Specific and rapid detection methods for spinal tuberculosis, with sufficient sensitivity in HIV-1 co-infected individuals, are needed, to ensure early initiation of appropriate treatment to prevent physical disability and neurological fallout. In addition, understanding the systemic and local pathophysiology of spinal tuberculosis, and its interaction with HIV-1 infection, is crucial to guide future therapeutic interventions. We prospectively enrolled adult patients presenting with signs and symptoms of suspected spinal tuberculosis, at Groote Schuur Hospital, between November 2020 and December 2021. TB diagnostic testing was performed on open and CT-guided spinal biopsies using Xpert MTB/RIF Ultra compared to gold standards TB culture and histology. A highly sensitive droplet digital PCR assay for detecting and quantifying Mycobacterium tuberculosis complex (MTBC) and HIV-1 DNA was tested. Plasma inflammatory proteins were measured to assess systemic inflammation. Xpert Ultra had a high sensitivity of 94.7% and specificity of 100% for STB against TB culture and histology in both open and CT-guided biopsy samples. The ddPCR assay confirmed TB detection in 94% of patients with positive Xpert Ultra results. Four patients with negative TB diagnostic results had MTBC DNA detected by ddPCR. HIV-1 DNA was detected in the spinal tissues from all HIV-1-infected patients. MTBC DNA levels were significantly higher in HIV-1-co-infected spinal tissue samples (p< 0.01). We identified four biomarkers significantly associated with higher bacterial burden at the disease site (p< 0.01). Xpert Ultra and MTBC ddPCR improve the detection of STB. DdPCR can be utilized as an additional, highly sensitive tool for detecting and quantifying Mtb, in pathological samples that may be paucibacillary. These findings provide novel diagnostic and pathophysiologic insight into STB, in the context of HIV-1 infection, and provide rationale to include these tests in hospital and research settings for patients from communities burdened by TB and HIV-1

Spinal tuberculosis is one of the most common presentations of skeletal tuberculosis. It is one of the major health issues of developing countries as it is associated with significant morbidity and mortality. Pott's paraplegia is a dreaded complication which can result in permanent neurological deficit, unless treated by timely intervention. We evaluated the efficacy of transpedicular decompression and functional recovery in patients of spinal tuberculosis with neurological deficit. A cohort of 23 patients (15 males and 8 female) with diagnosed spinal tuberculosis and having an average age of 37.5±8.4 years, satisfying our inclusion and exclusion criteria's and giving written informed consent were recruited in our study. All patients were managed by transpedicular decompression and fusion with posterior instrumentation. All the patients were followed up clinically, radiologically and hematologically. Patients were followed up at every six weeks for 4 months and thereafter at three monthly intervals to assess the long term outcomes and complications. Neurological evaluation was done by Frankel grading. Functional outcome was assessed by Visual Analog Score (VAS) and Owestry Disability Index score (ODI score). All the patients were followed for a minimum of 27 months. At the final follow-up, there was a statistically significant improvement in VAS score and ODI score. Out of 23 patients, all except three patients showed neurological recovery. We observed that transpedicular decompression is safe and effective approach for management of spinal tuberculosis as it allows adequate decompression of spinal cord while pedicular instrumentation provides stable spinal fixation and helps in early rehabilitation

Summary. There is little consensus regarding the regime for treatment of tuberculosis of spine, although WHO has laid down guidelines couple of years back classifying spinal tuberculosis in Category 1. This study proves the efficacy of WHO regime in spinal tuberculosis by clinico-radiological evaluation. Introduction. The medical fraternity is divided over the duration of chemotherapy in cases spinal tuberculosis. WHO clearly recommend spinal tuberculosis under Category I, but not accepted by most clinicians. Patient and Methods. In this prospective study during the period between August 2005 and July 2012, a total of 76 cases were diagnosed and evaluated clinico-radiologically to test the efficacy of WHO protocol (2HRZE+4HR) in our hospital with a mean follow up of 50 months (30 – 80 months). Results. Spinal tuberculosis was seen in 56% of all osteoarticular tuberculosis. Maximum population was between 11–50 years, females were involved more than males (66%), and regional distribution was different in males (Lumbar) and females (Thoracic). Skip and multifocal lesions were seen in 13% (6 cases), more common in immune compromised cases. Pain was the most common symptom (95%) followed by constitutional symptoms. Radiographic changes were nonspecific, appear late and suggestive of tuberculosis in 53%case, MRI is very useful in diagnosing in 95% cases especially when X ray is contributory. ESR is useful tool for follow up of patients, elevated in 94%cases. Results were evaluated on clinical, hematological and radiological basis. Of the total 64cases (after dropouts, lost in follow up, mortality), 50 patients (78%) received treatment for 6 months and14 cases for more than 6months (P value<0.001). No MDR cases were present. In 50 patients fall in ESR at the end of 2 months was found to be statistically significant (P value<0.05) and hence were given a treatment for 6 months, the fall at the end of 6 months was highly significant (P value<0.001). In rest of the 14 cases the duration of treatment was given for more than 6 months as the trend of fall of ESR was not significant. MRI changes were assessed in the form of osteitis, osteitis with discitis, abscess formation and granulation tissue on initiation of treatment, completion of treatment and 6 months after completion of treatment. Conclusion and Discussion. The experience shows that spinal tuberculosis is common in a tertiary health care centre in India with diagnosis possible by combination of clinical evaluation and radiological evaluation. Statistical significance was found in clinical symptoms, ESR trends and MRI evaluation in cases receiving 6 months of chemotherapy. With this study, WHO short course chemotherapy was found to be effective in spinal tuberculosis, with no relapse over a period of 6 years

