Absceso del psoas secundario a tuberculosis vertebral / Psoas abscess secondary to vertebral tuberculosis

Introducción: Presentamos el caso de un paciente masculino de 29 años con absceso del psoas bilateral secundario a tuberculosis vertebral. El absceso del psoas no suele ser frecuente en pacientes con tuberculosis extrapulmonar y principalmente con la enfermedad de Pott, pero cuando aparece suele ser subdiagnosticado debido a la inespecificidad de sus manifestaciones clínicas. Objetivos: Abordaje clínico-quirúrgico del absceso del psoas secundario a la tuberculosis vertebral, o Mal de Pott. Materiales y métodos: Búsqueda bibliográfica efectuada en pubmed. Relato de caso clínico: registro clínico y fotográfico, evolución, presentación de: resultados laboratoriales y de métodos auxiliares y tratamiento. Resultados: Síntomas presentados por un paciente de 29 años: dolor abdominal, dolor en miembro inferior, lumbalgia, expectoración sanguinolenta, dificultad en la deambulación, y cuadro respiratorio previo y síntomas constitucionales como pérdida de peso, anorexia, astenia. Con base en la anamnesis, examen físico y hallazgos en exámenes específicos, se pudo lograr el diagnóstico de absceso del psoas secundario a la tuberculosis vertebral. El tratamiento farmacológico seguido fue el propuesto por la OMS para la Tuberculosis más punción del absceso para drenaje y cultivo del mismo, con catéter multipropósito. El paciente tuvo una evolución favorable y posterior a la intervención neuroquirúrgica fue dado de alta. Conclusión: El paciente evolucionó de forma favorable, y las medidas aplicadas en el desarrollo de su enfermedad, fueron oportunas.

Introduction: We present de case of a 29 year old male patient with bilateral psoas abscess secondary to vertebral tuberculosis. Psoas abscess is not usually frequent in patient with extra-pulmonary tuberculosis and specially Pott's disease, but when it appears it is usually under diagnosed due to non-specificic clinical manifestations. Objectives: Clinical-surgical approach to psoas abscess secondary to vertebral tuberculosis, or Pott's disease. Materials and methods: Bibliographic search carried out in pubmed. Case report: clinical and photographic record, evolution and presentations of laboratory results, diagnostic auxiliary methods and treatment. Results: Symptoms presented by a 29 years old patient: abdominal pain, lower limb pain, low back pai, bloody expectoration, difficulty walking and previous respiratory and constitutional symptoms sucha as weight loss, anorexia, asthenia. Based on the clinicalhistory, physical examination and findins in specific tests, the diagnosis of psoas abscess secondary to vertebral tuberculosis could be achieved. The pharmacological treatment followed was the one proposed by WHO for tuberculosis, plus the drainage and culture of the abscess, with a multipurpose catheter. The patient had a favorable evolution and after the neurosurgical intervetntion he was discharged. Conclusion: The patient evolved favorably, and the measures applied in the development of his disease were appropriate.

Lumbar spinal tuberculosis implanted with artificial bone with streptomycin sulfate and percutaneous pedicle screw under transforaminal endoscopy / 中国组织工程研究

BACKGROUND: Animal model experiments on bone tuberculosis showed that calcium sulfate artificial bone loading could slowly and permanently release antituberculosis drugs, increase local drug concentration, and repair local bone defects and promote bone fusion. OBJECTIVE: To evaluate the safety and efficacy of implantation of artificial bone with streptomycin sulfate and posterior percutaneous pedicle screw in the treatment of lumbar tuberculosis under transforaminal endoscopy after removal of lesions. METHODS: Twenty-eight patients with lumbar spinal tuberculosis who were treated in the First Affiliated Hospital of Guangxi University of Chinese Medicine from July 2016 to June 2019 were selected, including 10 males and 18 females, at the age of 36-69 years. Twelve patients in the experimental group received implantation of artificial bone with streptomycin sulfate and posterior percutaneous pedicle screw under transforaminal endoscopy after removal of lesions. Sixteen patients in the control group received bone graft fusion and internal fixation under anterior and posterior combined approach or bone graft fusion and internal fixation after posterior approach. Operation time, intraoperative blood loss, and hospital stay were recorded. At 3 months postoperatively and at the last follow-up, erythrocyte precipitation, C-reactive protein level and Cobb angle, visual analogue scale score, lumbar Japanese Orthopaedic Association score and Oswestry disability index score were compared between the two groups. The experiment was approved by the Ethics Committee of First Affiliated Hospital of Guangxi University of Chinese Medicine. RESULTS AND CONCLUSION: (1) The operation time, intraoperative blood loss and hospital stay in the experimental group were all less than those in the control group (P 0.05). (5) The results show that compared with the traditional posterior approach and combined anterior and posterior approaches in the treatment of lumbar tuberculosis, posterior lateral foramen endoscopic implantation of artificial bone with streptomycin sulfate combined with posterior percutaneous pedicle screw fixation can also achieve satisfactory clinical effect, and has the advantages of small trauma and rapid recovery.

