Active tuberculosis of spine: Current updates

Shanmuganathan, Rajasekaran; Ramachandran, Karthik; Shetty, Ajoy Prasad; Kanna, Rishi Mugesh

doi:10.1016/j.xnsj.2023.100267

Cited by 6 publications

(9 citation statements)

References 77 publications

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“…For instance, extended preoperative anti-tuberculosis treatment may be appropriate for older patients. The WHO recommends that patients with tuberculosis of the bones or joints should receive nine months of treatment ( Shanmuganathan et al., 2023 ). While 6 months of treatment is reportedly considered adequate, many experts still prefer 12-24 months of treatment ( Garg and Somvanshi, 2011 ).…”

Section: Discussionmentioning

confidence: 99%

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

Li,

Wu,

Feng

et al. 2024

Front. Cell. Infect. Microbiol.

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Spinal tuberculosis is a common extrapulmonary type that is often secondary to pulmonary or systemic infections. Mycobacterium tuberculosis infection often leads to the balance of immune control and bacterial persistence. In this study, 64 patients were enrolled and the clinicopathological and immunological characteristics of different age groups were analyzed. Anatomically, spinal tuberculosis in each group mostly occurred in the thoracic and lumbar vertebrae. Imaging before preoperative anti-tuberculosis therapy showed that the proportion of abscesses in the older group was significantly lower than that in the younger and middle-aged groups. However, pathological examination of surgical specimens showed that the proportion of abscesses in the older group was significantly higher than that in the other groups, and there was no difference in the granulomatous inflammation, caseous necrosis, inflammatory necrosis, acute inflammation, exudation, granulation tissue formation, and fibrous tissue hyperplasia. B cell number was significantly lower in the middle-aged and older groups compared to the younger group, while the number of T cells, CD4+ T cells, CD8+ T cells, macrophages, lymphocytes, plasma cells, and NK cells did not differ. Meaningfully, we found that the proportion of IL-10 high expression and TGF-β1 positive in the older group was significantly higher than that in the younger group. TNF-α, CD66b, IFN-γ, and IL-6 expressions were not different among the three groups. In conclusion, there are some differences in imaging, pathological, and immune features of spinal tuberculosis in different age groups. The high expression of IL-10 and TGF-β1 in older patients may weaken their anti-tuberculosis immunity and treatment effectiveness.

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Section: Discussionmentioning

confidence: 99%

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

Li,

Wu,

Feng

et al. 2024

Front. Cell. Infect. Microbiol.

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“…Most (53%) of cases of instability involved the lumbosacral region, with surgery required in 87% of cases of instability [12]. Despite improved antibiotic and surgical treatments, patient hospital stays can average 30-57 days, and mortality can be as high as 2-17% [18][19][20][21].…”

Section: Complicationsmentioning

confidence: 99%

“…Finally, 18 F-Fluorodeoxyglucose-positron emission tomography ( 18 F-FDG-PET) is a sensitive and whole-body imaging tool, though lacking anatomical details; combining it with CT or MRI improves spatial resolution and aids in distinguishing infectious from degenerative abnormalities (Figure 5) [42,45].…”

Section: Nuclear Medicinementioning

confidence: 99%

“…It can be interesting to detect multiple intra-and extra-osseous infectious locations with high sensitivity but low specificity, with standardized uptake values (SUV) between 4 and 30 [46]. If required, 18 F-FDG-PET/CT can help monitor the treatment efficacy, with a 39% decrease being found in responding patients on 18 F-FDG-PET/CT performed at 2 weeks after starting antibiotherapy [44,47]. Additionally, a SUV max decrease above 15% at 2 weeks would indicate a good treatment response with a sensitivity of 94% and specificity of 67%, i.e., with higher accuracy than concomitant conventional MRI (sensitivity = 37% and specificity = 50%) [44].…”

Section: Nuclear Medicinementioning

confidence: 99%

“…The median duration of antibiotic therapy is 148 days [16,17]. Although conservative treatment can be effective for 70% of cases of pyogenic infection, surgery may be required in over 50% of cases for all causes [12,17,18]. For pyogenic infection, complete healing without disability occurs in over three-quarters of cases; there is an overall healing rate of 91%, with 24% residual disabilities and a mortality rate of 8% [17].…”

Section: Introduction 1epidemiologymentioning

confidence: 99%

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Imaging of Spondylodiscitis: A Comprehensive Updated Review—Multimodality Imaging Findings, Differential Diagnosis, and Specific Microorganisms Detection

Crombé,

Fadli,

Clinca

et al. 2024

Microorganisms

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Spondylodiscitis is defined by infectious conditions involving the vertebral column. The incidence of the disease has constantly increased over the last decades. Imaging plays a key role in each phase of the disease. Indeed, radiological tools are fundamental in (i) the initial diagnostic recognition of spondylodiscitis, (ii) the differentiation against inflammatory, degenerative, or calcific etiologies, (iii) the disease staging, as well as (iv) to provide clues to orient towards the microorganisms involved. This latter aim can be achieved with a mini-invasive procedure (e.g., CT-guided biopsy) or can be non-invasively supposed by the analysis of the CT, positron emission tomography (PET) CT, or MRI features displayed. Hence, this comprehensive review aims to summarize all the multimodality imaging features of spondylodiscitis. This, with the goal of serving as a reference for Physicians (infectious disease specialists, spine surgeons, radiologists) involved in the care of these patients. Nonetheless, this review article may offer starting points for future research articles.

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Clinical Characteristics, Risk Factors, and Management Strategies of Postoperative Recurrence in Thoracolumbar Tuberculosis

Liang,

Zhao,

Luo

et al. 2024

Preprint

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Objective To investigate the clinical characteristics and identify risk factors of postoperative recurrence in thoracolumbar tuberculosis, aiming to assess clinical significance and propose management strategies. Methods Retrospective review of 69 patients' medical records with postoperative recurrence of thoracolumbar tuberculosis from 2006 to 2019, including demographics, clinical presentations, radiographic data, drug susceptibility, laboratory results, and recurrence patterns. Results The study included 40 males and 29 females, with a mean age of 36.1 ± 14.2 years at initial surgery and 37.5 ± 14.5 years at recurrence. Manifestations included pain (55.1%), sinus tracts (47.8%), and neurological deficits (37.7%). Radiographic assessments showed paravertebral (89.9%) and flowing abscesses (37.7%). Drug resistance was present in 41.5% of cases. Inflammatory markers were elevated in most patients, with anemia and hypoalbuminemia frequently observed. Most recurrences occurred within 24 months post-surgery, with a maximum interval of 84 months, and 37.7% had multiple recurrences. Conclusion Postoperative recurrence in thoracolumbar tuberculosis is multifactorial, linked to drug-resistant tuberculosis, inconsistent medication adherence, poor nutrition, inadequate immobilization, and systemic tuberculosis infections. Optimal postoperative surveillance and clinical management necessitate a focus on inflammatory markers, advanced imaging, diligent patient education, and rigorous follow-up to diminish recurrence rates and enhance patient outcomes.

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Active tuberculosis of spine: Current updates

Cited by 6 publications

References 77 publications

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

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

Imaging of Spondylodiscitis: A Comprehensive Updated Review—Multimodality Imaging Findings, Differential Diagnosis, and Specific Microorganisms Detection

Clinical Characteristics, Risk Factors, and Management Strategies of Postoperative Recurrence in Thoracolumbar Tuberculosis

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