Spinal tuberculosis: A systematic review of case studies and development of an evidence‐based clinical guidance tool for early detection

Abstract

Rationale, aims, and objectives: Despite research being done on spinal tuberculosis, diagnosing this condition at an early stage remains problematic due to its insidious onset and the varying symptoms being associated. Most individuals present to the health care facility with either simple back pain at an early stage or neurological complications at a later stage, when spinal compression and vertebral collapse have occurred as a result of delayed diagnosis. The prevention of secondary complications is therefore dependent on early recognition and diagnosis. The objective of this review was to identify common clinical patterns in case presentations and develop an evidence-based clinical guidance tool to assist clinicians in the early identification of spinal tuberculosis. Method: A comprehensive literature search was conducted for published spinal tuberculosis case studies, which yielded 28 cases after critical appraisal. Data from the studies were categorized in order to assist with a factor analysis and the development of an evidence framework for screening and diagnosing spinal tuberculosis. An evidence-based clinical guidance tool was then designed from the data obtained. Results: Factors associated with spinal tuberculosis and frequently reported symptoms and physical signs with which the patient could present upon assessment were identified. Options for investigations at primary, secondary, and tertiary levels were also identified. Conclusion: Through the use of an evidence-based clinical guidance tool, the clinician could be guided in the early suspicion and management of individuals with spinal tuberculosis and prevention of secondary complications.

The Diagnostic Accuracy of Magnetic Resonance Imaging (MRI) For Detection of Spinal Tuberculosis (TB)

“…The specific symptoms appear at advanced disease stage and include; development of neurologic deficit, cold abscess and kyphotic deformity but at this stage the mortality is very high. 7,8 The laboratory markers such as Ziehl Nielson stain, culture reporting have poor accuracy because of less bacterial load in spinal TB (<105 bacteria/mL). 9 Magnetic resonance imaging (MRI) is now commonly used for evaluation of patients having suspicion of spinal tuberculosis.…”

Spinal Tuberculosis

“…Hier finden sich in aller Regel erst in fortgeschrittenen Stadien der Erkrankung Hinweise wie Fehlstellungen und Destruktionen 4 . Ebenso wie bei der unspezifischen Spondylodiszitis treten radiologisch sichtbare Veränderungen wie Höhenverlust der Bandscheibe, Grund- und Deckplattenveränderungen oder ein Höhenverlust der ventralen Wirbelkörperanteile sowie kyphotische Deformationen erst mit einer Latenz von 8 und mehr Wochen auf 3 , 6 , 13 , 26 . Wichtig ist jedoch in der Frühphase der Erkrankung die Beurteilung der paravertebralen Bereiche, da sich hier schon in konventionellen Röntgenaufnahmen Hinweise auf abszesssuspekte Formationen zeigen können ( Abb.…”

“…Während es für die klinisch manifeste pulmonale Tuberkulose gute klinische Hinweiszeichen im Sinne von "red flags" gibt [1], wird der Befall der Wirbelsäule durch klinische Zeichen, wie sie von der unspezifischen pyogenen Spondylodiszitis bekannt sind, auffällig [25]. Dazu gehören Rückenschmerzen, überwiegend lokal, aber auch radikulär oder pseudoradikulär [3,26]. Der Schmerz wird oft als tief sitzend und belastungsunabhängig beschrieben.…”

Study on the expression level of NF-κB and clinical evaluations in spinal tuberculosis patients

“…Sometimes, due to the ambiguity and unknown clinical symptoms, the diagnosis is made late or even, in some cases, is made incorrect (2). Therefore, clinical awareness about this disease should always be considered to reduce patients suffering from the dangerous consequences (3).…”