A preliminary study on the surgical timing of spinal tuberculosis / 中国骨伤

OBJECTIVE@#To observe the changes of erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) and nerve function in patients with spinal tuberculosis before and after surgery, explore the timing of surgical intervention, and evaluate its influence on surgical safety.@*METHODS@#A retrospective analysis was conducted on 387 patients with spinal tuberculosis who received surgical treatment from March 2012 to March 2017, including 278 males and 109 females, aged 12 to 86 years old with an average of (49.9±19.1) years. There were 64 cases of cervical tuberculosis, 86 cases of thoracic tuberculosis, 76 cases of thoracolumbar tuberculosis and 161 cases of lumbar tuberculosis. There were 297 patients with single segmental involvementand 90 patients with multiple segmental involvement. Among them, 62 cases presented neurological damage, and preoperative spinal cord neurological function depended on ASIA grade, 5 cases of grade A, 8 cases of grade B, 39 cases of grade C, and 10 cases of grade D. According to the duration of preoperative antituberculosis treatment, the patients were divided into group A (256 cases, receiving conventional quadruple antituberculosis treatment for 2-4 weeks before surgery) and group B (131 cases, receiving conventional quadruple antituberculosis treatment for more than 4 weeks before surgery). The two groups were compared in terms of gender, age, preoperative complicated pulmonary tuberculosis, lesion site, lesion scope, surgical approach, drug resistance and other general clinical characteristics. ESR, CRP, visual analogue scale(VAS), Oswestry Disability Index (ODI), Frankel grade and postoperative complications were observed.@*RESULTS@#All 387 patients were followed up for 12 to 36 (18.3±4.5) months. There were no significant differences in gender, age, preoperative pulmonary tuberculosis, lesion site, lesion range, surgical approach, preoperative drug resistance and other characteristics between two groups. A total of 32 patients in two groups did not heal after surgery, with an incidence rate of 8.27%. The VAS and spinal cord dysfunction index of the two groups were significantly improved after surgery (@*CONCLUSION@#After 2-4 weeks of anti tuberculosis treatment before operation, patients with spinal tuberculosis could be operated upon with ESR and CRP in a descending or stable period. In principle, patients with spinal tuberculosis and paraplegia should be treated as soon as possible after active preoperative management of the complication without emergency surgery.

Postoperative outcome in thoracolumbar spinal tuberculosis: a retrospective study

Background: Spinal tuberculosis is the most common location of extra pulmonary tuberculosis. ATT alone may not be suitable in all situations, especially when treating patients with risk of instability, progression of neurologic deficit, and failure of medical treatment. Surgical intervention is a major treatment modality for symptom relief in spinal tuberculosis.Methods: The aim of this study was to assess the immediate post-operative outcome in surgically treated patients with dorsolumbar spine tuberculosis at Department of Neurosurgery Government Medical College, Thrissur. All operated patients of dorsolumbar spinal tuberculosis during 2014 September to 2019 august were included under study.Results: A total of 57 patients were included in the study. The mean age of the patient was 42.77 years. There were 40 males (70.2%) and 17 females (29.8%). 55 (96.5%) out of 57 patients were having sensory symptoms. 41 (71.9%) out of 57 patients were having motor symptoms. Bladder involvement 23 (40.4%) and bowel involvement 15 (26.3%) were also noted in the study. Sensory symptoms improvement in post-operative period was noted in 46 (80.7%). Motor symptoms improvement was observed in 23 (56.1%) out of 41. Bladder symptoms improved in 6 (26.1%) out of 23. There is improvement in clinical symptoms, neurological function immediately after surgery. Surgical patients have faster improvement and can be mobilized earlier. Improvement in sensory symptoms (96.5%), motor symptoms (56.1%) and bladder symptoms (26.1%) were noted in our study in the immediate post-operative period.Conclusions: There was significant immediate relief in symptoms and morbidity of patients undergoing surgical treatment for dorsolumbar spine tuberculosis.

Spinal stability in patients with lumbar spinal tuberculosis with anterior double titanium mesh support bone grafting and posterior pedicle screw fixation / 中国组织工程研究

BACKGROUND: Conventional anterior debridement and bone graft fusion for lumbar spinal tuberculosis have a great trauma, and bring more complications. The double titanium mesh support bone graft combined with posterior pedicle internal fixation reconstruction can significantly improve the prognosis of lumbar spinal tuberculosis. There is no clinical study to compare the efficacy between the two surgical methods. OBJECTIVE: To compare the efficacy of lumbar spinal tuberculosis via anterior double titanium mesh support bone graft combined with posterior pedicle internal fixation and conventional anterior debridement and bone graft fusion. METHODS: Case history data of 40 patients with lumbar spinal tuberculosis were retrospectively collected from the Department of Spinal Surgery, Mianyang Central Hospital, Southwest Medical University from May 2015 to March 2018. The patients were divided into experimental group and control group (n=20) according to the operation. Patients in the experimental group were treated with the anterior double titanium mesh support bone graft combined with the posterior pedicle screw fixation reconstruction. Patients in the control group were treated with anterior debridement and bone graft fusion. All patients signed the informed consent. This study was approved by the Hospital Ethics Committee. RESULTS AND CONCLUTION: (1) Lumbar spinal tuberculosis could be effectively treated with both surgical methods. (2) Compared with the control group, the operation time was shorter; the intraoperative blood loss was less; and the bone graft fusion was faster in the experimental group. (3) With prolongation of the postoperative time, the erythrocyte sedimentation rate and the sagittal Cobb angle of the lesion segment gradually decreased in the two groups. The erythrocyte sedimentation rate and the sagittal Cobb angle of the lesion segment in the experimental group were slightly lower than those in the control group. (4) After treatment, the classification of the American Spinal Cord Injury Association was improved in some patients. (5) The incidence of adverse reactions in the experimental group was lower than that of the control group. (6) The results suggest that double titanium mesh support bone graft combined with posterior pedicle internal fixation reconstruction can effectively improve the stability of the diseased vertebrae, and the treatment effect on lumbar spinal tuberculosis is better than conventional anterior lesion removal and bone graft fusion internal fixation.

