Tuberculosis of spine: Research evidence to treatment guidelines

Jain, Anil K.

doi:10.4103/0019-5413.173518

Cited by 18 publications

(22 citation statements)

References 31 publications

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“…Patients treated conservatively show an increase in deformity of about 15 degrees. Pan-vertebral lesions, therapeutically refractory disease, severe kyphosis, a developing neurological deficit, lack of improvement or deterioration are indications for surgery, which was also seen in our case [7]. …”

Section: Discussionsupporting

confidence: 57%

A Case of Koch's Spine Treated with Modified Transpedicular Vertebral Curettage and Posterior Fixation: A Novel Technique

Golwala¹,

Kapoor²,

Shah³

et al. 2016

Cureus

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Tuberculosis (TB) is a chronic granulomatous infection caused by acid-fast mycobacterium tuberculosis bacilli. Spinal involvement occurs in less than one percent of TB. Spinal TB (Pott’s disease) accounts for 50% of skeletal TB. Though it most commonly affects the thoracolumbar junction, it can occur at any level of the spine. Early diagnosis and treatment is mandatory in order to avoid neurological complications and spinal deformity. We report a case of a young female with tuberculosis of D12-L1 who was treated with posterior decompression using a modified transpedicular approach and posterior instrumentation with a successful outcome.

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Section: Discussionsupporting

confidence: 57%

A Case of Koch's Spine Treated with Modified Transpedicular Vertebral Curettage and Posterior Fixation: A Novel Technique

Golwala¹,

Kapoor²,

Shah³

et al. 2016

Cureus

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“…The author acknowledges the contribution taken from primary publication on the same subject in Indian Journal of Orthopaedics (33).…”

Section: Acknowledgementmentioning

confidence: 99%

Spinal TB: Impact of Research Evidence on Clinical Practice

Jain

2020

ANAMS

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The evidence generated while treating the patients is the key for growth of science. Finding answers to series of research questions spread over many years may change the clinical practice. This presentation is based on 25 research questions, 44 publications while treating 3300 patients over last 28 years ( 1990-2017) which has substantially changed the objective of treatment in spinal tuberculosis (TB) from healing of lesion with sequelae of spinal deformity and paraplegia to achieving healed status with near normal spine.Three cases of late-onset paraplegia were evaluated (1990) by newly introduced MRI. The syringohydromyelia and severe cord atrophy were attributed as the cause of paraplegia. We conducted a series of prospective studies to define and correlate MRI observations on spinal cord in paraplegia and followed the treatment outcomes. The cord edema, myelomalacia, cord atrophy and syringomyelia were observed in cases with neural complications. The patients with cord edema and liquid compression are predictor for neural recovery, while dry lesions and myelomalacia for poor neural recovery. The mild cord atrophy was consistent with neural recovery while severe cord atrophy with sequalae of neural deficit. Upto 76% canal encroachment was found compatible with intact neural state. Spinal deformity in TB spine is better prevented than treated. The contagious vertebral body disease with intact disc spaces, subperiosteal and paravertebral, septate abscesses, intra-osseous and intraspinal abscesses are considered features of spinal TB and resolution of abscess and fatty replacement is characteristic of healing. The clinicoradiological predictors for diagnosing spinal TB in predestructive disease were defined. Only 35% patients achieved healed status on MRI by DOTS regimen at 8 months, Hence, it is unscientific to stop antitubercular treatment (ATT) at fixed time schedule. The criteria to suspect multi-drug resistant (MDR)-TB and guide to treatment were definedResidual Kyphotic deformity in spine TB produces severe proximal/distal degeneration of spine and/or late-onset paraplegia. We correlated the final kyphosis with initial vertebral body (VB) loss, where 1.5 VB height loss will produce 600 spinal deformity or more, hence surgical correction of spinal deformity is indicated. The surgical steps of kyphotic deformity correction are: anterior corpectomy, posterior column shortening, instrumented stabilization, anterior gap grafting and posterior fusion in a single stage and sequentially. The surgical incision of costo-transversectomy was modified so that kyphosis correction and posterior Hartshill instrumentation can be performed simultaneously. The retroperitoneal extrapleural approach for dorsolumbar spine was described. Meta-analysis of spinal instrumentation in TB spine established the lack of defined indication of instrumented stabilisation. Panvertebral/ long segment disease, kyphotic deformity correction are listed as indications of instrumented stabilisation in TB spine. The end point of treatment in spinal TB still eludes us to resolve the optimum duration of ATT regimen. The PET scan may be used to define it. We believe if a clinician works slow and steady on a series of research questions and by sustained focused efforts can change the clinical practice. We after this sustained research work could contribute in framing Bone and Joint TB guidelines and publish as monograph.

