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PubMedDate not supplied

Morphological changes during growth in healed childhood spinal tuberculosis: a 15-year prospective study of 61 children treated with ambulatory chemotherapy.

STUDY DESIGN: A retrospective clinical study for prognostic purposes. OBJECTIVE: To study the morphological changes that dictate the variable progression of childhood spinal tuberculosis. SUMMARY OF BACKGROUND DATA: Posttuberculous kyphosis in children either improves or deteriorates during growth. Associated morphological changes in the kyphosis fusion mass and the uninvolved adjacent levels have not been described in literature. METHODS: The study group consisted of 61 children with 63 spinal lesions selected from a prospective multicenter clinical trial. These children were followed up for a uniform period of 15 years at regular intervals. Anterior and posterior heights of the kyphosis fusion mass were measured. Relative difference in anteroposterior growth was analyzed by calculating the anteroposterior ratio of heights. Wedge angle and height-width ratio of uninvolved adjacent vertebrae along with changes in the morphology of disk spaces above and below the lesion were also analyzed. RESULTS: An increase in the anteroposterior ratio of kyphosis fusion mass leading to a decrease in kyphosis was seen in 30 lesions. A decrease in the anteroposterior ratio leading to an increase in kyphosis was noticed in 16 lesions. Overgrowth of the kyphosis fusion mass resulting in formation of large vertebral bodies was noticed in 7 lesions. No change was noticed in 10 lesions. Interestingly, changes were also noticed in 234 adjacent vertebral bodies uninvolved by the disease process: anterior wedging (n = 53), growth alteration of ring apophysis (n = 26), decrease in anteroposterior diameter (n = 26), longitudinal overgrowth (n = 40), attrition at the point of contact resulting in irregular bodies (n = 44), and posterior wedging in the region of compensatory curve (n = 45). Changes in disk spaces were noted at 136 levels, the most common finding being an opening of the disk space anteriorly (n = 126) due to formation of compensatory lordotic curves. The secondary changes leading to an increase in deformity were observed significantly more in lesions with a deformity angle of more than 30 degrees and a vertebral body loss of more than 1, and in lesions of the thoracolumbar region. Children younger than 10 years differed from those 11 years or older by having a significantly more severe disease and more number of morphological changes with growth in both the fusion mass and the adjacent segments. CONCLUSIONS: Notable morphological changes occurred in both the kyphosis fusion mass and the uninvolved levels above and below the lesion in children with healed spinal tuberculosis. These changes occurred during growth, after complete healing of the disease was achieved, and were responsible for the variability in progression of the deformity during growth seen in these children. Our results imply that all children with spinal tuberculosis must be followed up regularly till the entire growth potential is completed.

Adolescent↗
PubMed1987

Evidence of spinal tuberculosis at the beginning of the fourth millennium BC from Arene Candide cave (Liguria, Italy).

This paper describes tuberculosislike lesions affecting the spine of Neolithic skeleton found in Arene Candide cave (Liguria, Italy) and representing one of the earliest cases of this disease in Europe. The burial is attributed to middle Neolithic (square-mouthed pottery culture) whose layers date, by 14C, to the first half of the fourth millennium BC. The skeleton, well preserved in the postcranial portion, belongs to a male aged about 15 years having a very light body build. Resorptive lesions localized to the lower thoracic and upper lumbar vertebral bodies, collapse and angular kyphosis, resulting from complete destruction of T11 and T12 and partial destruction of T10 and L1, are the main pathologic features. The morphology of the lesions, sites involved, and age of the specimen are consistent with a diagnosis of tuberculous spondylitis (Pott's disease). The extreme gracility of the skeleton, along with other signs of stress (Harris lines, enamel hypoplasia) suffered during the last years of life, and the limited bony regeneration point to a disease process in its late phase having arisen at the beginning of adolescence. The funerary ritual suggests that the social integration of this adolescent was not prevented by the severe infirmity.

Adolescent↗
PubMed1979

Spinal osteotomy to correct kyphosis in spinal tuberculosis.

Twenty-seven patients with severe tuberculous kyphosis have been treated at the National Murayama Hospital between 1966 and 1977. We have undertaken curettage of the foci and vertebral osteotomy through an anterior approach, followed by gradual correction with a halo pelvic distraction apparatus and subsequent vertebral fusion. Choice of this method depends upon the age of the patient, the degree of kyphosis before correction, and the presence of concomitant lesions. Details of postoperative management are given and their importance is emphasized. The major risks of correction are discussed and precautions suggested.