One-stage posterior debridement combined with lumbar-ilium fixation and bone graft fusion for the treatment of lumbosacral tuberculosis / 中国骨伤

OBJECTIVE@#To investigate the clinical effect of One-stage posterior debridement combined with lumbar-ilium fixation and bone graft fusion for the treatment of lumbosacral tuberculosis.@*METHODS@#The clinical data of 31 patients with lumbosacral tuberculosis treated by one-stage posterior debridement combined with lumbar-ilium fixation and bone graft fusion from January 2013 to February 2018 were retrospectively analyzed. There were 18 males and 13 females, aged from 18 to 77 years old with an average of (45.9±9.1) years. The lesion segment was form L to S. The preoperative ASIA grading showed that 2 cases were grade B, 17 cases were grade C, 12 were grade D. Pre- and post-operative C reactive protein (CRP), visual analogue scale (VAS), erythrocyte sedimentation rate (ESR), ASIA grade, lumbosacral angle and intervertebral space height were analyzed, the surgery complications, stability of internal fixation, bone fusion were observed.@*RESULTS@#All the 31 patients were followed up for 10 to 24 months with an average of (16.0±3.1) months. One patient with local infection and subcutaneous hydrops was cured by dressing change. Other 30 cases got primary healing without sinus formation and no recurrence of spinal tuberculosis. All the patients were cured, no internal fixation loosening and breakage were found. All bone fusion was successful with an average fusion time of (4.7±1.1) months. At the final follow-up, ESR and CRP were normal, the VAS was decreased from (6.13±1.21) points preoperatively to (1.92±0.57) pioints, the ASIA grading showed that 2 cases were grade C, 6 cases were grade D, and 23 cases were grade E. The lumbosacral angle and intervertebral space height was increased from preoperative (21.42±3.75) °, (7.84±0.41) mm to (27.21±3.12) °, (9.80±0.38) mm at the final follow-up, respectively.@*CONCLUSION@#One-stage posterior debridement combined with lumbar-ilium fixation and bone graft fusion is a practicable, effective and safe method for the treatment of lumbosacral tuberculosis. It can be recommended in clinical application.

One-stage transpedicular debridement, posterior internal fixation and fusion for the treatment of senile thoracolumbar tuberculosis / 中国骨伤

OBJECTIVE@#To evaluate the clinical outcomes of one-stage transpedicular debridement, posterior internal fixation, RBK mixed streptomycin filled bone grafting for the treatment of elderly patients with thoracolumbar tuberculosis.@*METHODS@#The clinical data of 20 elderly patients with thoracolumbar tuberculosis underwent one stage transpedicular debridement, posterior internal fixation, OSTEOSET RBK mixed streptomycin-filled bone grafting from September 2006 to July 2017 were retrospectively analyzed. There were 12 males and 8 females, aged from 62 to 83 years with an average of (72.4±6.9) years old. Visual analogue scale (VAS), Oswestry Disability Index (ODI)were used to evaluate the pain and spinal function. The kyphosis angle (Cobb angle) of the lesion segment and the bone growth of the lesion area were observed by the X-ray films.@*RESULTS@#All the operations were successful, the operation time was (160.9±23.8) min, and the intraoperative blood loss was (317.9± 112.7) ml. The incisions were healed by first intention, and no sinus and incision were delayed. Spinal tuberculosis was completely cured, Frankel grade has one or more improvements. The VAS score decreased from (7.50±1.15) points before surgery to (1.70±1.39) points at 12 months after surgery (<0.05). The ODI score decreased from preoperative (92.50±1.17)% to (12.80±0.89)% at the final follow up (<0.05). The sagittal Cobb angle of the lesion segment decreased from preoperative (24.2±1.6)° to (8.3±0.7)°at 12 months after surgery(<0.05), the kyphosis deformity was significantly corrected. In all cases, bone fusion was achieved in bone graft area, without bone nonunion and device fracture complications.@*CONCLUSION@#One-stage transpedicular debridement, posterior internal fixation, RBK mixed streptomycin filled bone grafting is suitable for thoracolumbar tuberculosis patients with good general condition and less vertebral destruction.

Management Of Paraparesis Developed After Spinal Tuberculosis Through Ayurveda- A Case Study

Spinal tuberculosis is one of the most dangerous and destructive form of tuberculosis. Predisposing factors for spinal TB are same as that of pulmonary TB, which include poverty, overcrowding, illiteracy, malnutrition, diabetes mellitus, HIV infection, alcoholism, drug abuse. Though TB of cervical spine is rare but neurological deficits are more common as compared to lumbar spine. This is a case of 9 year old male child who developed neurological deficits after TB cervical spine. Panchakarma therapy along with oral medicines given for duration of one year provided significant relief in symptoms as- generalized weakness, muscle rigidity, muscle weakness. Further continuation of treatment is expected to bring more benefit.