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“…Миелопатия при спондилитах, сопровождаясь отеком и миеломаляцией, разви-вается в активной фазе заболевания в результате механической компрессии мозга абсцессом, со-держащим грануляции, гной или казеозные массы, а также из-за деформации позвоночного столба и/или дислокации (патологического подвывиха) позвонка. При излеченном спондилите изменения в СМ могут быть обусловлены его сдавлением на фоне стеноза позвоночного канала, кифотической деформации и рубцового перерождения эпиду-рального пространства [23,24]. Нарастание спи-нальной дисфункции на фоне прогрессирующей спинальной компрессии согласуется с патологи-ческими изменениями, включающими венозную перегрузку, внутримозговые некрозы, кисты, валле-ровскую дегенерацию задних и боковых канатиков, глиозные изменения и смерть двигательных ней-ронов передних рогов [25].…”

Section: клиническая фармакологияunclassified

“…К механизмам рано возникшей параплегии/тетраплегии относят меха-ническое сдавление эпидуральными компонента-ми, наличие туберкулем в экстра-/интра дуральном пространствах и интрамедуллярно, туберкулезный миелит, тромбоз спинальных артерий, воспаление оболочек. В свою очередь, к механизмам поздней параплегии относят наличие кифотической дефор-мации (прежде всего, деформации, превышаю-щей 60° [23], и фиброз твердой мозговой оболочки (пахименингит)). После реконструктивно-восста-новительных операций регресс параплегии может происходить даже тогда, когда декомпрессия про-изведена спустя 11-12 месяцев после ее развития, при этом параплегия, развившаяся при активной стадии заболевания, имеет бо льшие шансы регрес-сировать, чем при исходе заболевания [24].…”

Section: клиническая фармакологияunclassified

Neurological status and imaging spinal cord in patients with infectious spondylitis: is it possible to comparisons with spondylogenic myelopathy?

Макогонова

Евгеньевна²,

Mushkin

et al. 2017

Rev Clin Pharm Drug Ther

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Spend a literary analysis of the role of radiation diagnosis in the first place - magnetic resonance imaging to visualize changes in the spinal cord in infectious spondylitis. Neurological disorders, manifested by radicular symptoms and signs of spinal cord irritation to deep paresis and plegia in violation of the pelvic organs, are observed in the majority of patients with spondylitis and may be due to the spinal cord and its roots and / or a breach of its microcirculation on the background of the pathological process in the vertebrae. Dynamic (pre- and postoperative) imaging of the spinal canal and its contents in tuberculous and nonspecific spondylitis is important for a more complete assessment of the disease, and for the prediction of the dynamics of neurological disorders. (For citation: Makogonova ME, Mushkin AYu, Gavrilov PV. Neurological status and imaging spinal cord in patients with infectious spondylitis: is it possible to comparisons with spondylogenic myelopathy?. Reviews on Clinical Pharmacology and Drug Therapy. 2017;15(2):64-72. doi: 10.17816/RCF15264-72).

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Tuberculosis of spine: Research evidence to treatment guidelines

Cited by 18 publications

References 31 publications

A Case of Koch's Spine Treated with Modified Transpedicular Vertebral Curettage and Posterior Fixation: A Novel Technique

A Case of Koch's Spine Treated with Modified Transpedicular Vertebral Curettage and Posterior Fixation: A Novel Technique

Spinal TB: Impact of Research Evidence on Clinical Practice

Neurological status and imaging spinal cord in patients with infectious spondylitis: is it possible to comparisons with spondylogenic myelopathy?

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