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PubMed2002

[Application of BACTEC MGIT 960 system and molecular identification of mycobacteria in the diagnosis of spinal tuberculosis].

OBJECTIVE: To evaluate the clinical application of BACTEC MGIT 960 system and molecular identification of mycobacterium species in diagnosis of spinal tuberculosis. METHODS: Thirty-one specimens were obtained from patients with spinal tuberculosis, followed by culturing with BACTEC MGIT 960 system and in Löwenstein-Jensen (L-J) medium respectively. Mycobacterium species of the clinical isolates were identified with PCR amplification of IS986 and PCR-single-strand conformation polymorphism (PCR-SSCP) analysis of 16S rRNA, with the conventional identification approach serving as control. RESULTS: The positivity rates of mycobacterium culture with BACTEC MGIT 960 system and L-J medium were 83.87 % and 61.29 % respectively. The average detection time with BACTEC MGIT 960 were 11.3 d, 15.4 d shorter than that with the L-J medium (26.7 d). The genetic identification of mycobacterium species was more rapid and accurate with consistent results with that from conventional method. CONCLUSION: BACTEC MGIT 960 system is preferable for detecting mycobacteria in spinal tuberculosis. The combined application of this instrument with genetic identification of mycobacteria is an effective strategy for the bacteriological diagnosis of tuberculosis.

Adolescent↗
PubMedDate not supplied

Computed tomography in spinal tuberculosis.

Exhaustive clinicoradiologic and computed tomographic (CT) analysis of 114 cases of spinal tuberculosis seen between January 1983 and January 1989 is presented. The mechanisms of the spinal involvement are reviewed. CT helped to diagnose cases of spinal tuberculosis in their initial stages. Inaccessible fixed areas of spine were seen with ease on axial sections of CT. The extent and anatomic depiction of soft-tissue involvement as depicted on CT helps surgeons choose the appropriate surgical approach, which may affect future spinal stability.

Abscess↗
PubMed2001

The pattern of spinal tuberculosis in Sarawak General Hospital.

This is a retrospective study of 53 patients with spinal tuberculosis treated in Sarawak General Hospital from 1994 until 1998. The study showed that the mean age in patients with spinal tuberculosis was 40.2 years, and was more common in male (70%) and in Iban population (50%). The clinical presentation included backache (94%); abscess (45%); neurological deficit (44%); and gibbus deformity (22%). The percentage of patient without BCG scar was 82% and 18% had evidence of pulmonary tuberculosis. The most common vertebra involved was the ninth thoracic vertebra and the least common was the third cervical vertebra. The average number of vertebra affected per patient was three. The most common radiological type of lesion was paradiscal (47%). The percentage of patients diagnosed by histological examination was 44%. All patients were given chemotherapy for 12 months' duration; 57% were treated surgically and 43% were treated conservatively. Twenty-four of patients (40%) had an excellent and good results and 28 of patients had a fair result and only one patient had poor result. In 23 of patients treated conservatively showed increment of 8 degrees of kyphosis angle and 22 of patients had a fair result and only one patient had poor outcome after 6 months of treatment. In 30 of patients treated surgically showed correction of 4 degrees of kyphosis angle and 24 of them had excellent and good outcome, where 6 of them had fair outcome after 6 months of treatment.

Adult↗
PubMed2003

Behaviour of the kyphotic angle in spinal tuberculosis.

We followed 70 adult patients with spinal tuberculosis for a minimum of 2 years. Forty patients were treated by ambulant multi-drug chemotherapy (group A), and 30 with neurological complications (group B) were treated by antero-lateral decompression and chemotherapy. We studied the angle of spinal kyphosis as calculated on lateral spinal X-ray by the modified Konstam's method. The angle at final follow-up was compared with the pre-treatment angle. The relationship between the amount of initial vertebral loss, the predicted kyphotic angle and the observed kyphotic angle was analysed. Mean initial vertebral loss, mean pre-treatment angle and mean observed kyphotic angle in group A were 0.77 degrees, 24.3 degrees and 31.75 degrees respectively, with a mean increase in angle of 7.4 degrees. In group B, the readings were 0.67, 25.9 degrees and 26.8 degrees respectively, with a mean increase in angle of 0.9 degrees. Kyphotic deformity continued to progress until 2 years' follow-up. Progression was more pronounced in the non-operative group.

