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1.
Coluna/Columna ; 20(2): 105-108, Apr.-June 2021. tab
Article in English | LILACS | ID: biblio-1249658

ABSTRACT

ABSTRACT Objective: To analyze the occurrence of notified cases of bone tuberculosis in Brazil during the period from 2009 to 2018. Methods: Quantitative, descriptive and retrospective study. The data consisted of cases reported to the Notifiable Diseases Information System (SINAN) of DATASUS. To analyze the results, the non-parametric statistical Chi-squared and G tests, capable of expressing statistical associations, were used. Results: 6,442 cases of bone tuberculosis were reported in Brazil, with an average of 644.2 cases per year. The Southeast was responsible for 41.5% of the cases (n = 2676). The extrapulmonary form accounted for 87.9% (5661). There was a predominance in males (66.1%, n = 4258), Whites (41.6%, n = 2678) and in the above 35 years of age group (73.9%, n = 4757). In the data collected, the risk factor data was not correctly filled out, making reliable statistical associations impossible in this study, mainly between alcoholism, tobacco use, AIDS, diabetes, mental illness, illicit drug use and homelessness. Conclusion: There was greater notification of cases of bone tuberculosis in the Southeast and Northeast regions of Brazil, which predominantly affected young, economically productive men. Tuberculosis has a correlation with diabetes, HIV / AIDS, smoking and alcohol and drug use, according to the results of this study. Level of evidence II; Retrospective, analytical, quantitative and descriptive study.


RESUMO Objetivo: Analisar a ocorrência de casos de tuberculose óssea notificados no Brasil entre o período de 2009 a 2018. Métodos: Estudo quantitativo, descritivo e retrospectivo. Os dados consistiram em casos notificados no Sistema de Informação de Agravos de Notificação (SINAN) do DATASUS. Para análise dos resultados, foram usados testes estatísticos não paramétricos, Qui-quadrado e teste G, capazes de expressar associação estatística. Resultados: Foram notificados 6.442 casos de tuberculose óssea no Brasil, com média de 644,2 casos por ano. O Sudeste foi responsável por 41,5% dos casos (n = 2676). A forma extrapulmonar correspondeu a 87,9% (5.661). Houve predomínio no sexo masculino (66,1%, n = 4258), em brancos (41,6%, n = 2678) e maiores de 35 anos (73,9%, n = 4757). Os dados coletados não tinham preenchimento correto dos fatores de risco, o que impossibilitou a associação estatística confiável neste estudo, principalmente entre alcoolismo, tabagismo, AIDS, diabetes, doença mental, uso de drogas ilícitas e moradores de rua. Conclusões: Houve maior notificação de casos de tuberculose óssea no Sudeste e no Nordeste do Brasil, que afetou predominantemente homens jovens e em plena atividade econômica. A tuberculose tem correlação com diabetes, HIV/AIDS, tabagismo e uso de álcool e drogas ilícitas, conforme os resultados deste estudo. Nível de evidência II; Estudo retrospectivo, analítico, quantitativo e descritivo.


RESUMEN Objetivo: Analizar la ocurrencia de casos de tuberculosis ósea notificados en Brasil en el período de 2009 a 2018. Métodos: Estudio cuantitativo, descriptivo y retrospectivo. Los datos consistieron en casos notificados en el Sistema de Información de Enfermedades de Notificación (SINAN) del DATASUS. Para análisis de los resultados, fueron usados tests estadísticos no paramétricos, Chi-cuadrado y test G, capaces de expresar asociación estadística. Resultados: Fueron notificados 6.442 casos de tuberculosis ósea en Brasil, con promedio de 644,2 casos por año. El sudeste fue responsable por 41,5% de los casos (n = 2676). La forma extrapulmonar correspondió a 87,9% (5661). Hubo predominio en el sexo masculino (66,1%, n = 4258), en blancos (41,6%, n = 2678) y mayores de 35 años (73,9%, n = 4757). Los datos colectados no tenían llenado correcto de los factores de riesgo, lo que imposibilitó la asociación estadística confiable en este estudio, principalmente entre alcoholismo, tabaquismo, SIDA, diabetes, enfermedad mental, uso de drogas ilícitas y personas sin techo. Conclusiones: Hubo mayor notificación de casos de tuberculosis ósea en el sudeste y en el noreste de Brasil, que afectó predominantemente a hombres jóvenes y en plena actividad económica. La tuberculosis tiene correlación con diabetes, VIH/SIDA, tabaquismo y uso de alcohol y drogas ilícitas, conforme a los resultados de este estudio. Nivel de evidencia II; Estudio retrospectivo, analítico, cuantitativo y descriptivo.


