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Xu Z, Zhu W, Zhou S, Yang Z, Xiang L, Zhang J, Liu K. Diagnostic imaging confusion in infectious spondylitis. J Orthop Surg Res 2025; 20:496. [PMID: 40399964 PMCID: PMC12096627 DOI: 10.1186/s13018-025-05781-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2025] [Accepted: 04/02/2025] [Indexed: 05/23/2025] Open
Abstract
BACKGROUND Infectious spondylitis is a rare but increasingly recognized condition involving infectious lesions of the spine. It can affect patients of all ages and is typically caused by bacterial, fungal, or other pathogens. The infection commonly targets the vertebral bodies and intervertebral discs. Early symptoms of infectious spondylitis are often nonspecific, making it challenging to differentiate from other spinal disorders such as tumors, degenerative diseases, or other types of infections. As the condition can progress rapidly, early diagnosis and intervention are crucial to improving patient outcomes. MAIN BODY Imaging plays a critical role in the early diagnosis of infectious spondylitis. Magnetic resonance imaging is considered the gold standard due to its superior ability to visualize soft tissue structures and assess the extent of infection. CT imaging and nuclear medicine scans also provide valuable information in certain clinical scenarios, particularly for evaluating bony involvement and detecting occult infection. However, imaging findings in infectious spondylitis can overlap with those of other spinal conditions, making differential diagnosis essential for accurate identification. This study explores the advantages and limitations of different imaging modalities in diagnosing infectious spondylitis, focusing on their ability to suggest the possible etiology, determine the severity of the disease, and guide treatment decisions. Additionally, the relationship between imaging characteristics and clinical symptoms is examined to offer clinicians a systematic approach to improve diagnostic accuracy. CONCLUSION Early and accurate diagnosis of infectious spondylitis is critical for preventing long-term complications. Imaging techniques, especially MRI, are invaluable tools for clinicians in identifying this condition, assessing its extent, and guiding treatment. Improved understanding of the imaging features associated with infectious spondylitis is essential for more accurate diagnosis and treatment planning.
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Affiliation(s)
- Zhihao Xu
- Department of Hepatobiliary Surgery, Huaqiao Hospital, Jinan University, Guangzhou, 510630, China
- Department of Radiology, Huaqiao Hospital, Jinan University, Guangzhou, 510630, China
| | - Weijian Zhu
- Department of Orthopedics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Street, Wuhan, Hubei, 430030, P.R. China
| | - Sirui Zhou
- Department of Respiration, Liyuan Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430077, China
| | - Zhiying Yang
- Department of Radiology, Zhongshan Hospital of Dalian Medical University, Dalian, 116001, China
| | - Liqiao Xiang
- Qichun Shunkang Nephrology Hospital, Qichun Avenue 127, Huanggang City, 435300, China
| | - Jinming Zhang
- Department of Orthopedics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Street, Wuhan, Hubei, 430030, P.R. China.
| | - Kangshou Liu
- Department of Hepatobiliary Surgery, Huaqiao Hospital, Jinan University, Guangzhou, 510630, China.
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Fei L, Li M, Shi J, Gu Z, Yang Z, Li Y. Comparison of the Effects of Mycobacterium tuberculosis H37Rv and Brucella ovis Infiltration on Tumor Necrosis Factor-Alpha and Interleukin-1 Beta Expression in Osteoblasts. Surg Infect (Larchmt) 2025; 26:175-182. [PMID: 39761119 DOI: 10.1089/sur.2024.221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2025] Open
Abstract
Objective: This study aims to compare the expression levels of tumor necrosis factor-alpha (TNF-α) and interleukin-1 beta (IL-1β) in osteoblasts infiltrated with Mycobacterium tuberculosis H37Rv (H37Rv) and Brucella ovis to understand the differential bone destruction in spinal tuberculosis (STB) versus Brucella spondylitis (BS). Methods: Primary osteoblasts were isolated and cultured from the cranial bones of 2-5 days old mice and characterized by alkaline phosphatase (ALP) staining and alizarin red staining (ARS). H37Rv and B. ovis were cultured to the logarithmic phase, and transfection solutions were prepared. Osteoblasts were infiltrated with these bacteria at various multiplicities of infection (MOI) and time points. Cell survival post-infiltration was assessed using CCK-8 to determine optimal infection conditions. Osteoblasts were divided into three groups: the H37Rv group (infiltrated with optimal MOI H37Rv), the B. ovis group (infiltrated with optimal MOI B. ovis), and a negative control group. TNF-α and IL-1β expression in the cytoplasm was observed using immunohistochemical staining, whereas their levels in cell supernatants were measured using enzyme-linked immunosorbent assay. Protein expression was analyzed by Western blot. Differences between groups were compared with using one-way analysis of variance and t-tests, with p < 0.05 indicating statistical significance. Results: Both H37Rv and B. ovis infiltrated osteoblasts, substantially increasing TNF-α and IL-1β expression. The H37Rv group showed substantially higher levels of TNF-α and IL-1β compared with the B. ovis group (p < 0.05). Conclusion: Infiltration of osteoblasts with H37Rv and B. ovis substantially increases TNF-α and IL-1β expression, with higher levels observed in H37Rv-infected osteoblasts. This overexpression may contribute to the more severe vertebral bone destruction seen in STB compared with BS.
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Affiliation(s)
- Le Fei
- Department of Orthopedic, General Hospital of Ningxia Medical University Yinchuan, Yinchuan, China
- First Clinical Medical College, Ningxia Medical University, Yinchuan, China
| | - Minyu Li
- First Clinical Medical College, Ningxia Medical University, Yinchuan, China
| | - Jiandang Shi
- Department of Orthopedic, General Hospital of Ningxia Medical University Yinchuan, Yinchuan, China
| | - Zhangui Gu
- Department of Orthopedic, General Hospital of Ningxia Medical University Yinchuan, Yinchuan, China
- First Clinical Medical College, Ningxia Medical University, Yinchuan, China
| | - Zongqiang Yang
- Department of Orthopedic, General Hospital of Ningxia Medical University Yinchuan, Yinchuan, China
- First Clinical Medical College, Ningxia Medical University, Yinchuan, China
| | - Yu Li
- First Clinical Medical College, Ningxia Medical University, Yinchuan, China
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Katsuno T, Sugiura Y, Morishita M, Osaki S, Suzuki M, Takasaki J, Iikura M, Izumi S, Hojo M, Sugiyama H. Spinal Echinococcosis in a Japanese Woman Living in Tokyo: Diagnostic Challenges in Non-endemic Areas and Public Health Implications. Intern Med 2025; 64:971-977. [PMID: 39135255 PMCID: PMC11986315 DOI: 10.2169/internalmedicine.3713-24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Accepted: 06/23/2024] [Indexed: 03/18/2025] Open
Abstract
Echinococcosis, caused by Echinococcus spp., often affects the lungs and liver, and spinal involvement is rare. Echinococcus multilocularis is prevalent in Japan, particularly in Hokkaido. We herein report a rare case of spinal echinococcosis in a 31-year-old woman who was diagnosed in Tokyo. Spinal echinococcosis is uncommon and often leads to misdiagnoses. The patient likely contracted the disease via contaminated fresh produce transported from an endemic region. This study emphasizes the diagnostic challenges of spinal echinococcosis in non-endemic regions and highlights the public health concerns related to the spread of infections in non-endemic areas.
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Affiliation(s)
- Takashi Katsuno
- Department of Respiratory Medicine, National Center for Global Health and Medicine, Japan
| | - Yuriko Sugiura
- Department of Respiratory Medicine, National Center for Global Health and Medicine, Japan
| | - Momoko Morishita
- Department of Respiratory Medicine, National Center for Global Health and Medicine, Japan
| | - Shuhei Osaki
- Department of Musculoskeletal Oncology, National Cancer Center Hospital, Japan
| | - Manabu Suzuki
- Department of Respiratory Medicine, National Center for Global Health and Medicine, Japan
| | - Jin Takasaki
- Department of Respiratory Medicine, National Center for Global Health and Medicine, Japan
| | - Motoyasu Iikura
- Department of Respiratory Medicine, National Center for Global Health and Medicine, Japan
| | - Shinyu Izumi
- Department of Respiratory Medicine, National Center for Global Health and Medicine, Japan
| | - Masayuki Hojo
- Department of Respiratory Medicine, National Center for Global Health and Medicine, Japan
| | - Haruhito Sugiyama
- Department of Respiratory Medicine, National Center for Global Health and Medicine, Japan
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Venugopal Menon K, Basu S, Oka G, Gohil K. Delphi-Based Survey for Surgical Indications in Biopsy Proven Active Adult Spinal Tuberculosis. Global Spine J 2025; 15:668-678. [PMID: 37776140 PMCID: PMC11877587 DOI: 10.1177/21925682231204157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/01/2023] Open
Abstract
STUDY DESIGN Delphi survey. OBJECTIVES To obtain an expert consensus on various dilemmas in the surgical treatment of adult spinal tuberculosis (TB) patients. METHODS Stage I included a literature review, stage II the identification of 40 Key Opinion leaders (KOLs) and a set of 46 questions, stage III included analysis of 3 rounds of the Delphi survey, and stage IV had final analysis and recommendations. For each question, the level of agreement needed to reach a consensus was set at greater than or equal to 70.0%. RESULTS The first and second Delphi survey rounds received 62 and 58 responses, respectively, with 16 questions having more than 70% and two questions having 100% agreement in the first stage. The second stage saw a 70% agreement on six questions. Thus, a consensus was obtained on 22 questions. The recommendations that emerged were as follows: neurodeficit with corresponding radiology and neurological deficit appearing/deteriorating while on anti-tubercular chemotherapy(ATT) are absolute indications for surgery, duration of ATT before neurological deterioration need not be considered, epidural abscess does not need decompression unless concordant clinical neurological findings are present, pain not responding to medical management is not a surgical indication, active pulmonary TB, drug-resistant TB, and tubercular sacroiliitis are not considered as surgical indications, and hemoglobin and other health markers have little contribution to surgical indications. CONCLUSION In order to resolve several conundrums in the surgical treatment of adult spinal TB, this Delphi survey is the first to achieve a national consensus from spine experts. The final recommendations cover the serological, radiographic, and clinical aspects of spinal TB.
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Affiliation(s)
- K. Venugopal Menon
- Department of Orthopedics, Bharati Vidyapeeth Medical College Hospital, Pune, India
| | - Saumyajit Basu
- Head of Department of Spine Surgery, Kothari Medical Centre, Kolkata, India
| | - Gauri Oka
- Research Consultant, Central Research and Publication Unit, Bharati Vidyapeeth Medical College and Hospital, Pune, India
| | - Kushal Gohil
- Department of Orthopedics, Grant Government Medical College and Sir JJ Group of Hospitals, Mumbai, India
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Heron MA, Forstot JZ, Nyárádi Z, Bethard JD. Exploring the antiquity of rheumatoid arthritis: A case study from medieval Transylvania. INTERNATIONAL JOURNAL OF PALEOPATHOLOGY 2025; 48:13-22. [PMID: 39615238 DOI: 10.1016/j.ijpp.2024.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/24/2024] [Revised: 10/22/2024] [Accepted: 11/03/2024] [Indexed: 02/22/2025]
Abstract
OBJECTIVE To evaluate erosive pathological lesions on a skeleton from medieval Transylvania. MATERIALS A skeleton from a Székely archaeological site in Transylvania was examined and radiocarbon dated to Cal 1300 CE - 1415 CE. METHODS The skeletal remains were examined macroscopically and with radiographic imaging. A differential diagnosis was conducted following established protocols. RESULTS The individual was estimated to be a probable adult female. Periarticular erosive lesions involving multiple synovial joints, particularly on the small joints of the hands and feet, were observed. CONCLUSIONS A differential diagnosis identifies lesions characteristic of rheumatoid arthritis dating prior to the mid-15th century. SIGNIFICANCE The significance of this diagnosis is great since researchers debate the antiquity and spread of rheumatoid arthritis. Some researchers hypothesize that RA originated in the Americas and spread to Europe after the mid-15th century. However, this study asserts that RA existed in Europe prior to European colonization of the Americas. LIMITATIONS Only 30-40 % of the skeletal material was excavated, potentially impacting the differential diagnosis. SUGGESTIONS FOR FURTHER RESEARCH This case encourages researchers to explore the presence of RA in other medieval groups within and beyond Transylvania as a means to reconstruct the antiquity and geographical distribution of the condition.
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Affiliation(s)
- Megan A Heron
- Department of Anthropology, Florida Atlantic University, FL, USA.
| | - Joseph Z Forstot
- Charles E. Schmidt College of Medicine, Florida Atlantic University, FL, USA
| | - Zsolt Nyárádi
- Department of Archaeology, Haáz Rezsö Múzeum, Odorheiu Secueisc, RO
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Fayisa S, Ghozy S, Zarrinttan A, Bilgin C, Kallmes DF. Magnetic resonance imaging in diagnosing spinal cord tuberculoma: A case series and literature review. Radiol Case Rep 2025; 20:1182-1188. [PMID: 39697263 PMCID: PMC11652861 DOI: 10.1016/j.radcr.2024.10.156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2024] [Revised: 10/24/2024] [Accepted: 10/30/2024] [Indexed: 12/20/2024] Open
Abstract
Spinal cord tuberculoma is a clinically significant form of extra-pulmonary tuberculosis, despite its rarity. It leads to considerable neurological deficits and morbidity. Accurate diagnosis and early intervention depend on radiologic imaging, typically MRI, which reveals T2 hypointensity with rim enhancement, forming a ``target sign'' characteristic of caseous stage tuberculoma. In this article, we present 3 cases of spinal cord tuberculoma without adjacent vertebral involvement; 2 cases affect the lower thoracic region, while one involves the cervical cord. All patients exhibited some degree of body weakness, which improved following the initiation of anti-tuberculosis treatment. Also, we discuss the role of MRI in diagnosing spinal cord tuberculoma, highlighting its characteristic findings, and review recent literature on the topic.
