ABSTRACT
Tuberculosis (TB) is mainly a disease of the lungs, but Mycobacterium tuberculosis (Mtb) can establish infection in virtually any organ in the body. Rising rates of extrapulmonary (EP) TB have been largely associated with the HIV epidemic, as patients co-infected with HIV show a four-fold higher risk of EPTB. Spinal TB (Pott's Disease), one of the most debilitating extrapulmonary forms of disease, is difficult to diagnose and can cause deformity and/or neurological deficits. This study examined the histopathology and distribution of immune cells within spinal TB lesions and the impact of HIV on pathogenesis. The overall structure of the spinal granulomas resembled that seen in lung lesions from patients with pulmonary TB. Evidence of efficient macrophage activation and differentiation were detectable within organized structures in the spinal tissue, irrespective of HIV status. Interestingly, the granulomatous architecture and macroscopic features were similar in all samples examined, despite a reversal in the ratio of infiltrating CD4 to CD8 T cells in the lesions from HIV-infected patients. This study provides a foundation to understand the mechanism of tissue destruction and disease progression in Spinal TB, enabling the future development of novel therapeutic strategies and diagnostic approaches for this devastating disease.
Subject(s)
AIDS-Related Opportunistic Infections/immunology , Granuloma/immunology , Tuberculosis, Spinal/immunology , AIDS-Related Opportunistic Infections/pathology , AIDS-Related Opportunistic Infections/physiopathology , AIDS-Related Opportunistic Infections/virology , Abscess/immunology , Abscess/pathology , Adolescent , Adult , Aged , Bone Remodeling/physiology , CD4 Lymphocyte Count , CD4-CD8 Ratio , CD8-Positive T-Lymphocytes/immunology , Child , Female , Granuloma/pathology , Granuloma/physiopathology , Humans , Macrophage Activation/immunology , Magnetic Resonance Imaging , Male , Middle Aged , T-Lymphocyte Subsets/immunology , Tuberculosis, Spinal/pathology , Tuberculosis, Spinal/physiopathology , Viral Load , Young AdultABSTRACT
One-hundred-twenty-three patients with neurological deficit due to spinal tuberculosis underwent anterior spinal decompression and anterior column reconstruction with fresh-frozen femoral allograft. Fifty-two patients with a follow-up of more than 5 years were evaluated to assess the incorporation and the efficacy of allograft in maintaining correction. The allograft was incorporated in 49 patients at a mean follow-up of 6.5 (5.3-8.2) years. Complete neurological recovery occurred in 39 patients. The mean pre-operative kyphosis of 37 degrees (15 degrees -67 degrees ) was corrected to 18 degrees (5 degrees -45 degrees ). Fresh-frozen allografts are a suitable alternative to autologous rib and iliac crest grafts in the treatment of spinal tuberculosis.
Subject(s)
Femur/transplantation , Tuberculosis, Spinal/surgery , Adult , Antitubercular Agents/therapeutic use , Combined Modality Therapy , Decompression, Surgical , Female , Humans , Male , Middle Aged , Radiography , Transplantation, Homologous , Treatment Outcome , Tuberculosis, Spinal/diagnostic imaging , Tuberculosis, Spinal/drug therapyABSTRACT
We present seven children with atlantoaxial rotatory fixation (AARF) of more than three months' duration after an injury to the upper cervical spine. The deformity was irreducible by skull traction. MRI and MR angiography (MRA) of the vertebral arteries were performed in four children. The patients were neurologically intact. Thrombosis of the ipsilateral vertebral artery was noted in two patients. The deformity was gradually corrected and stabilised after transoral release of the atlantoaxial complex, skull traction and posterior atlantoaxial fusion. Soft-tissue interposition and contractures within the atlantoaxial complex prevented closed reduction. MRI and MRA of the vertebral arteries were useful in elucidating the pathology of chronic atlantoaxial rotatory fixation.