Subject(s)
Humans , Epidemiology , Orthopedics , Tuberculosis, Osteoarticular , Tuberculosis, Spinal
2.
Coluna/Columna ; 20(2): 109-113, Apr.-June 2021. tab, graf
Article in English | LILACS | ID: biblio-1249652

ABSTRACT

ABSTRACT Objective: Tuberculosis (TB) represents one of the top ten causes of death in the world. Its insidious onset and nonspecific symptoms usually result in delayed diagnosis. The objective is to evaluate the characteristics of patients with tuberculous spondylodiscitis in follow-up at a South American reference hospital. Method: Retrospective evaluation of the medical records of patients of both sexes and between 0 and 80 years of age diagnosed with tuberculosis of the spine between 2009 and 2018. The variables were analyzed based on groups: epidemiological, clinical, laboratorial, microbiological, imaging tests and treatment. Results: Total of 26 cases, about 80.8% male, mean age 41.6 ± 22.46 years. Axial pain was the most prevalent symptom (84.6%), the VAS score was 6.85 ± 2.87. The mean time between symptom onset and diagnosis was 23.8 ± 24.1 weeks (4-96). The most affected region was the thoracic spine (50% of the cases). Most participants (61.4%) had no change in neurological function (Frankel D and E) at the beginning of treatment and after 6 months, and 84.5% improved. During treatment 34.6% required surgery and the main indication was isolated neurological deficit (55.5%). The most frequently performed procedure was decompression and arthrodesis (55.5%). The average time to cure was 12.0 ± 8.8 months (8-48). Conclusion: Disease with insidious onset, nonspecific symptoms, high frequency of negative microbiological tests in cases with the disease. A small number of the cases required surgical treatment and most of them achieved good neurological recovery. Level of evidence IV; Case series.


RESUMO Objetivo: A tuberculose (TB) é uma das dez principais causas de morte no mundo. O início insidioso e os sintomas inespecíficos geralmente resultam em atraso do diagnóstico. O objetivo é avaliar as características dos pacientes com espondilodiscite tuberculosa em acompanhamento, em um hospital de referência sul-americano. Método: Avaliação retrospectiva de dados de prontuários, diagnóstico de tuberculose da coluna vertebral entre 2009 e 2018, de ambos os sexos, entre 0 e 80 anos de idade. As variáveis foram analisadas com base em grupos: epidemiológicas, clínicas, laboratoriais, microbiológicas, exames de imagem e tratamento. Resultados: Total de 26 casos, cerca de 80,8% do sexo masculino, média de idade de 41,6 ± 22,46 anos. A dor axial foi o sintoma mais prevalente (84,6%), o escore da EVA foi de 6,85 ± 2,87. A média de tempo entre o início dos sintomas e o diagnóstico foi de 23,8 ± 24,1 semanas (4-96). A região mais acometida foi a coluna torácica (50% dos casos). A maioria (61,4%) dos participantes apresentou função neurológica inalterada (Frankel D e E) no início do tratamento e 6 meses depois, sendo que 84,5% obtiveram melhora. No tratamento, 34,6% necessitaram de cirurgia, e a principal indicação foi déficit neurológico isolado (55,5%). O procedimento mais realizado foi descompressão e artrodese (55,5%). O tempo médio até a cura foi de 12,0 ± 8,8 meses (8-48). Conclusão: Doença de início insidioso, sintomas inespecíficos, grande frequência de exames microbiológicos negativos em casos com a doença. A menor parte dos casos necessitou de tratamento cirúrgico e a maioria apresentou boa recuperação neurológica. Nível de evidência IV; Série de casos.


RESUMEN Objetivo: La tuberculosis (TB) es una de las diez principales causas de muerte en el mundo. El inicio insidioso y los síntomas inespecíficos generalmente resultan en atraso del diagnóstico. El objetivo es evaluar las características de los pacientes con espondilodiscitis tuberculosa en acompañamiento en un hospital de referencia sudamericano. Método: Evaluación retrospectiva de datos de historiales clínicos, diagnóstico de tuberculosis de la columna vertebral entre 2009 y 2018, de ambos sexos, entre 0 y 80 años de edad. Las variables fueron analizadas con base en grupos: epidemiológicas, clínicas, de laboratorio, microbiológicas, exámenes de imagen y tratamiento. Resultados: Total de 26 casos, cerca de 80,8% del sexo masculino, promedio de edad de 41,6 ± 22,46 años. El dolor axial fue el síntoma más prevalente (84,6%). El puntaje de la EVA fue de 6,85 ± 2,87. El promedio de tiempo entre el inicio de los síntomas y el diagnóstico fue de 23,8 ± 24,1 semanas (4-96). La región más acometida fue la columna torácica (50% de los casos). La mayoría (61,4%) de los participantes presentó función neurológica inalterada (Frankel D y E) al inicio del tratamiento y seis meses después, siendo que 84,5% obtuvo mejora. En el tratamiento, 34,6% precisó cirugía, y la principal indicación fue déficit neurológico aislado, (55,5%). El procedimiento más realizado fue descompresión y artrodesis (55,5%). El tiempo promedio hasta la cura fue de 12,0 ± 8,8 meses (8-48). Conclusión: Enfermedad de inicio insidioso, síntomas inespecíficos, alta frecuencia de exámenes microbiológicos negativos en casos con la enfermedad. La menor parte de los casos requirió tratamiento quirúrgico y la mayoría presentó buena recuperación neurológica. Nivel de evidencia IV; Serie de casos.