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Affiliation(s)
- Shimalis Fayisa
- Department of Radiology, Care Land General Hospital, Addis Ababa, Ethiopia
| | - Sherief Ghozy
- Neuro-Vascular Research Lab, Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | - Armin Zarrinttan
- Neuro-Vascular Research Lab, Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | - Cem Bilgin
- Neuro-Vascular Research Lab, Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | - David F. Kallmes
- Neuro-Vascular Research Lab, Department of Radiology, Mayo Clinic, Rochester, MN, USA
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Romaniyanto R, Ilyas MF, Lado A, Sadewa D, Dzikri DN, Budiono EA. Current update on surgical management for spinal tuberculosis: a scientific mapping of worldwide publications. Front Surg 2025; 11:1505155. [PMID: 39925700 PMCID: PMC11802825 DOI: 10.3389/fsurg.2024.1505155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2024] [Accepted: 12/27/2024] [Indexed: 02/11/2025] Open
Abstract
Introduction Spinal tuberculosis (TB), or Pott's disease, remains a significant global health issue, particularly in regions with high TB prevalence. Despite antitubercular drug therapy being the primary treatment, surgical intervention is often required in cases of spinal instability or neurological complications. This study aims to conduct a comprehensive bibliometric analysis of worldwide publications related to the surgical management of spinal TB and to compare contributions from orthopaedic surgery and neurosurgery in this field. Methods A bibliometric analysis was performed using data from the Scopus database, covering publications from 1896 to 2024. The search strategy focused on terms related to spinal TB and surgical interventions. The analysis included 1,857 publications, which were examined for trends, key contributors, and the evolution of surgical techniques. Metrics such as the number of publications, leading authors, affiliations, countries, and funding sponsors were compared between orthopaedic surgery and neurosurgery. Results This study identified a steady increase in the number of publications over time. Key topics evolved from basic surgical methods, including early spinal procedures, to integrating pharmacological approaches alongside surgical techniques, such as antitubercular drugs, advancing into imaging research and procedure research involving refined surgical methods like spinal fusion. The recent phase reflects a shift towards technology-driven approaches, including minimally invasive techniques, artificial intelligence, and machine learning. China emerged as the leading country with the most contributions based on author, affiliations, funding sponsors, and countries. Last, orthopaedic surgery had more publications (274) than neurosurgery (96). Discussion In conclusion, spinal TB surgery has evolved significantly, with a notable shift towards advanced, technology-driven approaches. Orthopaedic surgery leads in research output compared to neurosurgery. This bibliometric analysis provides valuable insights into the global research landscape, guiding future studies in the management of spinal TB.
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Affiliation(s)
- Romaniyanto Romaniyanto
- Department of Orthopedic and Traumatology, Prof. Dr. R. Soeharso Orthopedic Hospital, Surakarta, Indonesia
| | - Muhana Fawwazy Ilyas
- Department of Orthopedic and Traumatology, Prof. Dr. R. Soeharso Orthopedic Hospital, Surakarta, Indonesia
| | - Aldebaran Lado
- Department of Orthopedic and Traumatology, Prof. Dr. R. Soeharso Orthopedic Hospital, Surakarta, Indonesia
| | - Daffa Sadewa
- Department of Orthopedic and Traumatology, Prof. Dr. R. Soeharso Orthopedic Hospital, Surakarta, Indonesia
- Faculty of Medicine, Universitas Sebelas Maret, Surakarta, Indonesia
| | - Dykall Naf'an Dzikri
- Department of Orthopedic and Traumatology, Prof. Dr. R. Soeharso Orthopedic Hospital, Surakarta, Indonesia
| | - Enrico Ananda Budiono
- Department of Orthopedic and Traumatology, Prof. Dr. R. Soeharso Orthopedic Hospital, Surakarta, Indonesia
- Faculty of Medicine, Universitas Sebelas Maret, Surakarta, Indonesia
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Choo XW, Wong JW, Abdul Malik Khiew MA, Khoo KS, Ramanaidu A, Ramasamy A, Chang CY. Spinal Tuberculosis in a Young Male Patient With Empty Sella Syndrome and Panhypopituitarism. Cureus 2025; 17:e78223. [PMID: 40027031 PMCID: PMC11871524 DOI: 10.7759/cureus.78223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/29/2025] [Indexed: 03/05/2025] Open
Abstract
Spinal tuberculosis (TB), or Pott's disease, is a rare but serious form of extrapulmonary TB that primarily affects the thoracic spine and can result in severe neurological complications. Patients with underlying endocrine disorders, such as panhypopituitarism, are at increased risk of developing infections due to immune suppression caused by hormonal deficiencies and long-term steroid replacement therapy. We report the case of a 24-year-old Malay male patient with a known history of empty sella syndrome and panhypopituitarism on hormone replacement therapy, who presented with progressive left lower limb weakness over one week. An MRI of the spine revealed a multiloculated pre- and paravertebral collection with intraspinal extension. A spine biopsy confirmed the presence of Mycobacterium tuberculosis via TB GeneXpert testing. The patient was started on anti-TB therapy. However, due to worsening neurological function, he underwent posterior spinal fusion and decompression surgery, which resulted in improved lower limb function. Spinal TB should be considered in patients with neurological deficits and predisposing conditions, such as endocrine disorders, even in the absence of classical TB symptoms.
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Affiliation(s)
- Xin Wei Choo
- Internal Medicine, Sultanah Aminah Hospital, Johor Bahru, MYS
| | - Jing Wen Wong
- Internal Medicine, Sultanah Aminah Hospital, Johor Bahru, MYS
| | | | | | | | | | - Chee Yik Chang
- Infectious Diseases, Sultanah Aminah Hospital, Johor Bahru, MYS
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Aljehani Y, ALkhaldi N, Althunayyan L, Alghamdi R, Aljamaan S, Alwazzeh M, Alreshaid F. Exploring Thoracolumbar Pott's Disease in the Immunocompetent; Institutional Experience Over a Decade and Comprehensive Literature Review. Med Arch 2025; 79:41-46. [PMID: 40322305 PMCID: PMC12045595 DOI: 10.5455/medarh.2025.79.41-46] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2025] [Accepted: 04/01/2025] [Indexed: 05/08/2025] Open
Abstract
Background The presentation of Pott's has a wide variation and an insidious onset, which makes timely accurate diagnosis quite challenging. Objective To review Pott's cases to enhance the disease management and fill the literature gap regarding the approach to Pott's disease. Methods A descriptive observational retrospective hospital-based study conducted from 2007 to 2022 at KFHU. 346 patients who were diagnosed with TB were reviewed thoroughly. Only 13 cases were labeled as Pott's disease based on imaging or microbiology testing and hence were included in this study, and other TB pulmonary and extrapulmonary cases were excluded. Results In our analysis of 13 cases of Pott's disease, we observed a significant male predominance (69.23%) and diverse symptoms, with back pain (69.2%) being most prevalent among our patients. Lumbar involvement was the most frequently observed site (38.4%), and diagnoses were made through microbiology (69.2%) or clinical/radiological means (30.8%). Acid-fast bacilli (AFB) culture testing exhibited a positivity rate of 61.5%, while TB-PCR showed positive results in 57.1%. Imaging studies revealed vertebral lesions (90.9% CT, 81.8% MRI), abscesses (54.5% CT, 81.8% MRI), and spondylodiscitis (18.2% CT, 54.5% MRI). Treatment, administered in 92.3% of cases, involved the use of Isoniazid, Rifampicin, and Ethambutol. Surgical interventions, though less frequent, encompassed various procedures. Outcomes demonstrated a notable high cure rate of 84.9%, with a 15.4% incidence of cases experiencing loss of follow-up. Conclusion The high cure rate of 84.9% accentuates the effectiveness of early diagnosis and comprehensive treatment strategies that combine medical and surgical interventions when necessary.
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Affiliation(s)
- Yasser Aljehani
- Department of Surgery, King Fahad University Hospital, Khobar, SA
| | - Naif ALkhaldi
- Department of Surgery, King Fahad University Hospital, Khobar, SA
| | - Lama Althunayyan
- Imam Abdulrahman Bin Faisal University, King Fahad University Hospital, Khobar, SA
| | - Rahaf Alghamdi
- Department of Surgery, King Fahad Medical City, Riyadh, SA
| | - Sadeem Aljamaan
- Department of Surgery, King Fahad University Hospital, Khobar, SA
| | - Marwan Alwazzeh
- Department of Infectious Diseases, King Fahad University Hospital, Khobar, SA
| | - Farouk Alreshaid
- Department of Surgery, King Fahad University Hospital, Khobar, SA
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Hendriarto A, Juliandri R, Hartanto BR. Bridging the gap: Gardner-Wells tongs utilization in pediatric spinal tuberculosis: A case report. Int J Surg Case Rep 2025; 126:110638. [PMID: 39631124 PMCID: PMC11652940 DOI: 10.1016/j.ijscr.2024.110638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2024] [Revised: 11/15/2024] [Accepted: 11/20/2024] [Indexed: 12/07/2024] Open
Abstract
INTRODUCTION Spinal Tuberculosis (TB), or Pott's disease, is a significant form of extrapulmonary TB affecting the spine, especially in children. Standard treatments include anti-tuberculosis medications, immobilization, and surgery. The use of Gardner well tongs (GWT) in pediatrics spinal TB is rare due to associated risks and lack of supporting evidence. This case report aims to document the application of GWT traction in conjunction with surgical intervention for a pediatric patient with tuberculosis spondylitis. CASE PRESENTATION An 8-year-old boy presented with progressive weakness in both legs over 2.5 years, culminating in his inability to stand or walk. Physical examination revealed asymmetrical back, gibbus formation, tenderness, limited range of motion, and upper motor neuron neurological deficits. Radiographic imaging showed vertebral body destruction from T1-6, causing an 81-degree kyphotic curve. The patient underwent 5 kg of GWT traction for 2 weeks, resulting in a 10-degree improvement in curvature. Subsequent surgical procedures included laminectomy, posterior stabilization, deformity correction, and post-operative application of a SOMI brace. By discharge, the patient's kyphotic angle had improved from 81 to 63°, and there was notable improvement in motor strength and neurological function. DISCUSSION While surgical intervention is often necessary for vertebral deformity restoration, GWT offers advantages in spinal TB management, such as achieving stable cervical segments without skin incision and aiding gradual kyphotic correction. Serious complications from GWT, like skull perforation or neurovascular damage, are infrequent. CONCLUSION A comprehensive, holistic approach incorporating GWT traction and surgical intervention is essential for improving clinical outcomes in pediatric tuberculosis spondylitis.
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Affiliation(s)
- Andra Hendriarto
- Department of Orthopaedic and Traumatology, Dr. Cipto Mangunkusumo Hospital, Faculty of Medicine Universitas Indonesia, Indonesia
| | - Refky Juliandri
- Department of Orthopaedic and Traumatology, Dr. Cipto Mangunkusumo Hospital, Faculty of Medicine Universitas Indonesia, Indonesia.
| | - Bernadus Riyan Hartanto
- Department of Orthopaedic and Traumatology, Dr. Cipto Mangunkusumo Hospital, Faculty of Medicine Universitas Indonesia, Indonesia
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Kalanjiyam GP, Ramachandran K, Rajasekaran S, Shetty AP, Kanna RM. Surgical Correction of Thoracic and Thoracolumbar TB Kyphosis by Posterior Only Approach Using Rajasekaran's Kyphosis Classification. Global Spine J 2024:21925682241310828. [PMID: 39713926 DOI: 10.1177/21925682241310828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2024] Open
Abstract
STUDY DESIGN Prospective analysis of retrospective data. OBJECTIVES To analyse the clinical and radiological outcomes of thoracic and thoracolumbar TB kyphosis by a posterior-only approach using kyphosis classification. METHODS Patients with thoracic and thoracolumbar spinal TB who underwent posterior-only surgical correction for kyphotic deformity >30° were categorized into Group: A (Active TB) and Group B (Healed TB). Demographic, clinical and radiological data were collected, and kyphotic deformity was classified according to Rajasekaran classification. RESULTS 52 patients with a minimum 2-year follow-up were included. Group A included 25 patients with mean preop kyphosis of 39.5° (31.2°-53.7°), and Group B included 27 patients with mean preop kyphosis of 85° (44.2°-125.2°). Among 25 patients in Group A, 19 were Type IIIA, and 6 were Type IIA kyphosis. In Group B, 18 patients were Type IIIB, 5 were Type III C, 3 were Type IIA, and 1 was IIIA kyphosis. All patients in group A underwent posterior column shortening by Smith-Peterson Osteotomy, with 14 patients requiring additional anterior column reconstruction. Patients in Group B required Closing-Opening Wedge Osteotomy (18), Halo followed by vertebral column resection (6), disc bone osteotomy (2) and pedicle subtraction osteotomy (1). Mean kyphosis at 2 years follow-up was 20.8° (11.2°-32.8°) in Group A and 53.5° (8.1°- 96.4°) in Group B. CONCLUSIONS Correction of kyphosis in spinal TB involves completely different strategies in active and healed disease. Hence, a posterior-only treatment approach using Rajasekaran's kyphosis classification can help surgeons in appropriate decision-making.
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Aung WLL, Jibon N, Rawashdeh L, Raheem A, Jaffet M, Nasim S. Spinal Tuberculosis (Pott's Disease): A Case Report and Clinical Considerations. Cureus 2024; 16:e73903. [PMID: 39697911 PMCID: PMC11655093 DOI: 10.7759/cureus.73903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/17/2024] [Indexed: 12/20/2024] Open
Abstract
Pott's disease (PD), also known as spinal tuberculosis, accounts for an extremely low percentage of all tuberculosis (TB) cases and typically manifests secondary to an extra-spinal infection through the hematogenous spread. The thoracolumbar vertebrae are the most affected sites in PD, although other spinal regions can also be involved, albeit less frequently. Back pain is the predominant presenting symptom. Systemic symptoms such as fever and weight loss may occur in PD but are more commonly observed in patients with disseminated disease or concurrent extra-spinal TB. This report presents the case of a 26-year-old Asian woman, born outside the United Kingdom, with no significant past medical history or recent travel to TB-endemic areas, who was diagnosed with spinal TB following a series of medical evaluations. MRI of the spine revealed findings highly suggestive of tuberculous spondylitis. She is currently undergoing treatment and showing significant improvement. This case underscores an atypical patient profile for spinal TB, highlighting the necessity for awareness and consideration of this diagnosis even in unusual patient demographics.
