Clinicoradiologic Profile of Involvement and Healing in Tuberculosis of the Spine.

BACKGROUND: There is no much information about how tuberculous lesions of the spine progress/heal; what clinical and radiological features suggest progression/healing; what is the optimal duration of antitubercular treatment; and what clinical, laboratory, and radiological investigations and their frequency should be done to monitor the disease course. AIMS: The present study aimed to evaluate what specific clinicoradiologic features suggest involvement and healing in tuberculosis of the spine. SUBJECTS AND METHODS: Fifty spinal tuberculosis patients (30 males and 20 females) diagnosed clinicoradiologically were enrolled in the study. Patients were evaluated clinically, radiographically, and by magnetic resonance imaging (MRI) at regular intervals to monitor the disease course till 24 months of the initial presentation. RESULTS: Wedge/collapse (23/50 cases), soft tissue mass (29/50 cases), disc narrowing (45/54 discs), and endplate erosions (89/107 endplates) were the plain radiological findings of tubercular spinal involvement. Earliest sign of healing on plain radiography was decrease in fuzziness of endplate, ultimately leading to either sclerosis of endplate or fusion of adjacent vertebrae. Initial MRI findings included bone marrow edema (50/50 cases), discitis (53/62 discs), endplate erosions (105/123 endplates), pre- and para-vertebral collections (45/50 cases), epidural involvement (26/50 cases), epidural spread (77/109 vertebrae), and subligamentous spread (42/50 cases). Earliest feature of healing on magnetic resonance (MR) examination was decrease in inflammatory soft-tissue masses and reduction in marrow edema. CONCLUSIONS: Salient features of spinal involvement in tuberculosis on plain radiograph were paradiscal involvement, endplate destruction, and soft tissue masses. Marrow edema, paravertebral collections, subligamentous spread, extradural component, endplate erosion, and discitis suggested tubercular involvement of the spine on MRI. A decrease in these was observed to have prognostic value both in monitoring disease course and response to chemotherapy. Based on the clinicoradiologic findings of the present study, we propose decision-making algorithm, follow-up algorithm, and MR examination protocol for spinal tuberculosis. LEVEL OF EVIDENCE: This was a Level II study.

Role of local application of autologous platelet-rich plasma in the management of pressure ulcers in spinal cord injury patients.

STUDY DESIGN: Prospective clinical case series. OBJECTIVES: The objective of this study is to evaluate the local application of platelet-rich plasma (PRP) in relation to pressure ulcers (PrUs) healing on one PrU (case) versus saline dressing on another PrU (control) in the same patient. SETTING: Tertiary Level Care Centre, India. METHODS: Twenty-five spinal cord injury patients with at least two PrUs were included. All 25 PrUs (case) were grade IV, and PrUs (control) were grade II (n=11), grade IV (n=10) and grade III in 4 patients. Evaluation of PrU healing was done by measuring wound surface area, Pressure Ulcer Scale for Healing (PUSH), biopsy and clinical examination. RESULTS: Statistically significant decrease in mean PUSH scores of PrUs (case) (t=6.13, P<0.000) and PrUs (control) (t=3.98, P=0.000) was observed after 5 weeks. The wound surface area of PrU (case) decreased significantly (t=4.98, P=0.000); however, the decrease was not significant (t=0.095, P=0.924) in PrUs (control). Majority of histopathological pictures of PrUs (case) showed necrosis and suppuration (56%) at the time of enrollment and well-formed granulation tissue and epithelialization (60%) at the 5th week. Twenty-four (96%) PrUs (case) improved and only 1 deteriorated with PRP therapy, whereas in control group 17 (68%) PrUs improved, 7 (28%) deteriorated and 1 wound showed no change. CONCLUSIONS: Advanced wound therapy using local applications of PRP seems to be a promising alternative to standard saline dressings in PrU healing. With the advantages of simple preparation, biocompatible safety, low cost and significant clinical effectiveness, it may be beneficial to study the effects of PRP in large-scale trials to validate it as an ideal therapy for enhanced wound healing in PrUs.

Health-related problems and effect of specific interventions in spinal cord injury. An outcome study in Northern India.

AIM: The aim of this study was to assess the long-term health-related problems of patients with spinal cord injury (SCI), to develop specific strategies targeted to minimize these problems, and to assess the effect of these interventions on long-term problems of SCI patients. METHODS: Fifty persons with SCI were surveyed for various secondary medical problems, specific interventions were carried out to ameliorate them, and follow-up assessment was performed six months later to examine the impact of these over time. RESULTS: At mean 3.7 years post-SCI, bladder problems (44%), neuropathic pain (42%), bedsores (36%) and spasticity (60%) were the major secondary medical problems and were responsible for medical interventions or hospitalization in the participants. Specific interventions directed towards minimizing health-related problems in SCI population were effective in terms of minimizing the intensity and incidence at six-month follow-up survey. Ninety-two percent of the patients in the present study were either very satisfied or satisfied with the specific interventions. CONCLUSION: The present study highlights that incidence of secondary medical problems in SCI population is high compared to the Western world and this issue needs an urgent attention. The outcomes of this study further substantiate that by paying attention to general principles of care for paraplegics and by developing specific strategies targeted to minimize these health-related problems, persons involved in the management and rehabilitation of SCI population can reduce the incidence and intensity of secondary medical problems.