Comparison of MRI with x-ray in the evaluation of tuberculosis of spine

Introduction: MRI is the most valuable method for detecting early disease and is preferred technique to define the activity and extent of infection followed by x–ray. Aim: To evaluate MRI as a valuable noninvasive diagnostic tool in spinal tuberculosis and to correlate with plain radiograph for the early detection of spinal tuberculosis. Material and method: This cross-sectional study was carried out on 40 patients who were suspected as cases of spinal tuberculosis. Plain X-ray were done before the MRI examination. Results: The comparison of X-ray and MRI for evaluating spinal TB on the basis of end plate irregularity, thecal sac compression, cord compression and cord changes was statistically highly significant. It was statistically significant on the basis of Disk Space Narrowing/Disk Involvement, paravertebral Widening/Psoas abscess and Posterior Element Involvement. X-ray when compared to MRI was found to have a sensitivity of 48.72% and a specificity of 100% in detection of end plate irregularities, sensitivity of 89.47% and specificity of 100% in detection of vertebral height reduction, sensitivity of 78.79% and specificity of 100% in detection of disk Space narrowing / disk Involvement and sensitivity of 28.57% and specificity of 92.31% in detection of paravertebral widening/psoas abscess. Conclusion: MRI is a better and more Informative imaging modality in evaluation of patients of Pott’s spine providing the diagnosis earlier than conventional methods.

Four-rod Technique Stabilization after Pedicle Subtraction Osteotomy (PSO) for the Treatment of Thoracolumbar Hyperkyphosis Secondary to Pott Disease: A Two-Year Follow-Up Case Report

Pedicle subtraction osteotomy (PSO) is a powerful tool for themanagement of sagittal misalignment. However, this procedure has a high rate of implant failure, particularly rod breakages. The four-rod technique diminishes this complication in the lumbar spine. The aim of the present study is to provide a case report regarding PSO and fourrod technique stabilization in the treatment of short-angle hyperkyphosis in the thoracolumbar (TL) junction. The authors describe the case of a patient with TL hyperkyphosis secondary to spinal tuberculosis treated with L1 PSO and fixation with a four-rod technique. There were no major surgical complications. The self-reported quality of life questionnaires (the Short-Form Health Survey 36 [SF-36] and the Oswestry disability index) and radiological parameters were assessed preoperatively, as well as 6, 12 and 24 months after surgery, and they showed considerable and sustained improvements in pain control and quality of life. No hardware failure was observed at the two-year follow-up.

MRI differential diagnosis of Brucella spondylitis and spinal tuberculosis / 实用放射学杂志

Objective To analyze the MRI features of Brucella spondylitis and spinal tuberculosis,to improve the ability of differential diagnosis. Methods MRI features of 22 cases with Brucella spondylitis and 26 cases with spinal tuberculosis confirmed by laboratory examination and operative pathology were analyzed retrospectively.Results Among 22 cases of Brucella spondylitis,1 7 cases occurred in the lumbar spine (1 3 cases in the lumbar 4 vertebrae),2 cases in the cervical spine,2 cases in the thoracic spine and 1 case in the sacral spine.1 9 cases had normal vertebral morphology,slight bone destruction and extensive edema,3 cases had severe vertebral wedge deformation, 16 cases had marginal bone hyperplasia.15 cases had slight changes in the intervertebral space,with narrow (or normal)or slight destruction of intervertebral disc,7 cases had severe narrowing or disappearance of intervertebral space and serious destruction of intervertebral disc. 13 cases had small paravertebral abscess,and 1 case had large paravertebral abscess.Among 26 cases of spinal tuberculosis,20 cases occurred in the lumbar spine (11 cases in the 4th and 5th vertebral bodies),5 cases occurred in the thoracic spine and 1 case occurred in the sacral spine,21 cases had severe vertebral wedge deformation due to bone destruction,9 cases had slight narrowing of intervertebral space, slight destruction of intervertebral discs,and 1 7 cases had obvious narrowing or narrowing of intervertebral space.7 cases had small paravertebral abscess and 1 6 cases had large paravertebral abscess with flowing phenomenon.Conclusion Vertebral morphology of Brucella spondylitis is basically normal,bone destruction is light and edema range is large,bone hyperplasia is common,slight narrowing (or normal)of intervertebral space occurs in intervertebral disc with less destruction,range of paravertebral abscess is limited.Bone destruction of spinal tuberculosis is heavy and edema range is small,vertebral body is easy to deform with no osteoporosis,significant stenosis (or disappearance)and severe disruption occur in intervertebral disc,paravertebral abscess is large often with flowing phenomenon.