Subject(s)
Humans , Tuberculosis, Spinal , Spine , Tuberculosis , Diagnosis
3.
Coluna/Columna ; 20(1): 42-46, Jan.-Mar. 2021. tab, graf
Article in English | LILACS | ID: biblio-1154024

ABSTRACT

ABSTRACT Objective: To evaluate the clinical and radiological results of posterior vertebral column resection (PVCR) for the treatment of kyphosis from spinal tuberculosis. Methods: Retrospective study of a series of 14 cases, 9 female and 5 male, with a mean age of 28 years (1 to 64) at the time of surgery, with spinal tuberculosis with mean kyphosis of 56.42° (2° to 95°). Results: All patients underwent surgical treatment with PVCR, with a mean number of 2.57 (1 to 6) resected vertebrae and a mean number of instrumented vertebrae of 6.14 (4 to 8). The mean kyphosis correction was 64% after up to one year of follow-up. Prior to surgery, eight patients had signs of spinal cord impairment (ASIA score ranging from A to D), and six did not present any deficit of strength or sensory function (ASIA E). There was no neurological worsening and everyone with deficits improved by at least one degree on the scale. In the postoperative follow-up, bone consolidation was observed in all patients, except one. Among the intra- and postoperative complications, pleurotomy was the most prevalent. Conclusion: Posterior vertebral column resection has proven to be a safe and effective option for the treatment of kyphotic deformity from spinal tuberculosis. Level of evidence IV; Therapeutic studies - Investigation of treatment results.


RESUMO Objetivo: Avaliação dos resultados clínicos e radiológicos da ressecção da coluna vertebral por via posterior (RCVP) no tratamento da cifose por tuberculose vertebral. Métodos: Estudo retrospectivo de uma série de 14 casos, sendo 9 do sexo feminino e 5 do sexo masculino, com média de idade de 28 anos (1 a 64) à época da cirurgia, portadores de tuberculose vertebral, com média de cifose de 56,42° (2° a 95°). Resultados: Todos os pacientes foram submetidos ao tratamento cirúrgico com RCVP, com número médio de 2,57 (1 a 6) vértebras ressecadas e número médio de vértebras instrumentadas de 6,14 (4 a 8). A média de correção da cifose foi de 64%, com até um ano de seguimento. Antes da cirurgia, oito pacientes apresentavam sinais de sofrimento medular (escore ASIA variando de A a D) e outros seis não apresentavam déficit de força ou sensibilidade (ASIA E). Não houve piora neurológica, e todos os que tinham déficits melhoraram no mínimo um grau na escala. No seguimento pós-operatório, foi evidenciada consolidação óssea em todos os pacientes, exceto um. Dentre as complicações intra e pós-operatórias, a pleurotomia foi a mais prevalente. Conclusões: A ressecção por via posterior mostrou ser uma opção segura e eficaz no tratamento da cifose por tuberculose vertebral. Nível de evidência IV; Estudos terapêuticos - Investigação dos resultados do tratamento.


RESUMEN Objetivo: Evaluación de los resultados clínicos y radiológicos de la resección de la columna vertebral por vía posterior (RCVP) en el tratamiento de la cifosis por tuberculosis vertebral. Métodos: Estudio retrospectivo de una serie de 14 casos, 9 del sexo femenino y 5 del sexo masculino, con promedio de edad de 28 años (1 a 64) en el momento de la cirugía, portadores de tuberculosis vertebral con promedio de cifosis de 56,42° (2º a 95°). Resultados: Todos los pacientes fueron sometidos a tratamiento quirúrgico con RCVP, con número promedio de 2,57 (1 a 6) vértebras resecadas y número promedio de vértebras instrumentadas de 6,14 (4 a 8). El promedio de corrección de la cifosis fue de 64%, con hasta un año de seguimiento. Antes de la cirugía, ocho pacientes presentaban señales de sufrimiento medular (puntuación ASIA variando de A a D), y otros seis no presentaban déficit de fuerza o sensibilidad (ASIA E). No hubo empeoramiento neurológico, y todos los que tenían déficit mejoraron al menos un grado en la escala. En el seguimiento postoperatorio, fue evidenciada consolidación ósea en todos los pacientes, excepto en uno. Entre las complicaciones intra y postoperatorias, la pleurotomía fue la más prevalente. Conclusiones: La resección por vía posterior mostró ser una opción segura y eficaz en el tratamiento de la cifosis por tuberculosis vertebral. Nivel de evidencia IV; Estudios terapéuticos: investigación de los resultados del tratamiento.


Subject(s)
Humans , Osteotomy , Tuberculosis, Spinal , Neurologic Manifestations
4.
Article in Chinese | WPRIM | ID: wpr-879420

ABSTRACT

OBJECTIVE@#To investigate the clinical efficacy and superiority of direct lateral interbody fusion combined with posterior percutaneous screw fixation in the treatment of lumbar tuberculosis.@*METHODS@#From June 2013 to August 2016, the clinical data of 83 patients with lumbar tuberculosis were retrospectively analyzed, including 55 males and 28 females, aged from 27 to 72 (49.5±13.5) years. These 83 patients were divided into two groups according to different operation methods, 35 cases in group A were treated with direct lateral interbody fusion combined with posterior percutaneous screw fixation;48 cases in group B were treated with anterior traditional extraperitoneal debridement combined with posterior internal fixation. After operation, regular quadruple antituberculosis drugs were continued for 18 months. The operation time, intraoperative blood loss, hospital stay, bone graft fusion time and complications were compared between the two groups. Visual analogue score (VAS) of lumbar pain, Oswestry Disability Index (ODI), sagittal Cobb angle, erythrocyte sedimentation rate (ESR) and C-reactive protein(CRP) values before and after operation were analyzed.@*RESULTS@#The operation was successfully completed in both groups, and the operation mode was not changed during operation. The operation time, intraoperative blood loss and hospital stay were (149.4±13.3) min, (354.3±69.0) ml, (9.4±1.6) d in group A and(116.8±10.0) min, (721.9±172.3) ml, (11.8±1.7) d in group B, respectively, with significant difference between the two groups (@*CONCLUSION@#The two kinds of operation can obtain satisfactory clinical effect. Direct lateral interbody fusion combined with posterior percutaneous screw fixation can reduce intraoperative blood loss and hospital stay, which is conducive to early rehabilitation of patients.