Adolescent↗
PubMed1996

Spinal tuberculosis in developed countries: difficulties in diagnosis.

A review of 21 cases of patients with spinal tuberculosis has been performed, with special attention being paid to methods of diagnosis and the surgical treatment undertaken. We found that the clinical presentation of the condition was often similar to that of malignant disease within the spine, with the commonest presenting features being back pain (95%), an evaluated erythrocyte sedimentation rate (ESR) (100%) and neurological deficits (47%). The radiological appearances were diagnostic of spinal tuberculosis in less than 50% of cases. Microbiological confirmation of the diagnosis was possible only by direct analysis of tissue or pus, either at operation or from a vertebral biopsy. The difficulty of diagnosing this condition and the implications that this has on the timing and nature of surgery in patients presenting with neurological deficits are discussed.

Adult↗
PubMed2004

[Treatment of multi-segmental spinal tuberculosis by using focal debridement and internal fixation with CD rod].

OBJECTIVE: To study the clinical results of focal debridement and primary internal fixation with CD rod in treatment of multi-segmental spinal tuberculosis. METHODS: From July 1999 to November 2002, 16 patients with multi-segmental spinal tuberculosis were given focal debridement and primary internal fixation with CD rod trans sick vertebra. There were 9 males and 7 females, aging from 21 to 59 years. The course of disease was 2 to 11 months. The locations of lesion were T6-T11 in 11 patients and T10-L2 in 5 patients. The involved vertebral bodies were 3 segments in 13 patients, 4 or more than 4 segments in 3 patients. There were 5 cases of Pott's paralysis (according to Frankel classification system: 3 cases of degree C, 2 cases of degree D) and 4 cases of kyphosis and 2 cases of collapse. Focal debridement and internal fixation was performed in 1 or 2 incisions according to concrete conditions. RESULTS: All patients were followed up 11 months (6 months-3 years), spinal tuberculosis was completely cured and the grafted bones were fused in all 16 patients. All patients obtained primary healing of the incision. Postoperative complication met with cerebrospinal fluid leakage in 1 case. After 6 months, 5 cases of paraplegia recovered. The kyphosis was corrected partly. No loose and dislocation of the nails and rods was found. CONCLUSION: Focal debridement and primary internal fixation with CD rod can stabilize involved spinal segments, prevent and correct local deformity, and improve its curative ratio and fused ratio of grafted bone.

Adult↗
PubMed1983

Computed tomography of spinal tuberculosis.

The computed tomographic (CT) features of nine documented cases of spinal tuberculosis are analyzed. The mechanisms of vertebral involvement are reviewed. The ability of CT to facilitate the diagnosis as well as to delineate the extent of soft tissue involvement is emphasized. The need for increased alertness to the diagnosis of tuberculosis is stressed.

Adult↗
PubMed2002

Cervico thoracic junction spinal tuberculosis presenting as radiculopathy.

A case of cervico thoracic junctional area spinal tuberculosis presenting as painful radiculitis of the upper extremity is reported. The predominant symptom of radicular pain and muscle weakness in the hand, along with a claw deformity, led to considerable delay in diagnosis. The presence of advanced bone destruction with severe instability was demonstrated on the MRI scan done later. Surgical management by radical anterior debridement and fusion, along with chemotherapy, led to resolution of the upper extremity symptoms. The brachial plexus radiculopathy secondary to tuberculosis has not been reported. The absence of myelopathic signs even in the presence of advanced bone destruction, thecal compression and instability is uncommon in adults.

Adult↗
PubMed1992

Risk factors for neural deficit in spinal tuberculosis.

From 1975 through 1989, retrospective study of 155 patients with spinal tuberculosis was carried out at Ramathibodi Hospital to study predisposing factors to neural deficit and results of treatment. Two groups of patients who had no neural deficit and had neural deficit were compared. Clinical characteristics of the patients between the two study groups were similar with regard to sex, duration of symptoms, number of vertebrae involved, angle of gibbus deformity and erythrocyte sedimentation rate. There were statistical differences in age, cephalad level of infection, loss of vertebral body and clinical evidence of cold abscess. For patients with neural deficit, the results generally are good with anterior decompression and stabilization.

Abscess↗