Extended Posterior Decompression and Instrumented Fusion for Spinal Tuberculosis

STUDY DESIGN: Retrospective cohort.PURPOSE: To evaluate clinical outcomes, including pain and neurologic status, and to evaluate radiographic outcomes of patients treated with extended posterior decompression, posterior fixation, and fusion in different vertebral segments.OVERVIEW OF LITERATURE: The standard surgical treatment of spinal tuberculosis is radical debridement via anterior approach. However, this approach may lead to several serious complications. Meanwhile, extended posterior approach, the posterior surgical approach, involving the removal of posterior elements, ribs, and pedicles, is an alternative option that can achieve the aims of treatment in this disease and may reduce the serious complications from anterior approach.METHODS: The medical records and imaging of 50 patients admitted with spinal tuberculosis from January 2010 to June 2016 were reviewed. The Visual Analog Scale (VAS), Frankel grading scale, and kyphotic Cobb angle between the pre- and postoperative periods were used to evaluate the patients.RESULTS: The patients had significant improvement of VAS score in all the groups. The T/T–L, L, and L–S group scores improved from 7.2±1.5 to 1.7±1.2 (p<0.01), from 8.1±1.8 to 1.7±1.4 (p<0.01), and from 7.9±2.2 to 1.7±0.8 (p<0.01), respectively, and overall, the patient scores (n=50) improved from 7.8±1.4 to 1.7±1.3 (p<0.01). Ten patients (20%) had Frankel grade E preoperatively, which was improved to 38 patients (76%) postoperatively. A significant improvement of the kyphotic Cobb angle was observed when compared at the preoperative, early postoperative, and final follow-up period in the T/T–L, L, and L–S groups. The loss of correction angle in the LS group was 7.7°±4.3° at the final follow-up compared with the early postoperative correction angle at 9.1°±5.8°, with no statistically significant difference.CONCLUSIONS: Extended posterior decompression, posterior instrumentation, and fusion are effective methods of surgery for treatment of spinal tuberculosis involved in the thoracic, thoracolumbar, lumbar, and lumbosacral regions.

The Spectrum of Clinical and Urodynamic Findings in Patients with Spinal Tuberculosis Exhibiting Lower Urinary Tract Symptoms, before and after Spinal Surgical Intervention with Antitubercular Treatment: A Prospective Study

STUDY DESIGN: Observational study. PURPOSE: This study aims to assess the clinical and urodynamic parameters in patients with spinal tuberculosis (TB) exhibiting lower urinary tract symptoms (LUTS) at the time of presentation and after spinal surgical intervention. OVERVIEW OF LITERATURE: Variable urodynamic findings in patients with spinal TB. METHODS: We prospectively evaluated 10 patients with spinal TB exhibiting LUTS. Urinary symptoms were assessed by the American Urological Association (AUA) symptom score. We performed a urodynamic study (UDS), including electromyography, in all patients before and 3 months after spinal surgery. RESULTS: The mean age of patients was 29.7 years (range, 15–52 years), and the mean AUA symptom score was 12.5 and 11.8 before and after spinal surgery, respectively. Overall, five patients exhibited improvement in the AUA symptom score, and three showed no change, while two patients’ condition worsened. We observed detrusor overactivity (DO) in two patients, and detrusor sphincter dyssynergia (DSD) in four patients. In addition, high-pressure voiding (HPV) was noted in two patients. On follow-up after spinal surgery, DO and DSD exhibited no improvement. Although HPV resolved, two patients developed new-onset poor compliance with worsening DO and DSD. Furthermore, two patients had bilateral hydronephrosis before surgery, which resolved on follow-up. CONCLUSIONS: Patients with spinal TB exhibiting LUTS can display a spectrum of clinical presentations and variable UDS findings. As two patients exhibited new onset poor compliance with bilateral hydronephrosis in one of them, this study concludes that a close follow-up for upper tracts in these patients is required despite successful spinal surgery.

Comparison of short-term effectiveness of structural and non-structural bone graft fusion in treatment of single segment thoracic tuberculosis / 中国修复重建外科杂志

Objective: To compare the short-term effectiveness of one-stage posterior debridement with non-structural bone graft and structural bone graft in the treatment of single segment thoracic tuberculosis. Methods: The data of 61 patients with single segment thoracic tuberculosis, who were treated by one-stage posterior debridement, bone graft fusion, and internal fixation between June 2011 and August 2015, was retrospectively analyzed. All of them, 26 cases were treated with structural bone graft (group A) and 35 cases with non-structural bone graft (group B). No significant difference was found between the two groups in gender, age, disease duration, comorbidity, involved segments, paravertebral abscess, and preoperative American Spinal Injury Association (ASIA) grade, C reactive protein (CRP), visual analogue scale (VAS) score, and Cobb angle of involved segments ( P>0.05). But the preoperative erythrocyte sedimentation rate (ESR) in group B was significantly lower than that in group A ( t=3.128, P=0.003). The operation time, intraoperative blood loss, hospitalization stay, VAS score, ESR, CRP, ASIA grade, postoperative complications, Cobb angle of involved segments and its correction rate and loss rate, and bone fusion time were recorded and compared between the two groups. Results: Compared with group A, group B had shorter operation time, less intraoperative blood loss, and longer hospitalization stay, showing significant differences ( P0.05). At last follow-up, the ASIA grade of the two groups significantly improved when compared with those before operation, and there was no significant difference between the two groups ( Z=-1.104, P=0.270). There were 9 cases and 10 cases of complications in groups A and B, respectively, and there was no significant difference ( χ2=0.254, P=0.614). The Cobb angle in group B was significantly higher than that in group A at 3 days after operation ( t=-2.861, P=0.006), but there was no significant difference in Cobb angle between the two groups at last follow-up ( t=-1.212, P=0.230). The postoperative correction rate and loss rate of Cobb angle in group A were higher than those in group B, and there was a significant difference in the loss rate between the two groups ( t=2.261, P=0.031). All patients got bone graft fusion and the bone fusion time of group B was significantly shorter than that of group A ( t=4.824, P=0.000). Conclusion: Non-structural and structural bone graft can both achieve good effectiveness in the treatment of single segment thoracic tuberculosis, but the former has the advantages of less surgical trauma and shorter fusion time.