Subject(s)
Aged , Bone Transplantation , Debridement , Female , Humans , Lumbar Vertebrae/surgery , Male , Pedicle Screws , Retrospective Studies , Spinal Fusion , Thoracic Vertebrae , Treatment Outcome , Tuberculosis, Spinal/surgery
5.
Article in Chinese | WPRIM | ID: wpr-879409

ABSTRACT

OBJECTIVE@#To compare the clinical effects of three different methods of binding multi-fold rib graft, iliac bone graft and titanium mesh graft in tuberculosis of thoracic vertebra by approach of transverse rib process.@*METHODS@#A hundred and seven patients with tuberculosis of thoracic vertebra received surgical treatment from January 2010 to December 2016 were retrospectively analyzed. The patients were divided into three groups according different methods of bone graft. The surgical approach of the transverse rib process was used in all 107 patients, after thoroughly remove the necrotic tissue of tuberculosis, three different bone grafts were used respectively including iliac bone graft (36 cases, group A), binding multi-fold rib graft (35 cases, group B), titanium mesh bone graft (36 cases, group C). Perioperative indexes, the time required for bone graft during operation, intraoperation blood loss, the loss rate of the anterior edge of the lesion, Cobb angle, postoperative bone graft fusion time, spinal nerve recovery and Oswestry Disability Index were compared among three groups.@*RESULTS@#All the patients were followed up for 13 to 24 months, and the operation time required for bone graft was (23.2±4.1) min in group A, (23.8± 4.4)min in group B, and (25.5±4.2) min in group C, with no statistically significant difference among three groups (@*CONCLUSION@#The approach of transverse rib process for debridement of lesions can effectively treat tuberculosis of thoracic vertebra by binding multi-fold rib graft, iliac bone graft and titanium mesh graft, but binding multi-fold rib graft can effectively avoid iliac bone donor complications, and is an effective alternative to iliac bone graft, which is worth popularizing.


Subject(s)
Bone Transplantation , Humans , Lumbar Vertebrae , Retrospective Studies , Ribs/surgery , Spinal Fusion , Surgical Mesh , Thoracic Vertebrae/surgery , Titanium , Treatment Outcome , Tuberculosis, Spinal/surgery
6.
Article in Chinese | WPRIM | ID: wpr-888346

ABSTRACT

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.


Subject(s)
Adolescent , Adult , Aged , Aged, 80 and over , Blood Sedimentation , Child , Female , Humans , Male , Middle Aged , Retrospective Studies , Spinal Fusion , Thoracic Vertebrae , Tuberculosis, Spinal/surgery , Young Adult
7.
Article in Spanish | LILACS, BINACIS | ID: biblio-1353991

ABSTRACT

Se conoce como enfermedad de Gibbus al colapso de la porción anterior de uno o más cuerpos vertebrales que provoca una cifosis segmentaria de ángulo agudo. En general, este tipo de deformidades son producto de infecciones tuberculosas. Uno de los principales problemas que trae apareado esta deformidad es la compresión medular. En el caso presentado, el paciente sufrió esta enfermedad como consecuencia de una infección no tuberculosa, con cifosis angular pososteomielitis, tratado con doble vía de abordaje, utilizando implantes recubiertos con nanopartículas de plata. Los resultados clínico-radiológicos fueron muy satisfactorios. Este caso presenta la conjugación de dos temas poco frecuentes en la medicina actual; por un lado, un tipo de deformidad de la columna que, rara vez, se debe a una infección no tuberculosa y, por otro lado, el implante utilizado, recubierto con nanopartículas de plata que, pese a las controversias, ofrece una nueva posibilidad de tratamiento para pacientes con un riesgo aumentado de infección asociada a implantes, y resulta de interés que sea reconocido por los cirujanos ortopedistas, puesto que existe evidencia suficiente para afirmar su capacidad para reducir la formación de biopelículas. Nivel de Evidencia: IV


Gibbus disease is the collapse of the anterior portion of one or more vertebral bodies that results in acute angle segmental kyphosis. Generally, these types of deformities are caused by tuberculosis infections. One of the main problems associated with this deformity is spinal compression. In this case, the patient presented this condition as a consequence of a non-tuberculous infection, with angular kyphosis after osteomyelitis, treated with a double approach, using implants coated with silver nanoparticles. We obtained very satisfactory clinical and radiological outcomes. This case presents the intersection of two rare topics in current medicine; on the one hand, a type of spinal deformity that rarely occurs as a consequence of a non-tuberculous infection. On the other hand, the implant used, coated with silver nanoparticles. Although there are still controversies in the literature, this implant offers a new possibility of treatment for patients who are at increased risk of implant-related infection, and it is of interest for orthopedic surgeons, since there is sufficient evidence to support its ability to reduce the formation of biofilms. Level of Evidence: IV