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Affiliation(s)
| | - Noim Jibon
- Medicine, Southend University Hospital, Mid and South Essex NHS Foundation Trust, Southend-on-Sea, GBR
| | - Lama Rawashdeh
- Internal Medicine, Basildon University Hospital, Mid and South Essex NHS Foundation Trust, Basildon, GBR
| | - Ali Raheem
- Gastroenterology, Southend University Hospital, Mid and South Essex NHS Foundation Trust, Southend-on-Sea, GBR
| | - Marjorie Jaffet
- General Medicine, Southend University Hospital, Mid and South Essex NHS Foundation Trust, Southend-on-Sea, GBR
| | - Shahid Nasim
- Internal Medicine, Southend University Hospital, Mid and South Essex NHS Foundation Trust, Southend-on-Sea, GBR
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Abid W, Ladeb MF, Chidambaranathan N, Peh WCG, Vanhoenacker FM. Imaging of musculoskeletal tuberculosis. Skeletal Radiol 2024; 53:2081-2097. [PMID: 38231262 DOI: 10.1007/s00256-023-04556-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 12/15/2023] [Accepted: 12/20/2023] [Indexed: 01/18/2024]
Abstract
Tuberculosis (TB) represents a major public health problem worldwide. Any tissue may be infected. Involvement of the musculoskeletal (MSK) system account for 1-3% of all tuberculous infections. MSK TB may manifest as tuberculous spondylitis, arthritis, osteomyelitis, and soft tissue infections. Although TB spondylitis may present with distinctive imaging features compared to pyogenic infections of the spine, the imaging semiology of extra-spinal TB infections is mostly nonspecific and may mimic other lesions. TB infections should therefore always be considered in the differential diagnosis, particularly in immunocompromised patients. The aim of this article is to review the imaging features of spinal and extra-spinal MSK TB. Magnetic resonance imaging is considered the modality of choice to make the diagnosis and to evaluate the extent of the disease.
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Affiliation(s)
- Wiem Abid
- Department of Radiology, (Vrije Universiteit Brussel), University Hospital Brussel, Laarbeeklaan 101, 1090, Jette, Brussels, Belgium
| | - Mohamed F Ladeb
- Department of Radiology, MT Kassab Institute of Orthopaedics, Tunis, Tunisia
| | - Natesan Chidambaranathan
- Department of Radiology & Imaging Sciences, Apollo Hospitals, 21, Greams Lane, Chennai, 600 006, India
| | - Wilfred C G Peh
- Department of Diagnostic Radiology, Khoo Teck Puat Hospital, 90 Yishun Central, Singapore, 768828, Republic of Singapore
| | - Filip M Vanhoenacker
- General Hospital Sint-Maarten Mechelen, Liersesteenweg 435, 2800, Mechelen, Belgium.
- Department of Radiology, University Hospital Antwerp, Drie Eikenstraat, 655, B-2650, Edegem, Belgium.
- Faculty of Medicine and Health Sciences, University of Antwerp, Ghent and KU Leuven, Belgium.
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14
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Atmodiwirjo P, Ramadan MR, Lumbuun R, Gunawan K, Saekhu M, Nugroho SW, Ralena NA. Free Vascularized Osseous Fibula Flap for Vertebral Body Defect in a Patient with Tuberculosis Spondylitis. Plast Reconstr Surg Glob Open 2024; 12:e6169. [PMID: 39286610 PMCID: PMC11404908 DOI: 10.1097/gox.0000000000006169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2024] [Accepted: 07/30/2024] [Indexed: 09/19/2024]
Abstract
In the context of tuberculous spondylitis, a rare form of extrapulmonary tuberculosis causing significant discomfort and neurological deficits, surgery becomes imperative to alleviate symptoms alongside antituberculosis treatment. However, the utilization of free vascularized fibula flaps for repairing vertebral deformities remains uncommon. This report presents the case of a 21-year-old man with limb weakness and sensory disturbances who was referred to our hospital, where contrast magnetic resonance imaging revealed a paravertebral abscess spanning several thoracic vertebrae. Collaborating with neurosurgeons, we performed decompression laminectomy, pedicle screw fixation, thoracic vertebrectomy, and restoration of the corporal defect using a free fibula flap. Utilizing a 2.5-cm fibula segment from the patient's left leg without a skin paddle, the surgery demonstrated a pedicle length of 12 cm and a total ischemic time of 183 minutes. The fibula was press-fitted, with recipient vessels identified as 1-mm artery and vein from the intercostal artery perforator. Postsurgery, flap vitality was assessed using Doppler ultrasound, showing positive signals immediately and at 1-month follow-up, with the patient experiencing reduced pain and improved leg strength. Despite its rarity, free fibula flap reconstruction for spinal defects proves effective, safe, and beneficial, necessitating thorough preoperative planning and interdisciplinary collaboration for successful outcomes, marking this case as the first reported instance in Indonesia.
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Affiliation(s)
- Parintosa Atmodiwirjo
- From the Reconstructive Microsurgery Section, Division of Plastic, Reconstructive and Aesthetic Surgery, Dr. Cipto Mangunkusumo National Hospital, Universitas Indonesia, Jakarta, Indonesia
| | - Mohamad Rachadian Ramadan
- From the Reconstructive Microsurgery Section, Division of Plastic, Reconstructive and Aesthetic Surgery, Dr. Cipto Mangunkusumo National Hospital, Universitas Indonesia, Jakarta, Indonesia
| | - Ruth Lumbuun
- From the Reconstructive Microsurgery Section, Division of Plastic, Reconstructive and Aesthetic Surgery, Dr. Cipto Mangunkusumo National Hospital, Universitas Indonesia, Jakarta, Indonesia
| | - Kevin Gunawan
- Neurosurgery Department, Dr. Cipto Mangunkusumo National Hospital, Universitas Indonesia, Jakarta, Indonesia
| | - Mohamad Saekhu
- Neurosurgery Department, Dr. Cipto Mangunkusumo National Hospital, Universitas Indonesia, Jakarta, Indonesia
| | - Setyo Widi Nugroho
- Neurosurgery Department, Dr. Cipto Mangunkusumo National Hospital, Universitas Indonesia, Jakarta, Indonesia
| | - Nadhira Anindita Ralena
- From the Reconstructive Microsurgery Section, Division of Plastic, Reconstructive and Aesthetic Surgery, Dr. Cipto Mangunkusumo National Hospital, Universitas Indonesia, Jakarta, Indonesia
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15
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Karim Z, Abid S. Subcutaneous and paraspinal tuberculous abscesses in a patient with Crohn's disease. BMJ Case Rep 2024; 17:e260389. [PMID: 39181569 DOI: 10.1136/bcr-2024-260389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/27/2024] Open
Abstract
This case involves a man with longstanding Crohn's disease on azathioprine therapy who developed a rare manifestation of tuberculosis, presenting as a subcutaneous tuberculous abscess and tuberculous spondylitis. The patient's immunocompromised state due to azathioprine raised the risk for opportunistic infections. The unique aspects include the absence of disseminated tuberculosis and the development of tuberculous paraspinal and subcutaneous abscesses in a patient with Crohn's disease. The case underscores the importance of vigilance for rare infections in immunosuppressed individuals and highlights the need for tuberculosis screening before initiating immunosuppressive therapies. The patient was successfully treated with antituberculous medication, emphasising the importance of a tailored approach in managing such cases.
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Affiliation(s)
- Zohair Karim
- Medicine, Aga Khan University Hospital, Karachi, Pakistan
| | - Shahab Abid
- Gasteroenterology, Aga Khan University Hospital, Karachi, Sindh, Pakistan
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16
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Zhang X, Zhang L, Ma X, Zhou X. Cervical tuberculosis with a large abscess of subcutaneous soft tissue: A case report. Asian J Surg 2024:S1015-9584(24)01556-2. [PMID: 39174368 DOI: 10.1016/j.asjsur.2024.07.183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2024] [Accepted: 07/21/2024] [Indexed: 08/24/2024] Open
Affiliation(s)
- Xiong Zhang
- Affiliated Hospital of Hebei University, 212 Yuhua East Road, Baoding, Hebei, China.
| | - Lingnan Zhang
- Affiliated Hospital of Hebei University, 212 Yuhua East Road, Baoding, Hebei, China.
| | - Xiaoyong Ma
- Affiliated Hospital of Hebei University, 212 Yuhua East Road, Baoding, Hebei, China.
| | - Xiaozhe Zhou
- Affiliated Hospital of Hebei University, 212 Yuhua East Road, Baoding, Hebei, China.
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17
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Tanaviriyachai T, Pornsopanakorn P, Choovongkomol K, Virathepsuporn T, Piyapromdee U, Jongkittanakul S, Sudprasert W, Wiwatrojanagul S. A Comparative Factor Analysis and New Magnetic Resonance Imaging Scoring System for Differentiating Pyogenic Versus Tuberculous Spondylodiscitis. Neurospine 2024; 21:690-700. [PMID: 38955538 PMCID: PMC11224736 DOI: 10.14245/ns.2448120.060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Revised: 04/04/2024] [Accepted: 04/12/2024] [Indexed: 07/04/2024] Open
Abstract
OBJECTIVE This study aimed to compare and analyze differences in clinical and magnetic resonance imaging (MRI) findings between tuberculous spondylodiscitis (TbS) and pyogenic spondylodiscitis (PyS), and to develop and validate a simplified multiparameter MRIbased scoring system for differentiating TbS from PyS. METHODS We compared predisposing factors in 190 patients: 123 with TbS and 67 with PyS, confirmed by laboratory tests, culture, or pathology. Data encompassing patient demographics, clinical characteristics, laboratory results, and MRI findings were collected between 2015 and 2020. Data were analyzed using logistic regression methods, and selected coefficients were transformed into an MRI-based scoring system. Internal validation was performed using bootstrapping method. RESULTS Univariate analysis revealed that the significant risk factors associated with TbS included thoracic lesions, vertebral destruction > 50%, intraosseous abscess, thin-walled abscess, well-defined paravertebral abscess, subligamentous spreading, and epidural abscess. Multivariate analysis revealed that only thoracic lesions, absence of epidural phlegmon, subligamentous spreading, intraosseous abscesses, well-defined paravertebral abscesses, epidural abscesses, and absence of facet joint arthritis were independent predictive factors for TbS (all p < 0.05). These potential predictors were used to derive an MRI scoring system. Total scores ≥ 14/29 points significantly predicted the probability of TbS, with a sensitivity of 97.58%, specificity of 92.54%, and an area under the curve of 0.96 (95% confidence interval, 125.40-3,257.95). CONCLUSION This simplified MRI-based scoring system for differentiating TbS from PyS helps guide appropriate treatment when the causative organism is not identified.
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Affiliation(s)
- Terdpong Tanaviriyachai
- Department of Orthopedic Surgery, Maharat Nakhon Ratchasima Hospital, Nakhon Ratchasima, Thailand
| | - Patchara Pornsopanakorn
- Department of Orthopedic Surgery, Maharat Nakhon Ratchasima Hospital, Nakhon Ratchasima, Thailand
| | - Kongtush Choovongkomol
- Department of Orthopedic Surgery, Maharat Nakhon Ratchasima Hospital, Nakhon Ratchasima, Thailand
| | | | - Urawit Piyapromdee
- Department of Orthopedic Surgery, Maharat Nakhon Ratchasima Hospital, Nakhon Ratchasima, Thailand
| | - Sarut Jongkittanakul
- Department of Orthopedic Surgery, Maharat Nakhon Ratchasima Hospital, Nakhon Ratchasima, Thailand
| | - Weera Sudprasert
- Department of Orthopedic Surgery, Maharat Nakhon Ratchasima Hospital, Nakhon Ratchasima, Thailand
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Obiegbu HO, Ndukwu C. Tuberculous Paraplegia: Outcome of Operative Intervention. Niger J Clin Pract 2024; 27:565-569. [PMID: 38842704 DOI: 10.4103/njcp.njcp_390_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 03/17/2024] [Indexed: 06/07/2024]
Abstract
BACKGROUND Tuberculosis of the spine, a common manifestation of extra-pulmonary tuberculosis is characterized by vertebral destruction, paradiscal involvement, abscess collection and varying degrees of neurologic affectation. The primary disease caused by mycobacterium tuberculosis complex infects the lungs, lymph nodes of the mediastinum and gastrointestinal tract/ viscera with spinal involvement being secondary and caused by haematogenous spread. Tuberculous paraplegia arises as a complication of spinal involvement. AIM To determine the outcome of operative intervention in tuberculous paraplegia. Methodology: This was a retrospective study involving 10 patients with tuberculous spinal involvement with varying degrees of neurological deficit as defined by both Tuli and ASIA grading. The VAS score, ESR, ASIA grade (both pre-op and post op), Tuli's grade (pre-op and post op) were used to analyze the therapeutic effects of the surgery. RESULTS The mean pre-operative VAS score was 5.9 ±1.8, which significantly decreased to 2.2 ±1.3 six weeks post operatively. The mean pre-operative ESR and CRP was 78.9 ± 11.3mm/hr and 83 ± 13.5 respectively; which both showed a statistically significant decrease post-operatively, p<0.05. All cases achieved an increase of more than one ASIA grade post-operatively. CONCLUSION Early surgical intervention is beneficial in patients with tuberculous spinal disease with neurologic involvement.