Complicated lumbar tuberculous spondylodiscitis in disseminated tuberculosis, treated using a non-conventional anterior support system for hydrostatic distraction: a case report / Tratamento de espondilodiscite lombar complicada em tuberculose disseminada com sistema hidrostático de distração lombar: relato de caso

ABSTRACT Objective: To describe a case of disseminated tuberculosis affecting the lumbar spine that was treated using a non-conventional anterior support system. Background: Tuberculous spondylodiscitis is the most common and most severe form of extrapulmonary tuberculosis. Although antibiotic therapy is the most frequently used treatment, surgery is necessary in cases of neurological deficit, spinal instability, significant deformity, severe sepsis, paravertebral and epidural abscesses or in cases wherein clinical treatment has failed. A surgical procedure is also indicated when a biopsy is required. With the development of new methods for reconstruction and fixation of the spine, complete debridement of the tuberculous foci has become an increasingly common approach, but there is a lack consensus on the best technique. Methods and results: The patient suffered from disseminated tuberculosis affecting the lumbar region of the spine, with an abscess in the psoas muscle. He underwent extensive debridement via both anterior and posterior approaches, using a non-conventional anterior support system that promotes hydrostatic distraction. Conclusions: Treatment using the hydrostatic distraction system was able to reestablish both the stability and anatomy of the lumbar curve. Level of evidence IV, Case report.

RESUMO Objetivo: Descrever um caso de tuberculose disseminada afetando a coluna lombar, tratada com um sistema de suporte anterior não convencional. Contexto: Espondilodiscite tuberculosa é a forma mais comum e mais grave de tuberculose extrapulmonar. Embora o principal tratamento seja a antibioticoterapia, o tratamento cirúrgico é importante em casos de déficit neurológico, instabilidade da coluna e deformidade significativa, sepse grave, abscessos paravertebrais ou peridurais ou em casos de falha do tratamento clínico. Cirurgia também é necessária quando há necessidade de biópsia. Com o desenvolvimento de novos métodos para a reconstrução e fixação da coluna, cada vez mais se faz o debridamento completo do foco da tuberculose vertebral, mas há falta de consenso sobre a melhor técnica. Métodos e Resultados: O paciente sofria de tuberculose disseminada afetando a coluna, na região lombar, com abscesso do músculo psoas. Foi tratado com extenso debridamento pelas vias anterior e posterior, usando um sistema não convencional de suporte anterior que promove distração hidrostática. Conclusões: O tratamento com o distrator hidrostático foi capaz de restabelecer a estabilidade e a anatomia da curva lombar. Nível de evidência IV, Relato de caso.

Mielopatía compresiva por Mycobacterium tuberculosis en una niña de origen indígena: un caso clínico de zona endémica amazónica / Compressive Myelopathy caused by Mycobacterium Tuberculosis in an indigenous background child: A clinical case located within the Amazonian endemic zone / Mielopatia compressiva por Mycobacterium tuberculosis em uma menina indígena: um caso clínico da área amazônica endêmica

Introducción. La mielopatía compresiva es ocasionada por diversidad de condiciones. Los abscesos espinales se cuentan como una de sus causas de menor incidencia, con 0.2 a 2 casos por cada 10,000 ingresos hospitalarios, según estadísticas reportadas por el Hospital General de Massachusetts. El Mycobacterium tuberculosis es el segundo patógeno más frecuentemente implicado, con 25% de los casos. Objetivo.Presentar un caso de tuberculosis espinal en edad pediátrica, que es infrecuente pero de relevancia epidemiológica. Presentación del caso. Paciente femenina de siete años de edad, procedente de área endémica amazónica, con sintomatología de compresión de médula espinal. Su historia clínica, nexos epidemiológicos y hallazgos paraclínicos y quirúrgicos llevaron al diagnóstico de tuberculosis espinal. Recibió manejo descompresivo y terapia farmacológica con tetraconjugado, con evolución favorable al momento de su egreso. Conclusiones.La tuberculosis espinal, entidad infecciosa de baja frecuencia, requiere un alto índice de sospecha y un tratamiento oportuno. Las imágenes de resonancia magnética espinal orientan el diagnóstico, confirmándose mediante el aislamiento microbiológico del bacilo. Países como Colombia, con alta endemicidad para el Mycobacterium tuberculosis y con gran proporción de su población en riesgo, deben vigilar de manera constante la tuberculosis y tener presente esta entidad dentro de los diagnósticos diferenciales a descartar. [Leguizamón-Castillo DC, Espinosa-García E, Vélez-Pachón CV, Cediel-Echeverry M. Mielopatía compresiva por Mycobacterium tuberculosis en una niña de origen indígena: un caso clínico de zona endémica amazónica. MedUNAB. 2018;21(1):138-146.doi: 10.29375/01237047.2700].

