In management of patients suffering from tuberculosis of spine, levels of vertebral involvement, AIS grade at presentation, bladder and bowel involvement and its duration significantly affect the final neurological improvement.

Study DesignRetrospective study.PurposeThe aim of this study was to analyze various diagnostic tools, including GeneXpert, for the management of tuberculosis of the spine.Overview of LiteratureTraditional diagnostic methods of microscopy, histology, and culture have low sensitivity and specificity for the management of tuberculosis of the spine.MethodsOf the 262 treated cases of spinal tuberculosis, data on 1 year follow-up was available for 217 cases. Of these, only 145 cases with a confirmed diagnosis were selected for retrospective analysis.ResultsIn 145 of the 217 patients (66.80%), diagnosis was confirmed on the basis of a culture. Of the 145 patients with a confirmed diagnosis, 98 (66.20%) patients were diagnosed on the basis of clinical presentation, whereas 123 (84.8%) exhibited a typical magnetic resonance imaging (MRI) picture. In 99 surgically treated patients, the diagnosis was confirmed on the basis of an intraoperative tissue biopsy. Among the 46 patients treated conservatively, 35 underwent a transpedicular biopsy, 4 patients underwent computed tomography-guided biopsy, 6 patients were diagnosed on the basis of material obtained from a cold abscess, and 1 patient underwent an open biopsy. The sensitivity of the culture for the detection of Mycobacterium tuberculosis was 66.80% (145/217) in our patients. Among the cases in which GeneXpert was used, the sensitivity for the detection of Mycobacterium tuberculosis was 93.4% (43/46). Moreover, the sensitivity of GeneXpert to detect rifampicin resistance was 100% (7/7) in our study.ConclusionsMajority of the patients with tuberculosis of the spine can be diagnosed on the basis of a typical radiological presentation via MRI. In our study, 84.8% cases exhibited typical MRI findings. For patients presenting with atypical MRI features, a rapid and accurate diagnosis is possible by combining GeneXpert with MRI. The combined use of MRI and GeneXpert is a rapid and highly sensitive tool to diagnose tuberculosis and rifampicin resistance in patients with tuberculosis of the spine. Furthermore, we achieved a 97.9% sensitivity for the detection of Mycobacterium tuberculosis and 100% sensitivity for the detection of rifampicin resistance in our study.

ObjectiveThe purpose of the study was to study demographics of tuberculosis of Spine and analyze factors that might affect neurological improvement in patients suffering from tuberculosis of spine. Materials:Of the 638 suspected cases of spinal tuberculosis, 312 cases with confirmed diagnosis with at least one year follow up were selected for retrospective analysis. 200 cases that presented with neurological deficit were further divided into three groups-completely improved, partially improved, and no improvement according to AIS (American Spinal Injury Association impairment scale) grading. All continuous variables and categorical variables were compared across groups. Results 66.99% patients had typical clinical presentation. 84.62% had typical MRI presentation. Thoracic levels (T1-10) were most commonly affected in 45.78% followed by thoracolumbar levels 27.52%(T11-L2). In 80.32% disease was restricted to one or two adjoining vertebrae. At presentation 35.89% patients were neurologically intact whereas 31% were AIS-D, 20.83% were AIS-C, 2.5% were AIS-B and 9.61% were AIS-A. The three groups of patients with complete improvement, partial improvement, and no improvement were significantly different in their levels of vertebral involvement, AIS grade at presentation, bladder and bowel involvement and its duration on statistical analysis. ConclusionAge, sex, radiological presentation, co-morbidities and presence of pulmonary tuberculosis has no significant effect on neurological improvement. Levels of vertebral involvement, AIS grade at presentation, bladder and bowel involvement and its duration significantly effects the final neurological improvement in cases of tuberculosis of spine.

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