Subject(s)
Aged , Prostheses and Implants , Tuberculosis, Spinal , Metal Nanoparticles , Kyphosis
10.
Medisan ; 24(1)ene.-feb. 2020. imag
Article in Spanish | LILACS, CUMED | ID: biblio-1091168

ABSTRACT

Se describe el caso clínico de un paciente de 18 años de edad, seropositivo al VIH, quien fue atendido en el Hospital Provincial de Luena, provincia angolana de Moxico, por presentar dolor lumbar. Se le realizó tomografía axial computarizada, la cual mostró gran destrucción vertebral y colecciones paravertebrales bilaterales. El paciente mantuvo una evolución desfavorable y falleció 20 días después de realizado el diagnóstico.


The case report of an 18 years patient, HIV seropositive is described. He was assisted at Luena Provincial Hospital, angolan province of Moxico due to a lumbar pain. A computerized axial tomography was carried out, which showed great vertebral destruction and bilateral paravertebral collections. The patient maintained an unfavorable clinical course and died 20 days after the diagnosis.


Subject(s)
Tuberculosis, Spinal , Adolescent , Mycobacterium tuberculosis , HIV Seropositivity
11.
Article in Chinese | WPRIM | ID: wpr-828272

ABSTRACT

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.


Subject(s)
Aged , Aged, 80 and over , Bone Transplantation , Debridement , Female , Fracture Fixation, Internal , Humans , Lumbar Vertebrae , Male , Middle Aged , Retrospective Studies , Spinal Fusion , Thoracic Vertebrae , Treatment Outcome , Tuberculosis, Spinal
12.
Coluna/Columna ; 18(3): 217-221, July-Sept. 2019. tab, graf
Article in English | LILACS | ID: biblio-1019782

ABSTRACT

ABSTRACT Objective To evaluate the clinical and radiological results of posterior vertebral column resection in the treatment of kyphosis due to vertebral tuberculosis in children under 9 years of age with neurological deficit. Methods Retrospective study of a series of 5 cases, 4 females and 1 male, mean age of 4.7 years at the time of surgery, with spinal tuberculosis and mean kyphosis of 89 degrees. Results All patients underwent surgical treatment with PVCR in multiple levels, with a mean number of 3.6 resected vertebrae, mean surgical time of 359 minutes, mean postoperative stay of 21.2 days. The mean follow-up was 29 months. The mean kyphosis correction was 62.6%. Before surgery, all patients had signs of spinal cord injury, one of which did not present a deficit of strength or sensibility (ASIA E), but there were pyramidal signs and a history of falls. The other 4 had some degree of sensory-motor dysfunction, with ASIA score varying from A to D. Postoperative complications included two dehiscences of suture, one pneumothorax and one pneumonia, all with favorable evolution. Four patients progressed with neurological improvement and one of them had persistence of the neurological deficit until the last follow-up. Conclusions Multiple-level PVCR has proven to be a safe and effective option for the treatment of kyphotic deformity in spinal tuberculosis in children with neurological deficit. Level of evidence IV; Case Series.


RESUMO Objetivo Avaliação dos resultados clínicos e radiológicos da vertebrectomia posterior multinível no tratamento da cifose por tuberculose vertebral em crianças menores de 9 anos apresentando déficit neurológico. Métodos Estudo retrospectivo de uma série de 5 casos, sendo 4 do sexo feminino e 1 do sexo masculino, média de idade de 4,7 anos na época da cirurgia, portadoras de tuberculose vertebral múltiplos níveis, com média de cifose de 89°. Resultados Todos os pacientes foram submetidos ao tratamento cirúrgico com RCVP múltiplos níveis, com número médio de 3,6 vértebras ressecadas, média de tempo cirúrgico de 359 minutos, período médio de internação pós-operatória de 21,2 dias. O seguimento médio foi de 29 meses. A média de correção da cifose foi de 62,6%. Antes da cirurgia, todos os pacientes tinham sinais de sofrimento medular, sendo que um deles não apresentava déficit de força ou sensibilidade (ASIA E), porém havia a presença de sinais piramidais e história de quedas. Os outros 4 possuíam algum grau de disfunção sensitivo-motora, com escore ASIA variando de A a D. Como complicações pós-operatórias ocorreram duas deiscências de sutura, um pneumotórax e uma pneumonia, todas com evolução favorável. Quatro pacientes evoluíram com melhora neurológica e um deles apresentou manutenção do déficit neurológico até o último seguimento. Conclusão A RCVP múltiplos níveis se mostrou uma opção segura e eficaz no tratando da cifose na TB vertebral em crianças com déficit neurológico. Nível de evidência IV; Série de Casos.