Introduction. Compressive Myelophaty is caused by multiple factors. Spinal abscesses are one of the causes with lowest occurrence rates. According to statistics provided by Massachusetts' General Hospital, these abscesses represent from 0.2 to 2 cases in 10,000 hospital admissions. Mycobacterium tuberculosis is the second pathogen associated with this disease, as it was found in 25% of related cases. Objective. To present a spinal tuberculosis case at a pediatric age, which is an infrequent medical situation but that has epidemiologic relevance. Case Presentation. A 7 year old female patient coming from the Amazonian endemic zone with symptoms of spinal cord compression. Her medical history, epidemiological links and paraclinical and surgical findings lead to a spinal tuberculosis diagnosis. She received decompression procedures and first-line anti-tuberculous drug treatment (RIPE). At the moment of hospital discharging, the patient showed positive response and evolution to these treatments. Conclusions. Spinal tuberculosis is a low-frequency infectious entity, that requires high level of suspicion and prompt treatment. Magnetic resonance imaging (MRI) of the spine guides towards the final diagnosis, that it is confirmed by microbiological isolation of the bacillus. Countries like Colombia, that is a high-endemic zone for Mycobacterium tuberculosis and that has a high percentage of population at risk, must keep a detailed surveillance of tuberculosis and must keep in mind this disease when constructing and ruling out differential diagnoses. [Leguizamón-Castillo DC, Espinosa-García E, Vélez-Pachón CV, Cediel-Echeverry M. Compressive Myelopathy caused by Mycobacterium Tuberculosis in an indigenous background child: A clinical case located within the Amazonian endemic zone. MedUNAB. 2018;21(1):138-146.doi: 10.29375/01237047.2700].

Introdução. A mielopatia compressiva é causada por uma variedade de condições. Abcessos na medula espinhal são contados como uma das causas de menor incidência, com 0.2 a 2 casos em cada 10,000 admissões hospitalares, segundo estatísticas relatadas pelo Hospital Geral de Massachusetts. O Mycobacterium tuberculosis é o segundo patógeno mais frequentemente envolvido, em 25% dos casos. Objetivo. Apresentar um caso de tuberculose espinhal em idade pediátrica que é infrequente, mas de relevância epidemiológica. Apresentação de caso. Uma paciente de sete anos de idade, da área endêmica da Amazônia, com sintomatologia de compressão medular. Sua história clínica, ligações epidemiológicas e achados paraclínicos e cirúrgicos levaram ao diagnóstico de tuberculose espinhal. A paciente recebeu tratamento descompressivo e terapia medicamentosa com tetra conjugado e teve evolução favorável no momento da alta. Conclusões.A tuberculose espinhal, infecção de baixa frequência, requer um alto índice de suspeita e tratamento oportuno. As imagens da ressonância magnética espinhal orientam o diagnóstico, confirmado por meio do isolamento microbiológico do bacilo. Países como Colômbia, com alta endemicidade para o Mycobacterium tuberculosis e com uma grande proporção de população em risco, devem monitorar constantemente a tuberculose e manter essa entidade em mente nos diagnósticos diferenciais a serem descartados. [Leguizamón-Castillo DC, Espinosa-García E, Vélez-Pachón CV, Cediel-Echeverry M. Mielopatia compressiva por Mycobacterium tuberculosis em uma menina indígena: um caso clínico da área amazônica endêmica. MedUNAB. 2018;21(1):138-146.doi: 10.29375/01237047.2700].

Clinical Analysis of One-Stage Debridement,Bone Grafting and Internal Fixation for the Treatment of Single-Segmental Lumbar Spinal Tuberculosis with Extreme Lateral Approach / 中山大学学报(医学科学版)

[Objective]To analyze the feasibility and clinical efficacy of one-stage debridement,bone grafting and in-ternal fixation for the treatment of single-segmental lumbar spinal tuberculosis with extreme lateral approach.[Methods]Thirteen patients of single-segmental lumbar spinal tuberculosis that received the surgeries from April 2013 to August 2016 were included.The operation duration and the amount of intraoperative blood loss were recorded.The VAS and ODI of the back pain,lumbar kyphosis angle,segment height restoration,and vertebral fusion rate were used to analyze the clinical efficacy.[Results]Thirteen patients were successfully followed up for 13-32 months(mean,20.3 months);the operation duration was 160-280 min(average,214±96)min;the amount of intraoperative blood loss was 150-350 mL, average(average,263±63)mL. At the final follow-up,ESR and CRP were normal and lower back pain(VAS)and Oswestry disability index(ODI)were significantly reduced(7.2±1.6 vs 2.5±1.2 and 63.3±5.4 vs 31.9±3.7,respectively)compared to preoperative values;there were no significant difference in the lumbar kyphosis angle,segment height resto-ration between preoperation(segmental lordosis,7.1°±4.7°;segmental height,64.8 mm±9.3 mm)and the values at final follow-ups(segmental lordosis,5.2°±3.5°;segmental height,69.4 mm±10.5 mm;P>0.05). All cases acquired good lumbar interbody fusion with no internal fixation failure or recurrence of tuberculosis.[Conclusions]Under systemic and routine antituberculosis chemotherapy,one-stage extreme lateral approach debridement,bone graft and internal fixation is effective and feasible for single-segmental lumbar spinal tuberculosis.

