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Some problems in diagnosis and management of spinal tuberculosis.

In Victoria spinal tuberculosis is now rare in childhood. Some features of the disease in adults are described. A paravertebral abscess, although a late feature of the disease, is commonly present before a diagnosis is made. Antituberculosis drug therapy has greatly altered the pattern of healing of both the bone lesion and, in contrast to the era before chemotherapy, the healing of the abscess is no longer the dominant factor in the healing of the bone lesion. The controversy about radical surgery is discussed.

Abscess

Transcriptome analysis of the diseased intervertebral disc tissue in patients with spinal tuberculosis.

OBJECTIVE: To investigate the differential expression genes (DEGs) in spinal tuberculosis using transcriptomics, with the aim of identifying novel therapeutic targets and prognostic indicators for the clinical management of spinal tuberculosis. METHODS: Patients who visited the Department of Orthopedics at the Second Hospital, Lanzhou University from January 2021 to May 2023 were enrolled. Based on the inclusion and exclusion criteria, there were 5 patients in the test group and 5 patients in the control group. Total RNA was extracted and paired-end sequencing was conducted on the sequencing platform. After processing the sequencing data with clean reads and annotating the reference genome, FPKM normalization and differential expression analysis were performed. The DEGs and long non-coding RNAs (LncRNAs) were analyzed for Kyoto Encyclopedia of Genes and Genomes (KEGG) and Gene Ontology (GO) enrichment. The cis-regulation of differentially expressed mRNAs (DE mRNAs) by LncRNAs was predicted and analyzed to establish a co-expression network. RESULTS: This study identified 2366 DEGs, with 974 genes significantly upregulated and 1392 genes significantly downregulated. The upregulated genes are associated with cytokine-cytokine receptor interactions, tuberculosis, and TNF-α signaling pathways, primarily enriched in biological processes such as immunity and inflammation. The downregulated genes are related to muscle development, contraction, fungal defense response, and collagen metabolism processes. Analysis of LncRNAs from bone tuberculosis RNA-seq data detected a total of 3652 LncRNAs, with 356 significantly upregulated and 184 significantly downregulated. Further analysis identified 311 significantly different LncRNAs that could cis-regulate 777 target genes, enriched in pathways such as muscle contraction, inflammatory response, and immune response, closely related to bone tuberculosis. There are 51 genes enriched in the immune response pathway regulated by cis-acting LncRNAs. LncRNAs that regulate immune response-related genes, such as upregulated RP11-451G4.2, RP11-701P16.5, AC079767.4, AC017002.1, LINC01094, CTA-384D8.35, and AC092484.1, as well as downregulated RP11-2C24.7, may serve as potential prognostic and therapeutic targets. CONCLUSION: The DE mRNAs and LncRNAs in spinal tuberculosis are both associated with immune regulatory pathways. These pathways promote or inhibit the tuberculosis infection and development at the mechanistic level and play an important role in the process of tuberculosis transferring to bone tissue.

Humans

Evaluation of radiological investigations in spinal tuberculosis.

Thirty-four cases of spinal tuberculosis were investigated by plain radiography, computerised tomography and myelography followed by computerised tomography. All the patients were operated on and the findings compared with the results of the investigations.

Adolescent

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

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

Computed tomography of spinal tuberculosis.

CT findings of 20 proven cases of tuberculous spondylitis were reported. Vertebral fragmentation and paravertebral abscesses were found to be important findings. CT should be performed in cases without characteristic plain radiographic features and in cases that the extent of the disease is to be evaluated.

Adolescent

Radiological features during and following treatment of spinal tuberculosis.

A retrospective study was performed in order to document the sequence and time scale of radiological changes occurring during the healing of spinal tuberculosis. 28 episodes occurred in 26 patients, of whom only two were Caucasian. All demonstrated good response to conventional chemotherapy. Soft-tissue masses increased in size for up to 1.5 months and took about 12 months to resolve. Bone destruction was seen in all cases and progressed in 70% of patients, whilst on treatment. There was loss of vertebral body height in 79%, which progressed for up to 14 months; any recovery of height was a very late feature. Sclerosis was seen at presentation in 52% and developed in most of the remaining patients within 5 months of instigating treatment. It progressed for up to 14 months and took, on average, 31 months to return to normal. Reduction in disc height was commonly seen and the vertebrae fused in three-quarters of those affected, the time of onset of fusion being very variable. To manage patients with spinal tuberculosis, an appreciation of the variability of radiological changes that can occur during treatment is necessary.

Adolescent

Stablization of the spine in the surgical treatment of severe spinal tuberculosis in children.

This is a 5- to 10-year survey of 160 children, all with severe surgically-treated spinal tuberculosis. The treatment consisted of: anterior spinal fusion alone, anterior with posterior fusion, posterior fusion alone and posterior with anterior fusion. The results indicate that in the less severe cases, where an abscess is not evident on plain radiographs, psoterior fusion alone can be of value in the growing spine. In severe cases, especially where an abscess is seen, the combined approaches give the best results. The risk of posterior fusion alone is an unsatisfactory, long term neurological outcome in too many patients. The combined procedure of anterior fusion with posterior fusion is the treatment of choice for all immature spines with this disease.

Abscess

Spinal tuberculosis treated by antituberculous chemotherapy and radical operation.

Between 1956 and 1968, 208 patients with spinal tuberculosis healed by chemotherapy with and without surgical intervention. Two vertebral bodies were affected in 82 patients, one in 23 cases, more than 4 in 70 patients. Sixty-one patients had neural involvement at the time of admission, 42 of them an incomplete or complete paraplegia. All patients were treated by triple-drug chemotherapy. Chemotherapy and bed rest alone was sufficient for 76 patients. Surgical intervention was indicated in 132 cases. Debridement was carried out in 33 cases, debridement and spinal fusion was performed in 18 cases, anterolateral decompression of the spinal cord alone was employed in 15 cases, and together with spinal fusion recommended in 15 cases. Minor surgical procedures were made necessary in 8 cases. The indications for surgery were: (1) unfavorable response to conservative treatment during 3 months, (2) Pott's paraplegia showing no signs of recovery by conservative treatment, (3) Pott's paraplegia developing during conservative treatment (4) cases with unstable spinal lesions, and (5) cases with paravertebral abscesses and sinuses. Complete or good recovery occurred in 61 out of 76 conservatively treated patients. Forty-two out of 61 patients with neural involvement made a complete or a good recovery, 31 being patients with paraplegia. No improvement was noted in 16 cases with neural involvement, and 2 had progression of the neurological signs. A complete recovery was noted in 101 out of 132 operatively treated patients, a good recovery in 21, and no improvement in 9 patients with paraplegia. One patient died; 141 patients returned to their former work, 30 of whom were recovered paraplegics. Fifteen had retired because of advanced age. Modern treatment begins with triple-drug chemotherapy and bed rest for 3 months. If the response is unsatisfactory, debridement or debridement with spinal fusion is carried out as soon as possible. Anterolateral decompression is applied in cases with paraplegia.

Adolescent