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Affiliation(s)
- H O Obiegbu
- Department of Orthopaedic Surgery, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Anambra State, Nigeria
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Arifin J, Biakto KT, Johan MP, Anwar SFZ. Clinical outcomes and surgical strategy for spine tuberculosis: a systematic review and meta-analysis. Spine Deform 2024; 12:271-291. [PMID: 37975989 PMCID: PMC10867033 DOI: 10.1007/s43390-023-00785-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 10/23/2023] [Indexed: 11/19/2023]
Abstract
PURPOSE Spinal tuberculosis (TB) is a slow-developing disease that often causes cord compression, spinal instability, and deformity. Surgery is generally required in cases of refractory disease, severe kyphosis, neurological deficits, or lack of improvement. However, there is a lack of comprehensive evidence in comparing the efficacy of various surgical approaches. The study aims to provide a clearer understanding of the relative effectiveness of the available surgical modalities in the management of spinal TB. METHODS This review adhered to the PRISMA statement with searching conducted until 11th April 2023. Inclusion criteria included studies involving surgical procedures for spinal tuberculosis, with relevant clinical outcomes reported. Data extraction involved the collection of information on study and population characteristics, interventions used, relevant clinical outcomes, and reported complications. The risk of bias was evaluated using Cochrane's Risk of Bias in Non-randomized Studies tool. RESULTS Searching resulted in 20 cohort studies that analyzed surgical methods for spinal tuberculosis. Eleven studies had low bias and nine studies had moderate bias. The anterior approach was associated with faster perioperative duration [- 2.02 (- 30.71, 26.67), p < 0.00001], less blood loss [- 4242 (- 176.02, 91.18), p < 0.00001], shorter hospitalization [- 0.19 (- 2.39, 2.01), p < 0.00001], better angle correction [1.01 (- 1.82, 3.85), p < 0.00001], and better correction rates [11.36 (- 7.32, 30.04), p < 0.00001] compared to the posterior approach. Regarding neurological function recovery, the anterior and posterior approaches were equally effective, while the posterior approach was associated with a higher incidence of complications. The review also reported on the complications associated with the surgical approaches, and 9 out of 20 studies reported complications. The anterior approach was found to have fewer complications overall. CONCLUSION The anterior approach is thought to have fewer complications than both combined and posterior-only approaches, but the variability of the findings indicates that the decision-making process for selecting a surgical approach must consider individual patient and disease characteristics, as well as surgeon training.
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Affiliation(s)
- Jainal Arifin
- Department of Orthopaedics and Traumatology, Hasanuddin University, Jl. Perintis Kemerdekaan No. 10, Tamalanrea Indah, Makassar, Sulawesi Selatan, 90245, Indonesia
| | - Karya Triko Biakto
- Department of Orthopaedics and Traumatology, Hasanuddin University, Jl. Perintis Kemerdekaan No. 10, Tamalanrea Indah, Makassar, Sulawesi Selatan, 90245, Indonesia
| | - Muhammad Phetrus Johan
- Department of Orthopaedics and Traumatology, Hasanuddin University, Jl. Perintis Kemerdekaan No. 10, Tamalanrea Indah, Makassar, Sulawesi Selatan, 90245, Indonesia
| | - St Fatimah Zahrah Anwar
- Department of Orthopaedics and Traumatology, Hasanuddin University, Jl. Perintis Kemerdekaan No. 10, Tamalanrea Indah, Makassar, Sulawesi Selatan, 90245, Indonesia.
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20
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Arifin J, Sakti M, Massi N, Bukhari A, Hamid F, Winangun PA. Vertebral destruction in tuberculous spondylitis correlates with Toll-like Receptor 4 (TLR-4) levels: a cross-sectional study. Ann Med Surg (Lond) 2024; 86:800-804. [PMID: 38333260 PMCID: PMC10849308 DOI: 10.1097/ms9.0000000000001707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2023] [Accepted: 12/29/2023] [Indexed: 02/10/2024] Open
Abstract
Background Tuberculous (TB) spondylitis is a hazardous infectious disease causing significant spinal deformity. Increased toll-like receptor-4 (TLR-4) activity promotes more extensive infections in patients with TB spondylitis, so it has the potential to be used as a biomarker to predict the severity. This study aims to determine the relationship between TLR-4 levels and the degree of vertebral destruction in TB spondylitis patients. Materials and methods A cross-sectional study was conducted from May to October 2023. A total of 27 TB spondylitis samples were then measured for TLR-4 serum levels. Vertebral destruction is assessed based on the Spine At Risk Signs (SARS) criteria on X-ray and MRI examinations. Moreover, the degree of sensory and motor impairment was also assessed in this study. The Spearman correlation test assessed the correlation between TLR-4 levels and vertebral destruction. Results Most of the samples in this study were less than 30 years old (10 people, 37%), female (14 people, 51.9%), had spinal destruction at 1 level (11 people, 40.7%), had paraplegia (8 people, 29.6%), and had hypoesthesia (11 people, 40.7%). TLR-4 levels had a mean value of 8254.1±1076.1 ng/ml. TLR-4 levels were positively correlated with the degree of vertebral destruction (r=0.599, P=0.001), motor disorders (r=0.632.x, P=0.000), and sensory disorders (r=0.574, P=0.002). Conclusion TLR-4 levels are associated with the severity of vertebral destruction in TB spondylitis, so it has the potential to be used as a prognostic biomarker.
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Affiliation(s)
- Jainal Arifin
- Department of Orthopedic and Traumatology, Spine Divison
| | - Muhammad Sakti
- Department of Orthopedic and Traumatology, Sports and Injury Division
| | | | | | | | - Putu A.N. Winangun
- Orthopaedic and Traumatology Study Program, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia
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21
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Hoffman CJ, France T, Cram T, Bodmer JL, Sanders JS. Pediatric Multidrug-Resistant Disseminated Tuberculosis Presenting as Small Finger Tuberculous Osteomyelitis: A Case Report. JBJS Case Connect 2024; 14:01709767-202403000-00023. [PMID: 38306445 DOI: 10.2106/jbjs.cc.23.00445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2024]
Abstract
CASE We report a case in the United States of a 12-year-old girl with multidrug-resistant tuberculous (MDR-TB) osteomyelitis of the hand managed with surgical debridement and second-line anti-TB therapy. The disease course was complicated by dissemination and multifocal progression. CONCLUSION Despite early intervention, multidrug resistance makes TB treatment challenging and facilitated progression to disseminated disease in this case. We review the difficulties in diagnosis and treatment of pediatric MDR-TB.
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Affiliation(s)
- Clayton J Hoffman
- Department of Orthopedics, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Thomas France
- Department of Orthopedics, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Tyler Cram
- Department of Orthopedics, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Jenna L Bodmer
- Department of Pathology, Children's Hospital Colorado, Aurora, Colorado
| | - Julia S Sanders
- Department of Orthopedics, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado
- Department of Orthopedics, Children's Hospital Colorado, Aurora, Colorado
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Waters R, Laubscher M, Dunn RN, Adikary N, Coussens AK, Held M. Higher Sensitivity of Xpert MTB/RIF Ultra Over Tuberculosis Culture for the Diagnosis of Spinal Tuberculosis With Open or Computed Tomography-Guided Biopsies. Open Forum Infect Dis 2024; 11:ofad621. [PMID: 38173845 PMCID: PMC10759005 DOI: 10.1093/ofid/ofad621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 12/06/2023] [Indexed: 01/05/2024] Open
Abstract
Background Diagnostic specimens for spinal tuberculosis (STB) are mostly collected via open surgery. Percutaneous computed tomography (CT)-guided biopsies are used in times of limited surgical availability. However, poor diagnostic accuracy of Mycobacterium tuberculosis (Mtb) culture has been reported with this method, due to limited sample volume and the paucibacillary nature of STB. We evaluated Xpert MTB/RIF Ultra on open and CT-guided biopsies as compared with the gold standard Mtb culture and histopathology. Methods We conducted a prospective diagnostic accuracy study of Xpert Ultra, as compared with tuberculosis culture and histopathology, in adults with signs and symptoms of STB at a tertiary academic hospital in South Africa from November 2020 to December 2021. Diagnostic testing was performed on 31 patients with available samples. Results Xpert Ultra had a sensitivity of 94.7% (95% CI, 75.3%-99.7%) and specificity of 100% (95% CI, 75.7%-100.0%) against a reference standard of Mtb culture and histopathology. Xpert Ultra had high diagnostic accuracy in open and CT-guided biopsy samples with sensitivity and specificity of 100% and 100% (open) and 89% and 100% (CT), respectively. Mtb culture had limited specificity for CT-guided biopsies (43%; 95% CI, 15.8%-74.9%). HIV-1 coinfection did not affect Mtb abundance measures by Xpert Ultra or culture. Xpert Ultra was also superior to culture for STB diagnosis in patients concurrently treated for pulmonary tuberculosis. Conclusions Xpert Ultra detected more STB cases than culture for CT-guided biopsy samples. There was also no difference in sensitivity for open biopsies, irrespective of HIV-1 status, making it an important tool for rapid diagnosis, especially during times or in locations where open surgery is not possible or concurrent pulmonary tuberculosis treatment is initiated.
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Affiliation(s)
- Robyn Waters
- Orthopaedic Research Unit, Division of Orthopaedic Surgery, Groote Schuur Hospital, Cape Town, South Africa
- Division of Orthopaedic Surgery, Groote Schuur Hospital, Cape Town, South Africa
- Centre for Infectious Disease Research in Africa, Institute of Infectious Disease and Molecular Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Maritz Laubscher
- Orthopaedic Research Unit, Division of Orthopaedic Surgery, Groote Schuur Hospital, Cape Town, South Africa
- Division of Orthopaedic Surgery, Groote Schuur Hospital, Cape Town, South Africa
| | - Robert N Dunn
- Orthopaedic Research Unit, Division of Orthopaedic Surgery, Groote Schuur Hospital, Cape Town, South Africa
- Division of Orthopaedic Surgery, Groote Schuur Hospital, Cape Town, South Africa
| | - Nawaal Adikary
- Microbiology Diagnostic Laboratory, National Health Laboratory Service, Groote Schuur Hospital, Cape Town, South Africa
| | - Anna K Coussens
- Centre for Infectious Disease Research in Africa, Institute of Infectious Disease and Molecular Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
- Infectious Diseases and Immune Defence Division, Walter and Eliza Hall Institute of Medical Research, Parkville, Australia
- Department of Medical Biology, University of Melbourne, Parkville, Australia
| | - Michael Held
- Orthopaedic Research Unit, Division of Orthopaedic Surgery, Groote Schuur Hospital, Cape Town, South Africa
- Division of Orthopaedic Surgery, Groote Schuur Hospital, Cape Town, South Africa
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Sareen A, Guha M, Bansal K, Hegde A, Boruah T. Single Sequence Whole-Spine Screening Magnetic Resonance Imaging: Diagnostic and Therapeutic Role in Multiple-Level Spinal Tuberculosis. Cureus 2024; 16:e52757. [PMID: 38389615 PMCID: PMC10882150 DOI: 10.7759/cureus.52757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/22/2024] [Indexed: 02/24/2024] Open
Abstract
INTRODUCTION Spinal tuberculosis (TB) is the most common form of skeletal tuberculosis. Paradiscal continuous vertebral involvement at a single level is the most prevalent pattern among all forms of spinal TB. There is a wide range of reported incidences of multiple-level non-contiguous spinal TB in the literature. We would like to discuss on the utility of single whole spine screening T2-weighted (T2W) mid-sagittal magnetic resonance imaging (MRI) film in diagnosing multiple-level spinal TB and therapeutic benefits it can provide. METHODS We have done a retrospective review of the collected data of patients in Vardhman Mahavir Medical College and Safdarjung Hospital from August 2017 to October 2021 to find the incidence of multiple-level spinal TB and possible factors attributed to this specific disease pattern. All the patients who had been diagnosed of spinal TB either microbiologically or histopathologically or by a good clinical response to anti-tubercular treatment (ATT) and had a whole spine screening MRI film, were included. Patients of spinal TB who did not have a whole spine screening MRI were excluded from the study. Multiple-level spinal TB was diagnosed when lesions were identified in vertebral levels other than a typical paradiscal lesion, and additional lesions were separated from the primary disease by at least one normal spinal segment. RESULTS Among the patients, 242 met the inclusion criteria, and 76 showed multiple-level non-contiguous spinal TB on MRI, incidence being 31.4%. The rest of the 166 patients showed typical single-segment contiguous lesions. By doing multivariate analysis to determine the independent risk factors for multiple-level spinal TB, extremes of age (<20 years and >50 years) have been found to be a significant factor with p value of 0.0001. Though drug resistance was not found to be a significant risk factor (p value 0.051), the proportion of patients having multiple-level TB was far more in the drug-resistant group (13/76). CONCLUSIONS Single sequence whole spine screening MRI film is an effective, economical, and time-saving tool to detect multiple-level spinal TB. Along with its diagnostic accuracy, it also provides therapeutic benefits like access to a more approachable site for biopsy.
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Affiliation(s)
- Atul Sareen
- Central Institute of Orthopaedics, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, IND
| | - Mayukh Guha
- Spine Surgery, Indian Spinal Injuries Centre, New Delhi, IND
| | - Kuldeep Bansal
- Spine Surgery, Yashoda Super Speciality Hospital, Ghaziabad, IND
| | - Amit Hegde
- Central Institute of Orthopaedics, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, IND
| | - Tankeswar Boruah
- Central Institute of Orthopaedics, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, IND
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Zhang M, Hu X, Lei S, Jia J, Kang X. Trends and prospects in spinal tuberculosis research: a future-oriented approach. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2023; 32:4246-4258. [PMID: 37115281 DOI: 10.1007/s00586-023-07728-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 03/09/2023] [Accepted: 04/18/2023] [Indexed: 04/29/2023]
Abstract
PURPOSE Tuberculosis is one of the oldest diseases in human history, and spinal tuberculosis (STB) is the most common form of extrapulmonary tuberculosis. A large number of research has been conducted in this field. However, there has been no bibliometric analysis performed in recent years in STB. The aim of this study was to analyze trends and hotspots in research on STB. METHODS Publications regarding STB between 1980 and 2022 were extracted from the Web of Science database. CiteSpace (V5.7.R2) and VOSviewer (1.6.10) were used to perform global analyses of the number of publications, countries, institutions, authors, journals, keywords, and cited references. RESULTS A total of 1262 articles were published between 1980 and 2022. We observed rapid growth in the number of publications since 2010. Spine had the highest number of publications (47, 3.7%). Zhang HQ and Wang XY were key researchers. The Central South University published the most papers (90, 7.1%). China was the leading contributor in this field with 459 publications and 29 H-index. National partnerships are dominated by the USA, and there is a lack of active cooperation between other countries and authors. CONCLUSION research on STB has achieved great progress, with an increasing number of publications since 2010. Surgical treatment and debridement are current research hots pots, and diagnosis, drug resistance, and kyphosis are likely research frontiers. Cooperation between countries and authors needs to be further strengthened.