RESUMEN Objetivo Evaluar los resultados clínicos y radiológicos de la vertebrectomía posterior en múltiples niveles en el tratamiento de la cifosis por tuberculosis vertebral en niños menores de 9 años con déficit neurológico. Métodos Estudio retrospectivo de una serie de 5 casos, siendo 4 del sexo femenino 1 del sexo masculino, con promedio de edad de 4,7 años en el momento de la cirugía y múltiples niveles de tuberculosis espinal con cifosis promedio de 89 grados. Resultados Todos los pacientes se sometieron a tratamiento quirúrgico por RPCV en niveles múltiples, con una media de 3,6 vértebras resecadas, tiempo operatorio promedio de 359 minutos y estancia promedio postoperatoria de 21,2 días. El seguimiento promedio fue de 29 meses. La corrección de la cifosis promedio fue del 62,6%. Antes de la cirugía, todos los pacientes tenían signos de lesión de la médula espinal, uno de los cuales no tenía déficit de fuerza o sensibilidad (ASIA E), pero tenía signos piramidales y antecedentes de caídas. Los otros 4 tenían algún grado de disfunción sensoriomotora con puntuación de ASIA que variaba de A a D. Las complicaciones postoperatorias incluyeron dos dehiscencias de sutura, un neumotórax y una neumonía, todas con evolución favorable. Cuatro pacientes tuvieron mejoría neurológica y uno de ellos tuvo persistencia del déficit neurológico hasta el último seguimiento. Conclusiones La RPCV ha demostrado ser una opción segura y eficaz en el tratamiento de la deformidad cifótica en la tuberculosis espinal en niños con déficit neurológico. Nivel de evidencia IV; Serie de Casos.


Subject(s)
Humans , Spinal Cord Compression , Tuberculosis, Spinal , Neurologic Manifestations
13.
Rev. patol. trop ; 48(2): 67-78, 2019. ilus
Article in English | LILACS | ID: biblio-1025471

ABSTRACT

This is a literature review on the pathogenesis and epidemiology of bone tuberculosis (BTB). Full-text papers from 2001 to 2017 were included. After inclusion criteria were met, 23 papers were selected for analysis. Results show that in most cases of BTB, the spine is the main site involved, regardless of the geographical regions analyzed; hip and knee involvement are also frequent. These three sites are the most prevalent, totaling approximately 70 - 80% of infections. The major forms of involvement are tuberculous spondylitis, tuberculous osteomyelitis, primarily in areas of long-bone growth, as well as cases of chronic disease leading to tuberculous arthritis, mainly in endemic areas. The results also indicated that bone involvement is still prevalent, being the fifth cause of extrapulmonary disease involvement in Brazil. This review highlights the role of tuberculosis in public health, especially in economically active groups where BTB is most prevalent.


Trata-se de uma revisão de literatura sobre patogênese e epidemiologia da tuberculose óssea (BTB). Foram incluídos artigos de texto completo de 2001 a 2017. Após o preenchimento dos critérios de inclusão, 23 artigos foram selecionados para análise. Os resultados mostram que, na maioria dos casos de BTB, a coluna é a principal local envolvido, independentemente das regiões geográficas analisadas; envolvimento do quadril e joelho também são frequentes. Esses três sites são os mais prevalentes, totalizando aproximadamente 70 - 80% de infecções. As principais formas de envolvimento são espondilite tuberculosa, tuberculosa osteomielite, principalmente em áreas de crescimento ósseo longo, bem como em casos de doença crônica levando à artrite tuberculosa, principalmente em áreas endêmicas. Os resultados também indicaram que os ossos o envolvimento ainda é prevalente, sendo a quinta causa de envolvimento extrapulmonar da doença no Brasil. Esta revisão destaca o papel da tuberculose na saúde pública, especialmente em grupos economicamente ativos nos quais o BTB é mais prevalente.


Subject(s)
Spine , Tuberculosis , Tuberculosis, Osteoarticular , Tuberculosis, Spinal
14.
Health sci. dis ; 25(1): 64-67, 2019. ilus
Article in French | AIM, AIM | ID: biblio-1262834

ABSTRACT

Objectif. Décrire les aspects morphologiques du mal de Pott chez l'adulte à Brazzaville. Patients et méthodes. Étude transversale descriptive, rétrospective menée dans les services de rhumatologie du CHU de Brazzaville, du 1er janvier 2013 au 30 juin 2017, soit 4 ans et 6 mois. Ont été inclus les dossiers des patients d'âge au moins égal à 18 ans, ayant un diagnostic du mal de Pott retenu sur la base des arguments anamnestiques, cliniques, paracliniques, évolutifs et thérapeutiques. Les variables d'étude étaient: le siège, le nombre de localisations, l'aspect de l'atteinte disco-vertébrale. Résultats. Cent dix (110) dossiers ont été retenus. La fréquence hospitalière du mal de Pott était de 6,4%. Il y avait 62 hommes (56,4%) et 48 femmes (43,6%). L'âge moyen était de 46  16 ans (extrêmes : 20-80 ans). Le délai moyen du diagnostic était de 6,6 mois (ET : 5 mois ; extrêmes: 1-26 mois). Le syndrome rachidien était présent dans 109 cas (99,1%). Tous les patients ont réalisé une radiographie standard du rachis. La tomodensitométrie a été obtenue chez 28 patients (25,5%) et l'imagerie par résonance magnétique chez 23 patients (20,9%). Un aspect morphologique typique de spondylodiscite était présent dans 76 cas (69,1%), associant un pincement discal (60%), une érosion (40%) et une déminéralisation (19, 1%). Les formes atypiques étaient retrouvées dans 34 cas (30,9%), dominées par l'aspect de spondylite dans 21 cas (61,8%). Conclusion. Le mal de Pott à Brazzaville prend souvent l'aspect d'une spondylodiscite et plus rarement d'une spondylite. L'imagerie permet de faire le diagnostic positif et le bilan lésionnel


