Tuberculous Spondylitis

Alothman, Adel; Memish, Z.; Awada, A.; Al-Mahmood, S; Al-Sadoon, S; Rahman, Md. Mahfuzur; Khan, Mahbub

doi:10.1097/00007632-200112150-00020

Cited by 78 publications

(31 citation statements)

References 21 publications

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“…The previous reports noted that the thoracic region was the most affected area in the vertebral column, followed by the lumbar region. [4,15] These findings are similar to those of the present study. McLain et al [16] reported that neurological deficits are common with long-standing thoracic and cervical involvement and, if untreated, neurological involvement may progress to complete and incomplete paraplegia.…”

Section: Discussionsupporting

confidence: 92%

Early predictive factors for lower-extremity motor or sensory deficits and surgical results of patients with spinal tuberculosis

et al. 2016

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Many studies about the characteristics of spinal tuberculosis (STB) have been published, but none has investigated the predictive factors for lower-extremity motor or sensory deficits (LMSD) in patients with STB.The objective of this study was to find early predictive factors for LMSD and evaluate surgical results of patients with STB.From 2001 through 2010, 329 patients with STB were treated in our department and surgical treatment was performed in 274 patients. The factors assessed included age, sex, duration of symptoms, worsening of illness, clinical symptoms, clinical signs, imaging characteristics, kyphotic angle, Oswestry disability index (ODI), and visual analogue scale (VAS) scores.Of the 329 patients studied, 164 presented with LMSD (the LMSD group), of which 93 patients (28.3%) had motor deficits and 177 patients (53.8%) had sensory disturbance. The other 165 patients were included in the control group (the No LMSD group). Using univariate logistic regression analysis, we found that the sex (P = 0.042), age (P = 0.001), worsening of sickness (P = 0.013), location (P = 0.009), and spinal compression (P = 0.035) were the risk factors of LMSD. Furthermore, the multivariate logistic regression analysis indicated that age (OR = 1.761, 95% CI: 1.227–2.526, P = 0.002), worsening of sickness (yes vs no: OR = 1.910, 95% CI: 1.161–3.141, P = 0.011), location (T vs C: OR = 0.204, 95% CI: 0.063–0.662, P = 0.008), and spinal compression (yes vs no: OR = 1.672, 95% CI: 1.020–2.741, P = 0.042) were independent risk factors of LMSD. Surgical treatment was performed in 274 patients. The kyphotic angle improved from 25.8 ± 9.1° preoperatively to 14.0 ± 7.6°, with a mean correction of 11.8 ± 4.0°, and a mean correction loss of 1.5 ± 1.8° at final visit. There were significant differences between the preoperative and the final ODI and VAS scores in both groups (P < 0.001 and P < 0.001, respectively).Spinal tuberculosis with cervical or lumbar vertebra involvement among the elder patients with a history of worsening of illness and spinal compression tended to cause LMSD, such as motor deficits or sensory disturbance. We should implement an appropriate treatment regimen to prevent exacerbation of STB such as operation, which can achieve thoroughness of debridement, adequate spinal stabilization, and better functional recovery.

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Section: Discussionsupporting

confidence: 92%

Early predictive factors for lower-extremity motor or sensory deficits and surgical results of patients with spinal tuberculosis

et al. 2016

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“…[161721222324] In our study also, these two regions were predominantly involved. Most common type of involvement seen in tuberculous spondylitis is paradiscal type.…”

Section: Discussionsupporting

confidence: 70%

“…[14] Various studies report that plain radiograph demonstrated changes consistent with spinal tuberculosis in 84%–99% cases. [1622] In the present study, 88% of the patients showed radiographic changes consistent with spinal tuberculosis. In the present study, at the initial presentation, 2.06 average numbers of vertebrae were affected and these increased to 2.12 at subsequent follow-up; these findings are consistent with other studies.…”

Section: Discussionsupporting

confidence: 56%

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Clinicoradiologic profile of involvement and healing in tuberculosis of the spine

Singh¹,

Magu²,

Rk³

2016

Ann Med Health Sci Res

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

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“…Our case definition of CNS TB was based on previous studies in which similar case definition was used [23]. Still there is no recognized international CNS TB case definition but a trial of making a consensus case definition has been done based on experts meeting few years ago [24].…”

Section: Discussionmentioning

confidence: 99%

Central Nervous System Tuberculosis: Clinical Characteristics and Outcome. A Saudi Tertiary Care Centre Experience

Saeed¹,

Alothman²,

Kojan³

et al. 2015

AID

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Background: Tuberculosis is an endemic problem that is of important public health concern in Saudi Arabia. Available recent prevalence of tuberculosis (pulmonary and extra-pulmonary) was estimated to be 13.7 per 100,000 people living in the Kingdom of Saudi Arabia. Methods: A retrospective chart review of all Central Nervous System tuberculosis patients (CNS-TB) treated at King Abdulaziz Medical City, Riyadh, Saudi Arabia between 1996 and 2010. CNS-TB was defined as follows: patients who had symptoms and signs of CNS-TB with radiographic, microbiologic, or histopathologic evidence of tuberculous infection and/or those with highly probable diagnosis, supported by radiographic typical features, not confirmed microbiologically but who responded to anti-TB therapy. Results: Eighty two patients (46 males) met our definition with the mean age of 50 years. Only 11 patients (13.4%) reported previous TB infection. The most common presenting symptoms were: headache (51%), fever (50%), weakness (43%), confusion (29%) and seizures (28%). The most common signs found by clinical examination were: weakness (45%) followed by sensory impairment. Positive CSF acid-fast bacilli (AFB) culture confirmed the diagnosis in 20 out of 49 tested patients (about 41%). Brain CT scan was done in 74 patients and meningeal enhancement was identified in only 6 patients (8%) but ring enhancing lesions were found in 19 patients (26%). In MRI meningeal enhancement was founded in 26 patients (37%) and ring enhanced lesions in 36 patients (51%). After receiving treatment, 45 patients (55%) had complete or good recovery and 23 patients (28%) had partial recovery. However, 15% (12 patients) had poor or no improvement. 2 patients (2%) lost their follow up. Conclusion: CNS-TB continues to be a major health issue especially in endemic areas such as Saudi Arabia. The diverse clinical presentations, lack of high yield, practical and reliable diagnosis methods and inconsistent management * Corresponding author. M. Bo Saeed et al. 64plans require further research and harder work in order to meet the current challenges and reach a unified case definition and evidence based management guidelines that would be a very practical step.

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Tuberculous Spondylitis

Cited by 78 publications

References 21 publications

Early predictive factors for lower-extremity motor or sensory deficits and surgical results of patients with spinal tuberculosis

Early predictive factors for lower-extremity motor or sensory deficits and surgical results of patients with spinal tuberculosis

Clinicoradiologic profile of involvement and healing in tuberculosis of the spine

Central Nervous System Tuberculosis: Clinical Characteristics and Outcome. A Saudi Tertiary Care Centre Experience

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