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Affiliation(s)
- Mingtao Zhang
- Department of Orthopaedics, Lanzhou University Second Hospital, No. 82 Cuiyingmen, Chengguan District, Lanzhou, 730000, Gansu, China
- Key Laboratory of Orthopedics Disease of Gansu Province, Lanzhou, 730000, Gansu, China
| | - Xuchang Hu
- Department of Orthopaedics, Lanzhou University Second Hospital, No. 82 Cuiyingmen, Chengguan District, Lanzhou, 730000, Gansu, China
- Key Laboratory of Orthopedics Disease of Gansu Province, Lanzhou, 730000, Gansu, China
| | - Shuanhu Lei
- Department of Orthopaedics, Lanzhou University Second Hospital, No. 82 Cuiyingmen, Chengguan District, Lanzhou, 730000, Gansu, China
- Key Laboratory of Orthopedics Disease of Gansu Province, Lanzhou, 730000, Gansu, China
| | - Jingwen Jia
- Department of Orthopaedics, Lanzhou University Second Hospital, No. 82 Cuiyingmen, Chengguan District, Lanzhou, 730000, Gansu, China
- Key Laboratory of Orthopedics Disease of Gansu Province, Lanzhou, 730000, Gansu, China
| | - Xuewen Kang
- Department of Orthopaedics, Lanzhou University Second Hospital, No. 82 Cuiyingmen, Chengguan District, Lanzhou, 730000, Gansu, China.
- Key Laboratory of Orthopedics Disease of Gansu Province, Lanzhou, 730000, Gansu, China.
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Shanmuganathan R, Ramachandran K, Shetty AP, Kanna RM. Active tuberculosis of spine: Current updates. NORTH AMERICAN SPINE SOCIETY JOURNAL 2023; 16:100267. [PMID: 37736557 PMCID: PMC10510092 DOI: 10.1016/j.xnsj.2023.100267] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 08/13/2023] [Accepted: 08/15/2023] [Indexed: 09/23/2023]
Abstract
Background Spinal tuberculosis (TB) is the most common extrapulmonary form of tuberculosis. In both developing and developed countries, TB has been on the rising trend due to factors such as increasing HIV coinfection, multidrug resistance of the organism, and global migration. Spinal TB, which most often affects the lower thoracic and thoracolumbar area, accounts for 50% of all musculoskeletal tuberculosis. Methods Using the Cochrane Database of Systematic Reviews, EMBASE, and PubMed, a systematic computerized literature search was performed. Analyses of studies published within the past 10 years were conducted. The searches were performed using Medical Subject Headings terms, with "spinal tuberculosis," "diagnosis," "epidemiology," and "etiology","management," "surgery," and "therapy" as subheadings. Results Progressive collapse, kyphosis, and neurological deficiency are hallmarks of the disease because of its destructive effect on the intervertebral disc and adjacent vertebral bodies. The condition may be identified using laboratory testing and distinctive imaging features, but the gold standard for diagnosis is tissue diagnosis using cultures, histology, and polymerase chain reaction. Uncomplicated spinal TB is today a medical condition that can be adequately treated by multidrug ambulatory chemotherapy. Surgery is reserved for individuals who have instability, neurological impairment, and deformity correction. Debridement, deformity correction, and stable fusion are the cornerstones of surgical treatment. Conclusions Clinical results for the treatment of spinal TB are generally satisfactory when the disease is identified and treated early. However, the major health issue and the biggest obstacle in achieving the goals of the "End TB strategy" is the recent rise in the emergence of drug resistance. Hence strict vigilance and patient perseverance in the completion of the treatment is the main need of the hour.
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Affiliation(s)
- Rajasekaran Shanmuganathan
- Department of Spine Surgery, Ganga Medical Centre and Hospitals Pvt. Ltd., Mettupalayam Rd, Coimbatore, 641043 India
| | - Karthik Ramachandran
- Department of Spine Surgery, Ganga Medical Centre and Hospitals Pvt. Ltd., Mettupalayam Rd, Coimbatore, 641043 India
| | - Ajoy Prasad Shetty
- Department of Spine Surgery, Ganga Medical Centre and Hospitals Pvt. Ltd., Mettupalayam Rd, Coimbatore, 641043 India
| | - Rishi Mugesh Kanna
- Department of Spine Surgery, Ganga Medical Centre and Hospitals Pvt. Ltd., Mettupalayam Rd, Coimbatore, 641043 India
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Tanaviriyachai T, Choovongkomol K, Pornsopanakorn P, Jongkittanakul S, Piyapromdee U, Sudprasert W. Factors Affecting Neurological Deficits in Thoracic Tuberculous Spondylodiscitis. Int J Spine Surg 2023; 17:645-651. [PMID: 37553257 PMCID: PMC10623663 DOI: 10.14444/8522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/10/2023] Open
Abstract
BACKGROUND Thoracic spinal tuberculosis (TB) causes destruction of the spine and compression of the adjacent spinal cord. This study aimed to identify the risk factors for neurological deterioration in patients with thoracic spinal TB to guide decision-making regarding immediate surgery before the onset of weakness. METHODS Demographic, clinical, laboratory, and radiologic (x-ray and magnetic resonance imaging) data of 115 patients with active thoracic spinal TB were retrospectively analyzed. Patients with neurological status categorized as Frankel grades A, B, or C (n = 71) were classified as the neurological deficit group, while those with neurological status categorized as Frankel grades D and E (n = 44) constituted the control group. Univariate and multivariate logistic regression analyses were used to predict the risk factors for neurological deficits. RESULTS The mean patient age was 57.2 years. The most common lesion location was the distal thoracic region (T9-L1; 62.6%). Paradiscal involvement was the most common form of involvement (73%). In the univariate analysis, the significant risk factors associated with neurological worsening were overweight (body mass index [BMI] >25), C-reactive protein level > 20 mg/L, panvertebral involvement, loss of cerebrospinal fluid posterior to the cord, cord signal changes, and canal compromise. The multivariate analysis revealed that only BMI >25 (adjusted OR = 16.18; 95% CI 1.60-163.64; P = 0.018), cord signal changes (adjusted OR = 7.42; 95% CI 1.85-29.74; P = 0.005), and canal encroachment >50% ( adjusted OR = 51.86; 95% CI 5.53-486.24; P = 0.001) were independent risk factors for predicting the risk of neurological deficits. CONCLUSIONS Overweight (BMI >25), cord signal changes, and canal compromise >50% significantly predicted neurological deficits in patients with thoracic spinal TB. Prompt spinal surgery should be considered before progressive worsening of the neurological condition in patients with all of these risk factors. CLINICAL RELEVANCE Predictive factors for neurological deficits in thoracic spinal TB were determined. Overweight, cord signal changes, and canal compromise >50% showed predictive value. These factors can help identify patients who require early surgical intervention. LEVEL OF EVIDENCE: 3
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Affiliation(s)
- Terdpong Tanaviriyachai
- Department of Orthopedic Surgery, Maharat Nakhon Ratchasima Hospital, Nakhon Ratchasima, Thailand
| | - Kongtush Choovongkomol
- Department of Orthopedic Surgery, Maharat Nakhon Ratchasima Hospital, Nakhon Ratchasima, Thailand
| | - Patchara Pornsopanakorn
- Department of Orthopedic Surgery, Maharat Nakhon Ratchasima Hospital, Nakhon Ratchasima, Thailand
| | - Sarut Jongkittanakul
- Department of Orthopedic Surgery, Maharat Nakhon Ratchasima Hospital, Nakhon Ratchasima, Thailand
| | - Urawit Piyapromdee
- Department of Orthopedic Surgery, Maharat Nakhon Ratchasima Hospital, Nakhon Ratchasima, Thailand
| | - Weera Sudprasert
- Department of Orthopedic Surgery, Maharat Nakhon Ratchasima Hospital, Nakhon Ratchasima, Thailand
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Al Tobing SD, Malau VD. Anterior and posterior fusion via a posterior and costotransversectomy approach for thoracic spinal tuberculosis: A case report. Int J Surg Case Rep 2023; 111:108698. [PMID: 37757733 PMCID: PMC10539854 DOI: 10.1016/j.ijscr.2023.108698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 08/14/2023] [Accepted: 08/15/2023] [Indexed: 09/29/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE Left untreated, spinal tuberculosis can lead to irreversible neurological deficit in patients, lowering quality of life. Combination of antitubercular drugs and surgical approach is important in managing spinal tuberculosis. We report a case of thoracic spinal tuberculosis treated by anterior and posterior fusion via a posterior and costotransversectomy approach. PRESENTATION OF CASE A 38 years-old woman diagnosed with paraplegia due to spinal tuberculosis of the thoracic vertebra (Th8) with Frankel A grade for spinal function. Pre-op kyphotic angle was 27.2°. Antitubercular drugs prescribed did not improve paraplegia symptom. Thoracal X-ray and MRI showed pathological fracture on Th8 and paravertebral abscess along anterior corpus of the Th6-9. We performed Sapardan's alternative VI approach that consists of debridement and abscess evacuation, decompression by laminectomy of the Th8, flavectomy and costotransversectomy of the Th8, posterior stabilization of the Th6-7 and Th9-10, and interbody fusion of the Th8. One month postoperative follow up showed improvement on motor function and sensory function. Post op kyphotic angle was 26.7°. CLINICAL DISCUSSION Adequate debridement followed by costotransversectomy, interbody fusion and surgical stabilization relieves pain, improves neurologic function, and prevents deformity of spinal tuberculous patient. CONCLUSION Although costotransversectomy approach is rarely used in surgical management of spinal TB, it is beneficial in cases with massive abscess involvement since it provides better view to collect and drain massive abscess.
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Affiliation(s)
- S Dohar Al Tobing
- Department of Orthopaedic and Traumatology, Dr. Cipto Mangunkusumo Hospital, Faculty of Medicine Universitas Indonesia, Indonesia
| | - Vino Daniel Malau
- Department of Orthopaedic and Traumatology, Dr. Cipto Mangunkusumo Hospital, Faculty of Medicine Universitas Indonesia, Indonesia.
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Compagnone D, Cecchinato R, Pezzi A, Langella F, Damilano M, Redaelli A, Vanni D, Lamartina C, Berjano P, Boriani S. Diagnostic Approach and Differences between Spinal Infections and Tumors. Diagnostics (Basel) 2023; 13:2737. [PMID: 37685273 PMCID: PMC10487270 DOI: 10.3390/diagnostics13172737] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 08/08/2023] [Accepted: 08/19/2023] [Indexed: 09/10/2023] Open
Abstract
STUDY DESIGN A systematic review of the literature about differential diagnosis between spine infection and bone tumors of the spine. BACKGROUND AND PURPOSE The differential diagnosis between spine infection and bone tumors of the spine can be misled by the prevalence of one of the conditions over the other in different areas of the world. A review of the existing literature on suggestive or even pathognomonic imaging aspects of both can be very useful for correctly orientating the diagnosis and deciding the most appropriate area for biopsy. The purpose of our study is to identify which imaging technique is the most reliable to suggest the diagnosis between spine infection and spine bone tumor. METHODS A primary search on Medline through PubMed distribution was made. We identified five main groups: tuberculous, atypical spinal tuberculosis, pyogenic spondylitis, and neoplastic (primitive and metastatic). For each group, we evaluated the commonest localization, characteristics at CT, CT perfusion, MRI, MRI with Gadolinium, MRI diffusion (DWI) and, in the end, the main features for each group. RESULTS A total of 602 studies were identified through the database search and a screening by titles and abstracts was performed. After applying inclusion and exclusion criteria, 34 articles were excluded and a total of 22 full-text articles were assessed for eligibility. For each article, the role of CT-scan, CT-perfusion, MRI, MRI with Gadolinium and MRI diffusion (DWI) in distinguishing the most reliable features to suggest the diagnosis of spine infection versus bone tumor/metastasis was collected. CONCLUSION Definitive differential diagnosis between infection and tumor requires biopsy and culture. The sensitivity and specificity of percutaneous biopsy are 72% and 94%, respectively. Imaging studies can be added to address the diagnosis, but a multidisciplinary discussion with radiologists and nuclear medicine specialists is mandatory.
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Affiliation(s)
| | | | - Andrea Pezzi
- IRCCS Ospedale Galeazzi—Sant’Ambrogio, 20157 Milan, Italy
- Residency Program in Orthopaedics and Traumatology, University of Milan, 20141 Milan, Italy
| | | | - Marco Damilano
- IRCCS Ospedale Galeazzi—Sant’Ambrogio, 20157 Milan, Italy
| | | | - Daniele Vanni
- IRCCS Ospedale Galeazzi—Sant’Ambrogio, 20157 Milan, Italy
| | | | - Pedro Berjano
- IRCCS Ospedale Galeazzi—Sant’Ambrogio, 20157 Milan, Italy
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Yahia S, Khalil IA, Ghoniem MG, El-Sherbiny IM. 3D-bioimplants mimicking the structure and function of spine units for the treatment of spinal tuberculosis. RSC Adv 2023; 13:17340-17353. [PMID: 37304785 PMCID: PMC10251188 DOI: 10.1039/d3ra02351f] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Accepted: 06/02/2023] [Indexed: 06/13/2023] Open
Abstract
Approximately 1-2% of the reported tuberculosis (TB) cases have skeletal system problems, particularly spinal TB. The complications of spinal TB involve the destruction of vertebral body (VB) and intervertebral disc (IVD) which consequently leads to kyphosis. This work aimed at utilizing different technologies to develop, for the first time, a functional spine unit (FSU) replacement to mimic the structure and function of the VB and IVD along with a good ability to treat spinal TB. 3D-printed scaffolds with different porous patterns (hexagonal or grid) were fabricated from biocompatible acrylonitrile butadiene styrene, and polylactic acid to replace damaged VB and IVD, respectively. The VB scaffold is filled with gelatine-based semi-IPN hydrogel containing mesoporous silica nanoparticles loaded with two antibiotics, rifampicin and levofloxacin, to act against TB. The IVD scaffold incorporates a gelatin hydrogel loaded with regenerative platelet-rich plasma and anti-inflammatory simvastatin-loaded mixed nanomicelles. The obtained results confirmed the superior mechanical strength of both 3D-printed scaffolds and loaded hydrogels as compared to normal bone and IVD with high in vitro (cell proliferation, anti-inflammation and anti-TB), and in vivo biocompatibility profiles. Moreover, the custom-designed replacements have achieved the expected prolonged release of antibiotics up to 60 days. Given the promising study findings, the utilization of the developed drug-eluting scaffold system can be extrapolated to treat not only spinal TB but also to resolve diverse backbone/spine problems that need a critical surgical process including degenerative IVD and its consequences like atherosclerosis, sliding or spondylolisthesis and severe traumatic bone fracture.