Adolescent↗
PubMed1985

A clinical study and classification of posterior spinal tuberculosis.

Tuberculous involvement of the posterior elements of the spine is uncommon. Review of the literature reveals little information and there is scant mention of this subject in standard textbooks of orthopaedics. A study of 27 cases of such lesions seen over 6 years is presented, drawn from two separate centres, 21 from Central India and 6 from South Eastern Iran. The clinical presentation, investigations and treatment are analysed. A new four point classification is described based upon the site of the lesion, the stage of the lesion, associated lesions and neurological deficit.

Abscess↗
PubMed1999

Five-year assessment of controlled trials of short-course chemotherapy regimens of 6, 9 or 18 months' duration for spinal tuberculosis in patients ambulatory from the start or undergoing radical surgery. Fourteenth report of the Medical Research Council Working Party on Tuberculosis of the Spine.

The five-year assessment of three randomised trials of short course (6, 9 or 18 months) chemotherapy for tuberculosis of the spine is reported. In Hong Kong patients were randomised to isoniazid plus rifampicin (HR) daily for 6 or 9 months, combined with radical surgical resection with bone grafting and streptomycin for 6 months for all patients. In Madras patients were randomised to chemotherapy with HR for 6 or 9 months, or 6 months HR chemotherapy combined with surgical resection. In Korea all patients were ambulatory and were randomised to different regimens of chemotherapy 6 or 9 months HR, or 9 or 18 months isoniazid plus ethambutol. (EH) or isoniazid plus PAS (PH). In all centres the results of the 6- and 9-month regimens of HR were excellent and similar to the 18-month EH and PH regimens. The 9-month EH/PH regimens were clearly inferior. In Hong Kong excellent results were achieved by the radical resection. The disease was however less extensive than in Madras, where the results after surgery were no better than with ambulatory chemotherapy. Chemotherapy is the critical factor in the management of tuberculosis of the spine. Efforts should be concentrated on ensuring that appropriate regimens are given under adequate supervision.

Adolescent↗
PubMed2001

Imaging of musculoskeletal and spinal tuberculosis.

The diagnosis of tuberculosis of the musculoskeletal system is difficult for many reasons. As Walker states, to diagnose tuberculosis one must consider the possibility. The uncommonness of osteoarticular MTb results in clinician inexperience, which leads to overlooking the diagnosis. Subtle early manifestations may elude detection. Negative skin tests and normal chest films do not exclude the consideration of tuberculosis. The most conclusive means of reaching the diagnosis (biopsy and culture) necessitate invasive procedures that are not always definitive, and may require repeated attempts. Management and surgical decisions, however, rely on prompt diagnosis; diagnostic delay has prognostic implications and results in significant morbidity. Musculoskeletal tuberculosis produces no pathognomonic imaging signs, and in advanced stages mimics other disease processes. Despite these difficulties, the diagnostician's goal is to catch the disease as early as possible, because antibiotic treatment can lead to resolution and obviate more radical management. The radiologist must be aware of the groups at greatest risk, and typical and atypical presentations at imaging. The eventual eradication of MTb is conceivable, although not presently within our grasp. Maintaining reasonable suspicion and developing cognizance of the patterns of presentation allow the radiologist to diagnose efficiently the patient who presents with osteoarticular tuberculosis.

Diagnosis, Differential↗
PubMed1983

Examination of operation specimens from patients with spinal tuberculosis for tubercle bacilli.

Operation specimens from 52 Hong Kong patients considered to have tuberculosis of the spine were sent at -78 degrees C to London where they were cultured on two Löwenstein-Jensen medium slopes, a slope of 7H11 medium made selective with antibiotics and in two bottles of selective liquid Kirchner medium. Cultures of M tuberculosis, usually with only scanty colonies, were obtained from 37 of the patients. Pus and caseous matter yielded more positive cultures and more numerous colonies than other specimens, but eight of the 37 patients yielded positive cultures only from tissues lining abscess walls or from bone or intervertebral disc specimens. Cultures in Kirchner medium were never contaminated and twice as many were positive as cultures on the slopes; nine patients had cultures positive only on Kirchner medium. It is recommended that (i) a variety of operation specimens, always including pus or caseous material in volumes of at least 1 ml, should be sent for bacteriology; (ii) specimens should be cultured in selective Kirchner medium, with or without Löwenstein-Jensen slopes; (iii) cultures should be incubated for a minimum of 8-9 wk.

Culture Media↗