relapsed with complex spinal tuberculosis in 4 weeks postoperation), 2 patients suffered from kyphosis deformity and pain. CONCLUSIONS: The type and incidence of complications with thoracoscopic spine surgery mainly depend on indication, operation procedures and anesthesia, only by limit surgical indication, ameliorate technique, obey surgical principle and consummate perioperative treatment can we obtain mini-invasive effect by thoracoscopic assisted spine surgery.

Adolescent↗