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Affiliation(s)
- Sarah Yahia
- Nanomedicine Research Labs, Center for Materials Sciences, Zewail City of Science and Technology 6th of October City 12578 Giza Egypt
| | - Islam A Khalil
- Department of Pharmaceutics, College of Pharmacy and Drug Manufacturing, Misr University of Science and Technology (MUST) 6th of October Giza 12582 Egypt
| | - Monira G Ghoniem
- Department of Chemistry, College of Science, Imam Mohammad Ibn Saud Islamic University (IMSIU) Riyadh 11623 Saudi Arabia
| | - Ibrahim M El-Sherbiny
- Nanomedicine Research Labs, Center for Materials Sciences, Zewail City of Science and Technology 6th of October City 12578 Giza Egypt
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Leowattana W, Leowattana P, Leowattana T. Tuberculosis of the spine. World J Orthop 2023; 14:275-293. [PMID: 37304201 PMCID: PMC10251269 DOI: 10.5312/wjo.v14.i5.275] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 02/24/2023] [Accepted: 04/12/2023] [Indexed: 05/18/2023] Open
Abstract
Pott's spine, commonly known as spinal tuberculosis (TB), is an extrapulmonary form of TB caused by Mycobacterium TB. Pott's paraplegia occurs when the spine is involved. Spinal TB is usually caused by the hematogenous spread of infection from a central focus, which can be in the lungs or another location. Spinal TB is distinguished by intervertebral disc involvement caused by the same segmental arterial supply, which can result in severe morbidity even after years of approved therapy. Neurological impairments and spine deformities are caused by progressive damage to the anterior vertebral body. The clinical, radiographic, microbiological, and histological data are used to make the diagnosis of spinal TB. In Pott's spine, combination multidrug antitubercular therapy is the basis of treatment. The recent appearance of multidrug-resistant/extremely drug-resistant TB and the growth of human immunodeficiency virus infection have presented significant challenges in the battle against TB infection. Patients who come with significant kyphosis or neurological impairments are the only ones who require surgical care. Debridement, fusion stabilization, and correction of spinal deformity are the cornerstones of surgical treatment. Clinical results for the treatment of spinal TB are generally quite good with adequate and prompt care.
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Affiliation(s)
- Wattana Leowattana
- Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, Rachatawee 10400, Bangkok, Thailand
| | - Pathomthep Leowattana
- Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, Rachatawee 10400, Bangkok, Thailand
| | - Tawithep Leowattana
- Department of Medicine, Faculty of Medicine, Srinakarinwirot University, Wattana 10110, Bangkok, Thailand
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Tobing SDAL, Kurniawan D, Canintika AF, Defian F, Zufar MLL. A novel predictive model of perioperative blood transfusion requirement in tuberculous spondylitis patients undergoing posterior decompression and instrumentation. INTERNATIONAL ORTHOPAEDICS 2023; 47:1545-1555. [DOI: 10.1007/s00264-023-05744-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 02/23/2023] [Indexed: 03/28/2023]
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Dhungel S, Mishra S. Tubercular Hepatic Abscess: An Incidental Finding. Cureus 2023; 15:e35447. [PMID: 36994275 PMCID: PMC10042495 DOI: 10.7759/cureus.35447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/25/2023] [Indexed: 03/31/2023] Open
Abstract
Tuberculosis (TB) is an infectious disease caused by a bacterium, Mycobacterium tuberculosis. It is known to generally affects the lungs, but it can also affect multiple other parts of the body. Liver involvement with hepatic abscess is an infrequent manifestation of TB which is missed because of the rarity and non-specific symptoms, especially in the west. A thorough literature review shows very few case reports published in the western world. We present a rare case of isoniazid-resistant pulmonary TB associated with a hepatic abscess in the United States. It was diagnosed by aspiration of the abscess that later grew M. tuberculosis and treated with antitubercular drugs.
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Affiliation(s)
- Swati Dhungel
- Internal Medicine, John H. Stroger, Jr. Hospital of Cook County, Chicago, USA
| | - Satya Mishra
- Gastroenterology, John H. Stroger, Jr. Hospital of Cook County, Chicago, USA
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Talebzadeh AT, Talebzadeh N. Diagnosis, Management, and Prognosis of Spinal Tuberculosis: A Case Report. Cureus 2023; 15:e35262. [PMID: 36968870 PMCID: PMC10035557 DOI: 10.7759/cureus.35262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/10/2023] [Indexed: 03/29/2023] Open
Abstract
Spinal tuberculosis (TB) is a condition that affects numerous people around the world. The incidence of TB prior to the pandemic was decreasing by about 1.8% per year; however, COVID-19 has complicated this incidence rate leading to an increase of 4.5% in 2020 and 2021. Spinal TB is a rare event in all TB patients. The management could be multifactorial including location, severity, and symptom, and this case demonstrates an example of issues to consider in the diagnosis and management of patients. This is a case of a patient presenting with back pain which was subsequently diagnosed as spinal TB. We will review this patient's presentation and consideration for multifactorial opinions in the literature. This literature review demonstrates that there is no one treatment option available. Providers need to tailor treatment to each individual case. This is an example of a case that illustrates that diagnosis of spinal TB is not straightforward and clinicians may have to make a judgment call and treat prophylactically to prevent a poor prognosis.
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Doxycycline as a Potential MMP-1 Inhibitor for the Treatment of Spondylitis Tuberculosis: A Study in Rabbit Model. BIOMED RESEARCH INTERNATIONAL 2023; 2023:7421325. [PMID: 36743515 PMCID: PMC9897918 DOI: 10.1155/2023/7421325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/26/2021] [Revised: 10/21/2022] [Accepted: 12/12/2022] [Indexed: 01/29/2023]
Abstract
Background Tuberculosis (TB) of the spine is a highly disruptive disease, especially in underdeveloped and developing countries. This condition requires standard TB treatment for 9-18 months, which increases patient risk of drug-resistant TB. Consequently, this raises the concern of adopting additional therapies to shorten the treatment duration, improve the efficacy of anti-TB drugs, and further decrease damage in the affected tissues and organs. Matrix metalloproteinase- (MMP-) 1 is a key regulator of the destruction of the extracellular matrix and associated proteins and is a new potential target for TB treatment research. In the present study, we investigated the effects of doxycycline as an MMP-1 inhibitor in patients with spondylitis TB. Methods Seventy-two New Zealand white rabbits with spondylitis TB were divided into 12 different groups based on incubation period (2, 4, 6, and 8 weeks) and doxycycline administration (without, 1 mg/kg body weight (BW), and 5 mg/kg BW). We observed the course of infection through the blood concentration changes and immunohistochemical examination of MMP-1, in addition to BTA staining, culture, polymerase chain reaction (PCR), and histopathological examination. Results Treatment with once daily 5 mg/kg BW doxycycline significantly improved the blood MMP-1 level (p < 0.05) compared with the placebo and 1 mg/kg BW doxycycline. A significantly reduced ongoing infection and a higher healing rate were demonstrated in rabbits with a higher doxycycline dose through BTA staining, culture, PCR, and histopathology. Various degrees of vertebral endplates, vertebral body, and intervertebral disc destruction were observed in 32 rabbits with positive histopathological findings, in addition to positive inflammatory cell infiltration, characterized by numerous lymphocytes, macrophages, and epithelial cells, as well as abundant granulation tissue and necrotic substances proximal to the inoculated vertebral area. Bone and intervertebral disc destructions were more apparent in the untreated rabbits. Conclusion Our study demonstrated the potential of doxycycline as an adjunctive treatment in spondylitis TB. However, limitations remain regarding the differences in the pathogenesis and virulence of Mycobacterium tuberculosis between rabbit and human systems, sample size, and the dose-dependent effect of doxycycline. Further studies are needed to address these issues.
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Miyamoto K, Imada H, Yoshida S, Oka H, Iida S, Saita K, Ogihara S. Atypical clinical and radiological presentations of lumbar spinal tuberculosis mimicking a spinal tumor: A case report. Medicine (Baltimore) 2023; 102:e32730. [PMID: 36701731 PMCID: PMC9857248 DOI: 10.1097/md.0000000000032730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
INTRODUCTION Tuberculosis (TB) is an important infectious disease worldwide. Classical spinal TB has specific radiological findings involving adjacent vertebral bodies with destruction of the intervertebral disc and involvement of paravertebral soft tissues with cold abscess formation. However, a few cases not exhibiting the radiological characteristics of TB spondylitis have been reported. We report a rare case of lumbar spinal TB with atypical clinical and radiological presentations that was difficult to differentiate from a malignant spinal tumor. PATIENT CONCERNS A 21-year-old man, who had immigrated to Japan from the Philippines 5 years ago, without a significant medical history, presented with back pain lasting 1 month and progression of gait disturbance 2 weeks prior to presentation. DIAGNOSIS Laboratory tests showed normal blood cell counts and normal value of C-reactive protein levels. Preoperative imaging studies indicated a possible spinal tumor. However, histopathologic findings of the epidural soft tissues at the first surgery led to the diagnosis of spinal mycobacterial infection. The diagnosis of spinal TB was confirmed by a positive culture of Mycobacterium tuberculosis obtained at the second surgery. INTERVENTIONS Given the progressive nature of neurologic deterioration, instead of needle biopsy, we proceeded with surgical intervention 8 days after admission; simultaneous neural decompression and open biopsy. Histological findings of the excised epidural soft tissues led to the diagnosis of spinal mycobacterial infection. We performed the second surgery involving additional resection of epidural soft tissues for further dural decompression and to obtain specimens for mycobacterial culture. Immediately after the second surgery, the patient commenced combination therapy with anti-tuberculous drugs. OUTCOMES The patient demonstrated significant recovery of motor function in the lower extremities, and was able to run at 2 months after the second surgery. The epidural granulomas completely disappeared on magnetic resonance imaging 3 months postoperatively. CONCLUSION Atypical clinical and radiological presentations of spinal TB present a challenge for appropriate diagnosis and early treatment. Even in developed countries where there are very few spinal TB patients, clinicians should be aware that spinal TB is an important differential diagnosis, especially in elderly patients or patients coming from countries with a middle-high prevalence of TB.
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Affiliation(s)
- Kodai Miyamoto
- Department of Orthopaedic Surgery, Saitama Medical Center, Saitama Medical University, Saitama, Japan
| | - Hiroki Imada
- Department of Pathology, Saitama Medical Center, Saitama Medical University, Kawagoe, Saitama, Japan
| | - Shinsuke Yoshida
- Department of Neurosurgery, Saitama Medical Center, Saitama Medical University, Saitama, Japan
| | - Hideaki Oka
- Department of General Medicine, Saitama Medical Center, Saitama Medical University, Saitama, Japan
| | - Shunpei Iida
- Department of Orthopaedic Surgery, Saitama Medical Center, Saitama Medical University, Saitama, Japan
| | - Kazuo Saita
- Department of Orthopaedic Surgery, Saitama Medical Center, Saitama Medical University, Saitama, Japan
| | - Satoshi Ogihara
- Department of Orthopaedic Surgery, Saitama Medical Center, Saitama Medical University, Saitama, Japan
- * Correspondence: Satoshi Ogihara, Department of Orthopaedic Surgery, Saitama Medical Center, Saitama Medical University, 1981 Kamoda, Kawagoe, Saitama 350-8550, Japan (e-mail: )
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Berneri M, Murray F, Davel S. A rare case of vertebral osteomyelitis with associated epidural abscess complicating BCG immunotherapy for transitional cell carcinoma of the bladder. IDCases 2023; 32:e01773. [PMID: 37187939 PMCID: PMC10176054 DOI: 10.1016/j.idcr.2023.e01773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 04/19/2023] [Accepted: 04/25/2023] [Indexed: 05/17/2023] Open
Abstract
Bacillus Calmette-Guérin (BCG), a live attenuated strain of Mycobacterium bovis was first described as a vaccine against tuberculosis in 1921. The use of intravesical BCG to treat non-muscle invasive bladder cancer (NMIBC) was first described by Morales in 1921. The therapeutic effect of BCG is related to stimulation of the immune system following direct contact with tumour cells. As a result of this intended immune response some minor symptoms including fever, malaise and bladder irritation manifesting as dysuria, urinary frequency and mild haematuria, are expected. These side effects are however, generally easily managed and well tolerated. Severe complications are rare and can be temporally remote from the instillation of therapy. In this report we describe the case of a 74-year-old immunocompetent man with biopsy confirmed BCG T11/12 discitis and adjacent osteomyelitis of the T11/T12 vertebral bodies with an associated an epidural abscess following intravesical administration of BCG therapy for recurrent bladder transitional cell carcinoma (TCC).