Subject(s)
Academic Medical Centers , Adult , Congo , Tuberculosis, Spinal/diagnosis , Tuberculosis, Spinal/physiopathology , Tuberculosis, Spinal/radiotherapy
15.
Article in French | AIM, AIM | ID: biblio-1263876

ABSTRACT

Objectif : décrire les aspects morphologiques atypiques au cours du Mal de Pott.Patients et méthodes : Etude descriptive menée dans le service de Rhumatologie du CHU de Brazzaville du 1er janvier 2013 au 31 juin 2017 (4 ans et 6 mois). Ont été inclus les dossiers des patients âgés de plus de 18 ans, dont le diagnostic de Mal de Pott était retenu, en l'absence de biopsie disco-vertébrale, sur la base des arguments cliniques, paracliniques, thérapeutiques et évolutifs.Les dossiers comportant une radiographie standard du rachis et/ou une imagerie en coupe (TDM/IRM) ont été exploités. Ceux dont l'imagerie ne mettait pas en évidence l'aspect classique de spondylodisciteont été retenus. Les variables d'étude étaient le siège, le nombre de localisation, l'aspect de l'atteinte vertébrale ou discale. Cent dix dossiers ont été retenus.Résultats : Les hommes prédominaient (56,4%) avec un sex ratio de 1,3. L'âge moyen était de 46 ± 16ans (extrêmes : 20-80 ans).La radiographie standard du rachis était réalisée chez tous les patients, la TDM chez 28 patients (25,5%), l'IRM chez 23 patients (20,9%). Les formes atypiques étaient retrouvées dans 34 cas (30,9%), dominées par l'aspect de spondylite (21 cas).Les lésions siégeaient au rachis cervical dans 2 cas, au rachis dorsal dans 9 cas, au rachis lombaire dans 16 cas et au rachis dorsal et lombaire dans 7 cas. L'Atteinte était monofocale dans 2 cas, bifocale dans 20 cas, trifocale dans 9 cas et plus de trois vertèbres dans 3 cas.Conclusion : Les aspects morphologiques inhabituels sont dominés par la spondylite,le plus souvent pluri vertébrale, siégeant surtout au rachis lombaire et/ou dorsal


Subject(s)
Adult , Congo , Magnetic Resonance Imaging, Interventional , Pott Puffy Tumor , Tomography, X-Ray Computed , Tuberculosis, Spinal
16.
Article in French | AIM, AIM | ID: biblio-1264288

ABSTRACT

Introduction : L'association entre la maladie thromboembolique et la tuberculose est peu fréquente mais reste redoutable. Cette complication vasculaire, consécutive à un état d'hypercoagulabilité, peut en constituer une circonstance de découverte. Observation : Nous rapportons le cas d'une patiente âgée de 40 ans, admise dans un tableau d'embolie pulmonaire à risque intermédiaire secondaire à une thrombophlébite au niveau des deux veines iliaques et de la veine cave inférieure, chez qui on a posé le diagnostic d'une spondylodiscite tuberculeuse avec abcès froid en regard de L5 ­ S1. Conclusion : La tuberculose est considérée comme un facteur de risque thromboembolique avéré. La difficulté de la gestion thérapeutique de cette association est surtout liée aux interactions entre les anticoagulants de type antivitamine K ou les anticoagulants oraux directs (AOD), et les antituberculeux, en particulier la rifampicine. Cette maladie infectieuse constitue un véritable problème de santé publique dans certains pays, elle nécessite le renforcement du programme de lutte, des moyens de prévention et de dépistage


Subject(s)
Case Reports , Morocco , Pulmonary Embolism/diagnosis , Tuberculosis, Spinal , Venous Thromboembolism
17.
Article in Korean | WPRIM | ID: wpr-760120

ABSTRACT

Tuberculous spondylitis, also known as Pott's disease, is a disease involving the spine with progressive destruction. It most commonly involves the thoracic and lumbosacral spine and may result in severe deformity or neurologic deficit. Although cervical spine involvement is rare, it can cause life threatening event. Recently, 70-year-old man presented with progressive dyspnea and dysphagia. Physical examination and radiologic studies showed a huge retropharyngeal abscess with bony erosion and sclerotic change at the adjacent cervical spine. After incision and drainage, it was finally confirmed as a tuberculous abscess. Herein, we report our experience with literature review.


Subject(s)
Abscess , Aged , Congenital Abnormalities , Deglutition Disorders , Drainage , Dyspnea , Humans , Neurologic Manifestations , Physical Examination , Retropharyngeal Abscess , Spine , Spondylitis , Tuberculosis , Tuberculosis, Spinal
18.
Asian Spine Journal ; : 615-620, 2019.
Article in English | WPRIM | ID: wpr-762966

ABSTRACT

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.


