Clinical Characteristics of 1378 Inpatients with Spinal Tuberculosis in General Hospitals in South-Central China

Abstract

In this retrospective study, charts of inpatients with spinal tuberculosis (STB) treated in large-scale general hospitals in Changsha, Hunan, China, between 2007 and 2016 were reviewed to investigate their clinical characteristics. Demographic, epidemiological and clinical features, imaging findings, treatment methods, and prognosis were summarized and analyzed. There were 1378 patients, 805 males and 573 females, with a mean age of 43.7 years. The mean interval between symptom onset and diagnosis was 16.0 months (range 15 days–240 months). The incidence of back pain, radicular pain and symptoms of systemic toxicity was 92.5%, 40.1%, and 32.1%, respectively. The rate of neurological impairment was 49.9 %. STB was present in two or more vertebrae in 91.1% of patients, with two adjacent vertebrae being involved in 67.9% of them. The lumbar segment (38.2%) was the most frequently affected, followed by the thoracic spine (35.7%). The sacrococcygeal area was the least frequently involved (0.8%). Abscesses were detected in 65.5% of patients. One thousand patients (72.6%) were managed with surgery and 378 (27.4%) with anti-TB drugs only. Cure was achieved in 1215 patients (88.2%), whereas 49 (3.5 %) had relapses. Concomitant pulmonary TB (PTB) was diagnosed in 366 patients (26.6%) and 63 (4.6%) had concomitant diabetes. Compared with the previous five years, the number of older patients, urban patients, and medical staff with STB had increased by 6.1%, 5.2%, and 1.3%, respectively in the five years studied. STB remains a severe public health problem that cannot be ignored. Most of the patients ignored early symptoms and therefore received untimely treatment. Thus, surveillance for and treatment of STB in South-central China requires strengthening. In addition to the current China-wide database of patients with PTB, a China-wide database of patients with STB should also be set up.

Multi-drug resistant spinal tuberculosis-epidemiological characteristics of in-patients: a multicentre retrospective study

“…The best treatment regimen for MDR spinal TB remains controversial, especially with regard to the choice of chemotherapy and duration (chemotherapy alone or combined with surgery). Anti-TB drug chemotherapy is the key and foundation of curing spinal TB, with surgery being an adjuvant means of treatment [6]. However, improper dosing, inadequate duration of treatment and inappropriate selection of candidates for chemotherapy have not only resulted in the resurgence of TB but also led to the most dreadful consequence of multidrug resistant strains [7].…”

Posterior-only vs. combined posterior-anterior approaches in treating lumbar and lumbosacral spinal tuberculosis: a retrospective study with minimum 7-year follow-up

“…The intra-operative bleeding amount, surgery time, and hospitalization days were lower in group A than B (P = 0.000). All patients achieved complete cure within 2-year follow-up [3].…”

“…As a common extrapulmonary TB, spinal tuberculosis (STB) accounted for half of skeletal TB, which often leads to severe damage on health, resulting in a serious social and economic load [2]. In China, lumbar spinal tuberculosis (LSTB) is with most incidence [3], followed by thoracic STB, while lumbosacral spinal tuberculosis (LSSTB) is relatively uncommon. As the area with the maximum spinal load, lumbar and lumbosacral vertebrae are the stress concentration points with high range of motion.…”

One-stage posterior debridement, bone grafting fusion, and mono-segment vs. short-segment fixation for single-segment lumbar spinal tuberculosis: minimum 5-year follow-up outcomes

“…Comprehensive assessment of clinical symptoms, laboratory results, and imaging findings was necessary to diagnose STB [10]. The main clinical symptoms included low back pain, radiating pain, dysesthesia, and dyskinesia of the lower limb.…”