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Affiliation(s)
- Massimo Berneri
- Joondalup Health Campus, Cnr Grant Blvd &, Shenton Ave, Joondalup, WA 6027, Australia
| | - Fionnuala Murray
- St John of God Hospital Subiaco, WA 6008, Australia
- Fiona Stanley Hospital, 11 Robin Warren Drive, Murdoch, WA 6150, Australia
- Corresponding author at: Fiona Stanley Hospital, 11 Robin Warren Drive, Murdoch, WA 6150, Australia.
| | - Sue Davel
- Joondalup Health Campus, Cnr Grant Blvd &, Shenton Ave, Joondalup, WA 6027, Australia
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Spekker O, Hunt DR, Király K, Kis L, Madai Á, Szalontai C, Molnár E, Pálfi G. Lumbosacral tuberculosis, a rare manifestation of Pott's disease - How identified human skeletons from the pre-antibiotic era can be used as reference cases to establish a palaeopathological diagnosis of tuberculosis. Tuberculosis (Edinb) 2023; 138:102287. [PMID: 36450192 DOI: 10.1016/j.tube.2022.102287] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 11/19/2022] [Accepted: 11/21/2022] [Indexed: 11/27/2022]
Abstract
The macromorphological examination of identified human osteological collections from the pre-antibiotic era (e.g., Terry Collection) can provide invaluable information about the skeletal manifestations of tuberculosis (TB) in individuals who did not receive pharmaceutical therapy. With analysis of such collections, new diagnostic criteria for TB can be recognised which can be used in palaeopathological interpretation. The aim of our paper is to provide a reference and aid for the identification of TB in past populations by demonstrating and discussing in detail the vertebral alterations indicative of one of its rare skeletal manifestations, lumbosacral TB. These changes were detected in two individuals from the Terry Collection (Terry No. 760 and Terry No. 1093). These two case studies furnish palaeopathologists with a stronger basis for diagnosing lumbosacral TB in skeletons which exhibit similar vertebral lesions from osteoarchaeological series. To illustrate this, an archaeological case from Hungary (KK146) is also presented, displaying vertebral alterations resembling that of the two cases from the Terry Collection. Through the demonstrated case studies, we can derive a better insight into the disease experience of people who lived in the past and suffered from TB.
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Affiliation(s)
- Olga Spekker
- Department of Biological Anthropology, Institute of Biology, University of Szeged, Közép fasor 52, H-6726, Szeged, Hungary; Institute of Archaeological Sciences, Eötvös Loránd University, Múzeum körút 4/B, H-1088, Budapest, Hungary.
| | - David R Hunt
- Northern Virginia District Office of the Chief Medical Examiners, 10850 Pyramid Place, Manassas, VA, 20110, USA.
| | - Kitty Király
- Department of Biological Anthropology, Institute of Biology, University of Szeged, Közép fasor 52, H-6726, Szeged, Hungary; Móra Ferenc Museum, Roosevelt tér 1-3, H-6720, Szeged, Hungary.
| | - Luca Kis
- Department of Biological Anthropology, Institute of Biology, University of Szeged, Közép fasor 52, H-6726, Szeged, Hungary; Department of Archaeogenetics, Institute of Hungarian Research, Úri utca 54-56, H-1014, Budapest, Hungary.
| | - Ágota Madai
- Department of Biological Anthropology, Institute of Biology, University of Szeged, Közép fasor 52, H-6726, Szeged, Hungary; Department of Anthropology, Hungarian National History Museum, Ludovika tér 2-6, H-1083, Budapest, Hungary.
| | - Csaba Szalontai
- National Institute of Archaeology, Hungarian National Museum, Múzeum körút 14-16, H-1088, Budapest, Hungary.
| | - Erika Molnár
- Department of Biological Anthropology, Institute of Biology, University of Szeged, Közép fasor 52, H-6726, Szeged, Hungary.
| | - György Pálfi
- Department of Biological Anthropology, Institute of Biology, University of Szeged, Közép fasor 52, H-6726, Szeged, Hungary.
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Li S, Chen W, Feng M, Liu Y, Wang F. Drug Resistance and Molecular Characteristics of Mycobacterium tuberculosis: A Single Center Experience. J Pers Med 2022; 12:jpm12122088. [PMID: 36556308 PMCID: PMC9783070 DOI: 10.3390/jpm12122088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 12/11/2022] [Accepted: 12/16/2022] [Indexed: 12/23/2022] Open
Abstract
In recent years, the incidence of tuberculosis (TB) and mortality caused by the disease have been decreasing. However, the number of drug-resistant tuberculosis patients is increasing rapidly year by year. Here, a total of 380 Mycobacterium tuberculosis (MTB)-positive formalin-fixed and paraffin-embedded tissue (FFPE) specimens diagnosed in the Department of Pathology of the Eighth Medical Center, Chinese PLA General Hospital were collected. Among 380 cases of MTB, 85 (22.37%) were susceptible to four anti-TB drugs and the remaining 295 (77.63%) were resistant to one or more drugs. The rate of MDR-TB was higher in previously treated cases (52.53%) than in new cases [(36.65%), p < 0.05]. Of previously treated cases, the rate of drug resistance was higher in females than in males (p < 0.05). Among specimens obtained from males, the rate of drug resistance was higher in new cases than in previously treated cases (p < 0.05). Of mutation in drug resistance-related genes, the majority (53/380, 13.95%) of rpoB gene carried the D516V mutation, and 13.42% (51/380) featured mutations in both the katG and inhA genes. Among the total specimens, 18.68% (71/380) carried the 88 M mutation in the rpsL gene, and the embB gene focused on the 306 M2 mutation with a mutation rate of 19.74%. Among the resistant INH, the mutation rate of −15 M was higher in resistance to more than one drug than in monodrug-resistant (p < 0.05). In conclusion, the drug resistance of MTB is still very severe and the timely detection of drug resistance is conducive to the precise treatment of TB.
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Tbini H, Mahmoud I, Ben Tekaya A, Rouached L, Bouden S, Tekaya R, Saidane O, Abdelmoula L. Unexpected diagnosis of vertebral osteolysis. Clin Case Rep 2022; 10:e6677. [PMID: 36483856 PMCID: PMC9723402 DOI: 10.1002/ccr3.6677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Revised: 10/20/2022] [Accepted: 11/13/2022] [Indexed: 12/12/2022] Open
Abstract
This is the case of a 50-year-old patient suffering from inflammatory low back pain. Radiological exploration showed posterior vertebral damage compatible with discovertebral pseudo-tumor tuberculosis. Pathological examination found no malignant cells, but caseous necrosis was present. The patient was put on antitubercular drugs. The evolution was favorable under treatement.
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Affiliation(s)
- Houssem Tbini
- Rheumatology DepartmentCharles Nicolle HospitalTunisTunisia
- University of Tunis El ManarTunisTunisia
| | - Ines Mahmoud
- Rheumatology DepartmentCharles Nicolle HospitalTunisTunisia
- University of Tunis El ManarTunisTunisia
| | - Aicha Ben Tekaya
- Rheumatology DepartmentCharles Nicolle HospitalTunisTunisia
- University of Tunis El ManarTunisTunisia
| | - Leila Rouached
- Rheumatology DepartmentCharles Nicolle HospitalTunisTunisia
- University of Tunis El ManarTunisTunisia
| | - Selma Bouden
- Rheumatology DepartmentCharles Nicolle HospitalTunisTunisia
- University of Tunis El ManarTunisTunisia
| | - Raoudha Tekaya
- Rheumatology DepartmentCharles Nicolle HospitalTunisTunisia
- University of Tunis El ManarTunisTunisia
| | - Olfa Saidane
- Rheumatology DepartmentCharles Nicolle HospitalTunisTunisia
- University of Tunis El ManarTunisTunisia
| | - Leila Abdelmoula
- Rheumatology DepartmentCharles Nicolle HospitalTunisTunisia
- University of Tunis El ManarTunisTunisia
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Chiu YC, Yang SC, Kao YH, Tu YK. Single posterior approach for circumferential debridement and anterior reconstruction using fibular allograft in patients with skipped multifocal spinal tuberculosis. J Orthop Surg Res 2022; 17:489. [DOI: 10.1186/s13018-022-03372-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 09/21/2022] [Indexed: 11/17/2022] Open
Abstract
Abstract
Background
Skipped multifocal spinal tuberculosis (TB) is an atypical presentation of spinal TB. Surgical treatment for these unusual cases remains a challenge for spine surgeons. In our institute, we used single-stage circumferential debridement and anterior reconstruction with fibular allograft followed by posterior instrumentation through posterior-only approach for these patients. This study aimed to determine the efficacy and feasibility of this technique.
Methods
Twelve patients with skipped multifocal spinal TB who received our treatment method from January 2012 to June 2020 were enrolled in this study. The visual analog score (VAS), laboratory data, comorbidities, complications, and neurologic status based on Frankel scale were recorded. The patients’ clinical conditions were evaluated based on modified Brodsky’s criteria and Oswestry Disability Index (ODI).
Results
All the patients were infection free at the end of the treatment. The average VAS score was 7.5 (range, 7–8) before surgery and decreased to 2.1 (range, 1–3) one year postoperatively. No one experienced any severe complications such as neurologic deterioration, fixation failure, or bone graft dislodgement. Out of the three patients requiring debridement surgery, two had wound infection and one had seroma formation. The ODI score improved from 76.8 (range, 70–84) preoperatively to 25.5 (range, 22–28) one year after surgery. All patients achieved good or excellent outcome based on modified Brodsky’s criteria one year postoperatively.
Conclusions
In our study, the patients could achieve a good clinical outcome. This technique could be an alternative for patients with skipped spinal TB.
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Rajasekaran S, Pushpa BT, Soundararajan DCR, Sri Vijay Anand KS, Murugan C, Nedunchelian M, Kanna RM, Shetty AP, Tangavel C, Muthurajan R. Are Modic changes 'Primary infective endplatitis'?-insights from multimodal imaging of non-specific low back pain patients and development of a radiological 'Endplate infection probability score'. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2022; 31:2884-2896. [PMID: 35931790 DOI: 10.1007/s00586-022-07335-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Revised: 07/05/2022] [Accepted: 07/20/2022] [Indexed: 06/15/2023]
Abstract
PURPOSE To probe the pathophysiological basis of Modic change (MC) by multimodal imaging rather than by MRI alone. METHODS Nineteen radiological signs found in mild infections and traumatic endplate fractures were identified by MRI and CT, and by elimination, three signs unique to infection and trauma were distilled. By ranking the Z score, radiological 'Endplate Infection Probability Score' (EIPS) was developed. The score's ability to differentiate infection and traumatic endplate changes (EPC) was validated in a fresh set of 15 patients each, with documented infection and trauma. The EIPS, ESR, CRP, and Numeric Pain Rating Scale (NRS) were then compared between 115 patients with and 80 patients without MC. RESULTS The EIPS had a confidence of 66.4%, 83% and, 100% for scores of 4, 5 and, 6, respectively, for end plate changes suggesting infection. The mean EIPS was 4.85 ± 1.94 in patients with Modic changes compared to - 0.66 ± 0.49 in patients without Modic changes (p < 0.001). Seventy-eight (67.64%) patients with MC had a score of 6, indicating high infection possibility. There was a difference in the NRS (p < 0.01), ESR (p = 0.05), CRP (p < 0.01), and type of pain (p < 0.01) between patients with and without MC. CONCLUSION Multimodal imaging showed many radiological signs not easily seen in MRI alone and thus missed in Modic classification. There were distinct radiological differences between EPCs of trauma and infection which allowed the development of an EIPS. The scores showed that 67.64% of our study patients with Modic changes had EPCs resembling infection rather than trauma suggesting the possibility of an infective aetiology and allowing us to propose an alternate theory of 'Primary Endplatitis'.
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Affiliation(s)
- S Rajasekaran
- Department of Spine Surgery, Ganga Hospital, 313, Mettupalayam Road, Coimbatore, India.
| | - B T Pushpa
- Department of Radiodiagnosis, Ganga Hospital, 313, Mettupalayam Road, Coimbatore, India
| | | | - K S Sri Vijay Anand
- Department of Spine Surgery, Ganga Hospital, 313, Mettupalayam Road, Coimbatore, India
| | - Chandhan Murugan
- Department of Spine Surgery, Ganga Hospital, 313, Mettupalayam Road, Coimbatore, India
| | - Meena Nedunchelian
- Department of Radiodiagnosis, Ganga Hospital, 313, Mettupalayam Road, Coimbatore, India
| | - Rishi Mugesh Kanna
- Department of Spine Surgery, Ganga Hospital, 313, Mettupalayam Road, Coimbatore, India
| | - Ajoy Prasad Shetty
- Department of Spine Surgery, Ganga Hospital, 313, Mettupalayam Road, Coimbatore, India
| | - Chitraa Tangavel
- Ganga Research Centre, 187, Mettupalayam Road, Koundampalayam, Coimbatore, India
| | - Raveendran Muthurajan
- Department of Plant Biotechnology, Tamil Nadu Agricultural University, Lawley Road, Coimbatore, India
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Posterior limited unilateral fenestration approach for treating patients with single-segment thoracic and lumbar tuberculosis. Acta Neurochir (Wien) 2022; 164:2637-2644. [PMID: 36070003 DOI: 10.1007/s00701-022-05342-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 08/06/2022] [Indexed: 01/26/2023]
Abstract
BACKGROUND Posterior limited unilateral fenestration approach is extensively used in the treatment of many spinal diseases. But whether it is suitable for spinal tuberculosis (TB) is rarely reported. Hence, the current study evaluated the feasibility and efficacy of the posterior limited unilateral fenestration (PLUF) debridement, bone grafting fusion, and instrumentation to treat single-segment thoracic and lumbar TB. METHODS Eighty-three patients (45 male and 38 female) aged 17-79 years old with the single-segment thoracic and lumbar TB who underwent PLUF debridement, bone grafting fusion, and instrumentation from our hospital were recruited for this study. The operation time, blood loss volume, postoperative complication rate, kyphotic Cobb angle, neurological functional improvement defined by the American Spinal Injury Association (ASIA) classification, the visual analogue scale (VAS) score, and the bone fusion time were utilized for assessing the clinical feasibility and efficacy. RESULTS The average follow-up time was 46.9 ± 13.1 (24-72) months. At the last follow-up, the mean kyphotic Cobb angle was significantly reduced from preoperative 23.0° ± 15.3° to postoperative 8.3° ± 11.0° (p < 0.001). Based on the ASIA classification, 89.2% (33 out of 37) patients with preoperative neurological impairment indicated good neurological improvement after the surgery. The VAS pain score significantly decreased from preoperative 6.9 ± 1.1 to 1.3 ± 0.7 3 months after operation (p < 0.001). All the patients achieved solid bony fusion within 13 months of surgery. CONCLUSIONS For patients with single-segment thoracic and lumbar TB, PLUF debridement, bone grafting fusion, and instrumentation are a feasible and effective surgical treatment.
