A high proportion of caseous necrosis, abscess, and granulation tissue formation in spinal tuberculosis

Abstract

The special blood circulation, anatomy, and tissue structure of the spine may lead to significant differences in pathological features and drug resistance between spinal tuberculosis and pulmonary tuberculosis. Here, we collected 168 spinal tuberculosis cases and 207 pulmonary tuberculosis cases, and compared their clinical and pathological features as well as drug resistance. From the anatomical location, the highest incidence was of lumbar tuberculosis, followed by thoracic tuberculosis. PET-CT scans showed increased FDG uptake in the diseased vertebrae, discernible peripheral soft tissue shadow, visible internal capsular shadow, and an abnormal increase in FDG uptake. MRI showed infectious lesions in the diseased vertebral body, formation of paravertebral and bilateral psoas muscle abscess, and edema of surrounding soft tissues. As with control tuberculosis, the typical pathological features of spinal tuberculosis were chronic granulomatous inflammation with caseous necrosis. The incidence of granulomas was not statistically different between the groups. However, the proportions of caseous necrosis, acute inflammation, abscess, exudation, and granulation tissue formation in the spinal tuberculosis group were all significantly increased relative to the control tuberculosis group. Compared to the control tuberculosis group, the incidences of resistance to rifampicin (RFP) + isoniazid (INH) + streptomycin (STR) and INH + ethambutol (EMB) were lower in the spinal tuberculosis group, while the incidences of resistance to RFP + INH + EMB and RFP + EMB were higher. Moreover, we also found some differences in drug-resistance gene mutations. In conclusion, there are noticeable differences between spinal Mycobacterium tuberculosis and pulmonary tuberculosis in pathological characteristics, drug resistance, and drug resistance gene mutations.

IL-10 and TGF-β1 may weaken the efficacy of preoperative anti-tuberculosis therapy in older patients with spinal tuberculosis

“…inflammation, abscess, exudation, and granulation tissue formation in spinal tuberculosis compared to pulmonary tuberculosis (Wu et al, 2023). In this study, none of the pathologic features, except for abscesses, were statistically different between the groups.…”

“…We conducted a preliminary comparison of the pathologic features of pulmonary and spinal tuberculosis. Our findings showed that the proportion of caseous necrosis, acute inflammation, abscess, exudation, and granulation tissue formation was significantly higher in the spinal tuberculosis group ( Wu et al., 2023 ).…”

“…Spinal tuberculosis is diagnosed through pathology and typically involves chronic inflammation with caseous necrosis. Our previous study found higher rates of caseous necrosis, acute inflammation, abscess, exudation, and granulation tissue formation in spinal tuberculosis compared to pulmonary tuberculosis ( Wu et al., 2023 ). In this study, none of the pathologic features, except for abscesses, were statistically different between the groups.…”

Combined clinical significance of MRI and serum mannose-binding lectin in the prediction of spinal tuberculosis

“…MRI is often used for the diagnosing of STB due to its sensitivity in the early detection [ 24 , 25 ]. It outperforms other imaging techniques, clearly displaying early vertebral inflammation and slight swelling of paravertebral soft tissues [ 26 ]. It can also determine the extent and nature of intra-vertebral canal lesion invasion, especially Gd-DTPAZ enhancement scan [ 27 ].…”