Subject(s)
Ataxia , Compliance , Electromyography , Follow-Up Studies , Humans , Hydronephrosis , Lower Urinary Tract Symptoms , Observational Study , Prospective Studies , Tuberculosis, Spinal , Urodynamics
19.
Asian Spine Journal ; : 984-991, 2019.
Article in English | WPRIM | ID: wpr-785487

ABSTRACT

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.


Subject(s)
Cohort Studies , Debridement , Decompression , Follow-Up Studies , Humans , Lumbosacral Region , Medical Records , Postoperative Period , Retrospective Studies , Ribs , Tuberculosis, Spinal , Visual Analog Scale
20.
Rev. Assoc. Med. Bras. (1992) ; 64(6): 518-524, June 2018. tab, graf
Article in English | LILACS | ID: biblio-956488

ABSTRACT

SUMMARY OBJECTIVE: To investigate the safety and efficacy of percutaneous endoscopic debridement and irrigation for thoracic infections and to make an appropriate choice according to the patient's condition. METHODS. Thirty patients with thoracic infections who received surgical treatment from August 2014 to December2016 were retrospectively analyzed. There were 16 males and 14 females, aged from 41 to 90 years, with an average of 64.4 years. A total of 9 cases were treated with percutaneous endoscopic debridement and irrigation (minimal group), and 21 cases were treated with open debridement in combination with pedicle screw fixation (conventional group). Patients underwent follow-up for 1 month. General condition, operative index, laboratory results, and imaging features were recorded. RESULTS. Compared with the conventional group, there were more comorbidities in patients in the minimal group (8 cases in the minimal group, 10 cases in the conventional group, P=0.049), shorter hospital stay (10.1 + 2.26 days in the minimal group, 16.1 + 6.81 days in the conventional group, P=0.016), less bleeding volume (383.3 + 229.86ml in the minimal group, 90 + 11.18ml in the conventional group, P=0.000), lower VAS score at discharge (2.9 + 0.93 in the minimal group, 3.9 + 0.91 in the conventional group, P=0.013). There was no spinal instability case in the minimal group, 10 cases in the conventional group, P=0.013. There were significant differences. The C reaction protein prior to operation in the minimal group was 28.4±7.50mg/L. Compared with 45.1 + 15.78mg/L in the conventional group, P=0.005, it was lower. CONCLUSIONS. Percutaneous endoscopic debridement and irrigation are an effective surgery for treatment of thoracic infections, especially suitable for patients with comorbidities and poor general condition. However, for severe infection and spinal instability, we tend to choose open surgery in combination with fixation.


RESUMO OBJETIVOS: Investigar a eficácia e segurança de desbridamento endoscópico percutâneo e irrigação torácica para infecções e fazer uma escolha adequada de acordo com a condição do paciente. MÉTODOS: Trinta pacientes com infecção torácica que receberam tratamento cirúrgico de agosto de 2014 a dezembro de 2016 foram analisadosretrospectivamente. Havia 16 homens e 14 mulheres, de 41 a 90 anos, com uma média de 64,4 anos. Nove casos foram tratados com desbridamento endoscópico percutâneo e irrigação (grupo mínimo) e 21 casos foram tratados com desbridamento aberto em combinação com fixação do parafuso pedicular(grupo convencional). Os pacientes foram submetidos a acompanhamento durante um mês. Estado geral, índice operacional, resultados de laboratório e imagem e funcionalidades foram gravados. RESULTADOS: Em comparação com o grupo convencional, há mais comorbidades em pacientes do grupo mínimo (8 casos no grupo mínimo, 10 casos no grupo convencional, P = 0,049), menos tempo no hospital (10,1 + 2,26 dias no grupo mínimo, 16,1 + 6,81 dias no grupo convencional, P = 0,016), menos volume de sangramento (383,3 + 229,86 ml no grupo mínimo, 90 + 11,18 ml no grupo convencional, P = 0,000), menor pontuação no VAS a quitação (2,9 + 0,93 no grupo mínimo, 3,9 + 0,91 no grupo convencional, P = 0,013). Não houve nenhum caso de instabilidade espinhal no grupo mínimo, e 10 casos no grupo convencional, P = 0,013. Houve diferenças significativas. O nível de proteína C-reativa antes da operação no grupo mínimo era de 28,4±7,50mg/L. Em comparação com 45,1 + 15,78 mg/L no grupo convencional, P = 0,005, era mais baixa. CONCLUSÃO: O método de desbridamento endoscópico percutâneo e irrigação é eficaz para o tratamento de infecções em cirurgia torácica, especialmente adequado para pacientes com comorbidades e mau estado geral. Mas, para a infecção grave e instabilidade vertebral, tendemos a escolher a cirurgia aberta em combinação com a fixação.


Subject(s)
Humans , Male , Female , Adult , Aged , Aged, 80 and over , Bacterial Infections/surgery , Internal Fixators , Thoracic Surgical Procedures/methods , Debridement/methods , Endoscopy/methods , Postoperative Period , Spondylitis/surgery , Tuberculosis, Spinal/surgery , Pain Measurement , C-Reactive Protein/analysis , Retrospective Studies , Treatment Outcome , Combined Modality Therapy/methods , Operative Time , Pedicle Screws , Therapeutic Irrigation/methods , Middle Aged
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