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Meta-Analysis and Data Mining-Based Study on the Expression Characteristics of Inflammatory Factors and Causes of Recurrence in Spinal Tuberculosis. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2022; 2022:8246510. [PMID: 36238496 PMCID: PMC9553345 DOI: 10.1155/2022/8246510] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 08/19/2022] [Accepted: 08/30/2022] [Indexed: 11/17/2022]
Abstract
With the rapid development of modern medical information technology, hospitals are accumulating huge amounts of clinical data while providing medical services to patients, and in the era of big data, how to mine valuable information from the huge amount of clinical data so as to make new contributions to future disease diagnosis and medical research. In order to solve this problem, more and more scholars have introduced data mining techniques into the medical field in recent years, and mining and analysing medical data is a hot topic at present. If spinal TB is detected and treated early, not only can spinal deformities be prevented and treated but also the course of treatment can be shortened, the financial burden on the patient can be reduced, spinal function can be maintained, and eradication can be achieved without the need for surgical intervention. Early detection of spinal tuberculosis is the key to preventing and treating it. Therefore, in this paper, we use meta-analysis and data mining techniques to process and analyse the medical data of spinal tuberculosis disease, its main inflammatory factors expression characteristics, and the causes of patient recurrence.
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Ahuja K, Ifthekar S, Mittal S, Yadav G, Venkata Sudhakar P, Sharma P, Venkata Subbaih A, Kandwal P. Role of Diffusion Tensor Imaging in neurological prognostication in Spinal Tuberculosis – A prospective pilot study. Eur J Radiol 2022; 157:110530. [DOI: 10.1016/j.ejrad.2022.110530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 08/16/2022] [Accepted: 09/16/2022] [Indexed: 11/03/2022]
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Ambulgekar RK, Iqbal Z, Masne P. A Rare Case of Thoracolumbar Epidural Abscess with Tuberculous Etiology in an Adolescent Male with Neurological Deficit. J Orthop Case Rep 2022; 12:98-101. [PMID: 36873335 PMCID: PMC9983397 DOI: 10.13107/jocr.2022.v12.i09.3336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 08/02/2022] [Indexed: 01/07/2023] Open
Abstract
Introduction Spinal epidural abscess (SEA) refers to collection of infection of the epidural space due to various etiologies. Tuberculosis (TB) of the spine is one of the important causes of SEA. Patient with SEA usually presents with history of fever, back pain, difficulty in walking, and neurological weakness. Magnetic resonance imaging (MRI) is the initial modality for diagnosis and it can be confirmed by examination of abscess for microorganism growth. It can be treated by laminectomy and decompression which helps to drain out the pus and relive the compression on the cord. Case Report A 16-year-old male, student by profession, presented with a history of low back pain and progressive difficulty in walking for the past 12 days and lower limb weakness for the past 8 days associated with fever, generalized weakness, and malaise. Computed tomography brain and whole spine showed no significant changes MRI left facetal joint of L3 L4 vertebrae infective arthritis with abnormal soft-tissue collection in the posterior epidural region extending from D11-L5 vertebrae causing compression on the thecal sac, cauda equine nerve roots, and represents infective abscess with abnormal soft-tissue collection in the posterior paraspinal region and left psoas muscles representing infective abscess. Patient was taken for emergency decompression with clearance of abscess through posterior approach. Laminectomy was done extending from D11 TO L5 vertebrae and thick pus was drained through multiple pockets. Samples pus and soft tissue were sent for investigation. Pus culture ZN and Gram's stain did not show growth of any organism, but GeneXpert was positive for growth of Mycobacterium tuberculosis. Patient was registered under RNTCP program and anti TB drugs were started as per the weight scale. Sutures were removed on post-operative day 12 and neurological evaluation was done for any signs of improvement. Patient showed improvement of power in both lower limb; power 5/5 on the right lower limb whereas 4/5 in the left lower limb. Patient also had improvements in other symptoms and has no complaints of back ache and malaise at discharge. Conclusion Tuberculous thoracolumbar epidural abscess is a rare disease with potential to cause lifelong vegetative state if diagnosis and treatment is not done promptly. Surgical decompression by unilateral laminectomy and evacuation of collection is both diagnostic and therapeutic.
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Affiliation(s)
- Rajesh K Ambulgekar
- Department of Orthopaedics, Dr. Shankarrao Chavan Government Medical College, Nanded, Maharashtra, India
| | - Zafar Iqbal
- Department of Orthopaedics, Dr. Shankarrao Chavan Government Medical College, Nanded, Maharashtra, India
| | - Pratik Masne
- Department of Orthopaedics, Dr. Shankarrao Chavan Government Medical College, Nanded, Maharashtra, India
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Abstract
Aims Tuberculosis (TB) is one of the biggest communicable causes of mortality worldwide. While incidence in the UK has continued to fall since 2011, Bradford retains one of the highest TB rates in the UK. This study aims to examine the local disease burden of musculoskeletal (MSK) TB, by analyzing common presenting factors within the famously diverse population of Bradford. Methods An observational study was conducted, using data from the Bradford Teaching Hospitals TB database of patients with a formal diagnosis of MSK TB between January 2005 and July 2017. Patient data included demographic data (including nationality/date of entry to the UK), disease focus, microbiology, and management strategies. Disease incidence was calculated using population data from the Office for National Statistics. Poisson confidence intervals were calculated to demonstrate the extent of statistical error. Disease incidence and nationality were also analyzed, and correlation sought, using the chi-squared test. Results Between January 2005 and July 2017, 109 cases of MSK TB were diagnosed in Bradford. Mean incidence was 1.65 per 100,000 population, per calendar year (SD 0.75). A total of 38 cases required surgical intervention. Low rates of antimicrobial resistance were encountered. A low rate of loss to follow-up was observed (four patients; 3.7%). Overall, 94.5% of patients (n = 103) were successfully treated. 67% of patients (n = 73) reported their country of origin as either India, Pakistan, or Bangladesh. These ethnicities account for around 25% of the local population. Conclusion Bradford maintains a high prevalence of MSK TB infection relative to national data; the prevalence within the local immigrant population remains grossly disproportionate. Typical associated factors (HIV/hepatitis coinfection, drug resistance), have only modest prevalence in our dataset. However, local socioeconomic factors such as deprivation and poverty appear germane as suggested by global literature. We advocate a high degree of suspicion in treatment of atypical infection in any area with similar population factors to ensure timely diagnosis. Cite this article: Bone Jt Open 2022;3(5):432–440.
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Affiliation(s)
- Andrew D. Craig
- Department of Trauma & Orthopaedics, Bradford Royal Infirmary, Bradford, UK
| | - Samir Asmar
- Department of Trauma & Orthopaedics, Bradford Royal Infirmary, Bradford, UK
| | - Paul Whitaker
- Department of Infectious Diseases, Bradford Royal Infirmary, Bradford, UK
| | - David L. Shaw
- Department of Trauma & Orthopaedics, Bradford Royal Infirmary, Bradford, UK
| | - Dinesh Saralaya
- Department of Respiratory Medicine, Bradford Royal Infirmary, Bradford, UK
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Li Z, Wu F, Hong F, Gai X, Cao W, Zhang Z, Yang T, Wang J, Gao S, Peng C. Computer-Aided Diagnosis of Spinal Tuberculosis From CT Images Based on Deep Learning With Multimodal Feature Fusion. Front Microbiol 2022; 13:823324. [PMID: 35283815 PMCID: PMC8905347 DOI: 10.3389/fmicb.2022.823324] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2021] [Accepted: 01/13/2022] [Indexed: 11/13/2022] Open
Abstract
Background Spinal tuberculosis (TB) has the highest incidence in remote plateau areas, particularly in Tibet, China, due to inadequate local healthcare services, which not only facilitates the transmission of TB bacteria but also increases the burden on grassroots hospitals. Computer-aided diagnosis (CAD) is urgently required to improve the efficiency of clinical diagnosis of TB using computed tomography (CT) images. However, classical machine learning with handcrafted features generally has low accuracy, and deep learning with self-extracting features relies heavily on the size of medical datasets. Therefore, CAD, which effectively fuses multimodal features, is an alternative solution for spinal TB detection. Methods A new deep learning method is proposed that fuses four elaborate image features, specifically three handcrafted features and one convolutional neural network (CNN) feature. Spinal TB CT images were collected from 197 patients with spinal TB, from 2013 to 2020, in the People’s Hospital of Tibet Autonomous Region, China; 3,000 effective lumbar spine CT images were randomly screened to our dataset, from which two sets of 1,500 images each were classified as tuberculosis (positive) and health (negative). In addition, virtual data augmentation is proposed to enlarge the handcrafted features of the TB dataset. Essentially, the proposed multimodal feature fusion CNN consists of four main sections: matching network, backbone (ResNet-18/50, VGG-11/16, DenseNet-121/161), fallen network, and gated information fusion network. Detailed performance analyses were conducted based on the multimodal features, proposed augmentation, model stability, and model-focused heatmap. Results Experimental results showed that the proposed model with VGG-11 and virtual data augmentation exhibited optimal performance in terms of accuracy, specificity, sensitivity, and area under curve. In addition, an inverse relationship existed between the model size and test accuracy. The model-focused heatmap also shifted from the irrelevant region to the bone destruction caused by TB. Conclusion The proposed augmentation effectively simulated the real data distribution in the feature space. More importantly, all the evaluation metrics and analyses demonstrated that the proposed deep learning model exhibits efficient feature fusion for multimodal features. Our study provides a profound insight into the preliminary auxiliary diagnosis of spinal TB from CT images applicable to the Tibetan area.
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Affiliation(s)
- Zhaotong Li
- Institute of Medical Technology, Peking University Health Science Center, Beijing, China.,School of Health Humanities, Peking University, Beijing, China
| | - Fengliang Wu
- Beijing Key Laboratory of Spinal Disease Research, Engineering Research Center of Bone and Joint Precision Medicine, Department of Orthopedics, Peking University Third Hospital, Beijing, China.,Department of Orthopedic, People's Hospital of Tibet Autonomous Region, Lhasa, China
| | - Fengze Hong
- Medical College, Tibet University, Lhasa, China
| | - Xiaoyan Gai
- Department of Respiratory and Critical Care Medicine, Peking University Third Hospital, Beijing, China
| | - Wenli Cao
- Tuberculosis Department, Beijing Geriatric Hospital, Beijing, China
| | - Zeru Zhang
- Institute of Medical Technology, Peking University Health Science Center, Beijing, China.,School of Health Humanities, Peking University, Beijing, China
| | - Timin Yang
- Department of Orthopedic, People's Hospital of Tibet Autonomous Region, Lhasa, China
| | - Jiu Wang
- Department of Orthopedic, People's Hospital of Tibet Autonomous Region, Lhasa, China
| | - Song Gao
- Institute of Medical Technology, Peking University Health Science Center, Beijing, China
| | - Chao Peng
- Department of Orthopedic, People's Hospital of Tibet Autonomous Region, Lhasa, China
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Tuberculosis amidst COVID-19 in Pakistan: a massive threat of overlapping crises for the fragile healthcare systems. Epidemiol Infect 2022; 150:e41. [PMID: 35190004 PMCID: PMC8886085 DOI: 10.1017/s0950268822000358] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Mycobacterium tuberculosis is the cause of tuberculosis (TB), a granulomatous illness that mostly affects the lungs. Pakistan is one of the eight nations that accounts for two-thirds of all new cases of developing TB. TB has long been an endemic disease in Pakistan. According to the World Health Organization (WHO) estimates, the nation has over 500 000 incident TB infections per year, with a rising number of drug-resistant cases. Recently, the coexistence of COVID-19 and TB in Pakistan has provided doctors with a problem. Fever or chills, cough, shortness of breath or difficulty breathing are all signs of COVID-19. After SARS-CoV-2 infection, cough might persist for weeks or months and it is frequently accompanied by persistent tiredness, cognitive impairment, dyspnoea or pain – a group of long-term consequences known as post-COVID syndrome or protracted COVID. Coughing with mucus or blood, and coughing that continues over 2 months are indications of TB. The same clinical presentation features make it difficult for healthcare personnel to effectively evaluate the illness and prevent the spread of these fatal diseases. Pakistan lacks the necessary healthcare resources to tackle two contagious diseases at the same time. To counteract the sudden increase in TB cases, appropriate management and effective policies must be implemented. Thus, in order to prevent the spread of these infectious diseases, it is critical to recognise and address the problems that the healthcare sector faces, as well as to create an atmosphere in which the healthcare sector can function at its full potential.
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Lampejo T, Bhatt N. Musculoskeletal tuberculosis with spinal involvement: An important differential for chronic recurrent multifocal osteomyelitis. Clin Imaging 2022; 85:5-6. [PMID: 35219068 DOI: 10.1016/j.clinimag.2022.02.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Accepted: 02/16/2022] [Indexed: 11/03/2022]
Affiliation(s)
- Temi Lampejo
- Department of Infection Sciences, King's College Hospital, Denmark Hill, London SE5 9RS, UK.
| | - Naman Bhatt
- Department of Radiology, Northwick Park Hospital, London, UK
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Osho P, Osho E, Oluwatosin O. Pott's disease and multiple myeloma in the bone marrow: A rare coincidence. NIGERIAN JOURNAL OF MEDICINE 2022. [DOI: 10.4103/njm.njm_72_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/08/2023] Open
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