Logistic Regression Analysis of the Risk Factors for Retreatment of Spinal Tuberculosis After Operation / 现代医院

Objective To explore the risk factors for retreatment of spinal tuberculosis and to provide a theoretical basis for the formulation of clinical prevention and treatment measures. Methods the clinical data of 114 patients who received spinal tuberculosis operation from January 2011 to June 2014 were retrospectively analyzed. Among them, 13 cases were divided into group A after operation, and 101 cases without recurrence after operation were divided into B group. The clinical data of the two groups were compared and the multiple factor Logistic regression was used to analyze the risk factors for retreatment of spinal tuberculosis. Results In group A, preoperative albumin level, after standard anti-tuberculosis treatment, the proportion of complete removal of the lesion was significantly lower than that in group B, and tuberculosis in other parts of the proportion, the emergence of resistant strains, proportion of adverse conditions were significantly higher than those in group B (P＜0. 05). Multivariate Logistic regression analysis showed that preoperative albumin < 35g/L, without fusion, patients who did not receive regular anti-tuberculosis treatment, debridement is not complete, with other parts of tuberculosis, drug resistant strain and adverse conditions were risk factors of postoperative spinal tuberculosis retreatment (P＜0. 05). Conclusion Many factors can affect the incidence of relapse after spinal tuberculosis surgery, and clinical intervention should be carried out to reduce the risk of relapse after spinal tuberculosis operation.

Comparative analysis of clinical curative effects of allogeneic bone ring and titanium mesh in repairing adolescent spinal tuberculosis kyphosis / 重庆医学

Objective To compare the clinical curative effect of allogeneic bone ring and titanium mesh in repairing adolescent spinal tuberculosis kyphosis.Methods Forty-four cases of kyphosis after adolescent spinal tuberculosis operation in this hospital from January 2012 to January 2015 were selected as the study subjects and divided into the control group and observation group ac-cording to the treatment types,22 cases in each group.The control group was repaired with titanium mesh,while the observation group was given allogeneic bone ring fusion repair.Postoperative follow up lasted for 2 -5 years.The perioperative indexes,repair material and vertebral fusion and neurological score,preoperative and postoperative Cobb angle,ESR,CRP and postoperative com-plications occurrence were compared between the two groups.Results There was no statistically significant difference in periopera-tive indexes between the two groups(P>0.05).The fusion time,occurrence rate of local pain and motion limitation had statistical differences between the two groups(P<0.05).The occurrence rate of material loosening had no statistical difference(P>0.05). No grade A and B spinal injury appeared in both groups.The incidence rate of grade D and E in the observation group was signifi-cantly lower than that in the control group,the difference was statistically significant(P<0.05).The postoperative Cobb angle, ESR and CRP had no statistical difference between the two groups(P>0.05),moreover no significant adverse reactions and post-operative tuberculosis recurrence occurred.Conclusion Allogeneic bone ring and titanium mesh have satisfactory effect for repairing juvenile spinal tuberculosis kyphosis,allogeneic bone ring fusion time is longer,early stability is worse than the titanium mesh,the brace protection is needed in the early time,but the clinical effect of patients is more significant,which is worthy of being promoted and applied in clinical treatment.

Treatment of senile spinal tuberculosis with posterior percutaneous pedicle screw fixation combined with local percutaneous endoscopic debridement / 中国骨伤

OBJECTIVE@#To explore the short-term efficacy of posterior percutaneous screw fixation combined with local percutaneous endoscopic debridement in treating senile spinal tuberculosis.@*METHODS@#The clinical data of 19 senile patients with spinal tuberculosis underwent surgical treatment from January 2015 to September 2016 were retrospectively analyzed. There were 13 males and 6 females, aged from 60 to 73 years old with an average of (66.2±4.0) years. All patients have been diagnosed with spinal tuberculosis prior to hospitalization with abscess, dead bone formation but no sinus, neurological symptoms, open surgical indications. All patients were treated with posterior percutaneous screw fixation combined with local percutaneous endoscopic debridement, and were given appropriate chemotherapy for 3 weeks preoperatively. Pre-and post-operative visual analogue score (VAS), Oswestry Disability Index (ODI), sagittal Cobb angle of lesion segment, erythrocyte sedimentation rate(ESR), C-reactive protein(CRP) were analyzed.@*RESULTS@#All the 19 patients successfully completed the operation and passed through the perioperative period safely. The operation method was unchanged during the operation. The average operation time was (153.2±14.0) min. Except for 1 patients who had delayed incision healing, other patients healed at I stage within 2 weeks after operation. All patients were followed up for 15 to 26 months with an average of (19.6±3.2) months.VAS, ODI, sagittal Cobb angle of lesion segment, ESR, CRP were decreased from preoperative(5.9±1.1) points, (80.9±4.0)%, (30.8±5.5)°, (79.6±14.4) mm/h, (56.9±9.5) mg/L to(1.8±0.9) points, (66.4±5.4)%, (15.9±2.5)°, (20.4±4.6) mg/L, (32.0±8.1) mm/h at final follow-up(<0.05).@*CONCLUSIONS@#Senile spinal tuberculosis have more complications and poor general body condition. Posterior percutaneous pedicle screw fixation combined with local percutaneous endoscopic debridement in treating the patients can reduce trauma, got satisfactory effect.