Instrumentation in Spinal Tuberculosis is a controversial issue. The introduction of Pedicle screws in spinal fixation offered a new dimension to the management of this difficult problem. We operated on 127 patients with Spinal Tuberculosis between 1990 and 2000. Between 1990 and 1995, we treated 45 patients in the traditional manner with anterior decompression and strut grafting. During this period we encountered an unacceptably high rate of complications, such as graft collapse, progression of deformity and pseudoarthrosis. Between 1995 and 2000, we adopted the practice of anterior radical surgery combined with instrumentation, and employed this approach in 82 patients. Of these:. 18 patients underwent surgery at dorsal vertebral level, 30 at dorsolumbar level, and 34 at lumbar level. Our experience has enabled us to develop a protocol in the management of these patients depending on:. a/ the level of vertebral involvement (cervicodorsal/ dorsolumbar/ lumbar),. b/ the presence of single or multilevel disease, and. c/ location of disease in the spinal columns. In Dorsal lesions involving less than two consecutive levels with no deformity, we performed anterior procedure only. In multilevel dorsal lesions with no deformity we did anterior followed by posterior surgery. In Dorsal lesions with deformity we performed Back-Front-Back procedure. In single level Dorsolumbar lesion we did anterior procedure only. In presence of multisegment involvement with or without deformity we did Back-Front-Back procedure. In Lumbar lesion with anterior and middle column involvement without deformity anterior surgery was performed. In presence of all column involvement with deformity we did anterior followed by posterior surgery. With the use of instrumentation we achieved satisfactory results in terms of correction of deformity. We were also able to carry out extensive debridement (with anticipation of gaining stability with instrumentation), thereby clearing infection locally and effecting neurological improvement in all our cases. There were a few minor complications in our second (instrumented) group. No major complications (death, deep secondary infection or deterioration of the neurology), occurred in this group. We conclude that Instrumentation in Spinal Tuberculosis is safe. It allows the surgeon to debride the tissues safely and to stabilise the spine and thus prevent deformity. Instrumentation also allows early mobilisation. The radical debridement leads to a reduction in recurrence of infection at the operative site

Introduction. Pulmonary Tuberculosis (TB) can be detected by sputum cultures. However, Extra Pulmonary Spinal Tuberculosis (EPSTB), diagnosis is challenging as it relies on retrieving a sample. It is usually discovered in the late stages of presentation due to its slow onset and vague early presentation. Difficulty in detecting Mycobacterium Tuberculosis bacteria from specimens is well documented and therefore often leads to culture negative results. Diagnostic imaging is helpful to initiate empirical therapy, but growing incidence of multidrug resistant TB adds further challenges. Methods. A retrospective analysis of cases from the Infectious Disease (ID) database with Extra Pulmonary Tuberculosis (EPTB) between 1. st. of January 2015 to 31. st. of January. Two groups were compared 1) Culture Negative TB (CNTB) and 2) Culture Positive TB (CPTB). Audit number was. Results. 31 cases were identified with EPSTB. 68% (n=21) were male. 55% (n=17) patients were Asian, (19% (n=6) were black and 16% (n=5) were of white ethnicity. 90.4% (n=28) patients presented with isolated spinal TB symptoms. No patient had evidence of HBV/HCV/HIV infections. CPTB Group was 51.6% (n=16) compared to CNTB Group with 48.4% (n=15) 48% (15) lumbar involvement, 42% (13) thoracic and 10% (3) cervical. 38.7% (12) patients presented with late neurology, equally in both groups. 56% CPTB patients showed signs of vertebral involvement on plain radiograph compared to 13.3% in CNTB patients. 68.7% CPTB patients had pathological changes or paraspinal collections seen on CT scan compared to 53.3% of CNTB patients. 81% of CPTB showed positive MRI findings compared to 86% in CNTB. Both groups were treated with Anti-TB medications according to local guidelines. 83% patients were followed up till the end of the treatment course. 22.5% (n=7) patients had Ultrasound guided aspiration. 29% (n=9) patients underwent surgical intervention. 3 patients had Laminectomy for decompression. 6 patients underwent Spinal Decompression and Fixation due to extensive bone destruction. No mortality occurred. Conclusion. TB continues to be a growing problem in the developed world with high numbers of patients travelling from endemic regions. 75% of our cases were from Asian or Black ethnicity. The thoracolumbar region was most commonly effected (90%). Approximately 50% of cases of extrapulmonary spinal TB were culture negative. Neurological deficit occurred in 40% patients and 30% of patients required surgery. Standard anti-TB treatment was however effective in all cases with no significant drug resistant variants noted. MRI and CT imaging remain the superior diagnostic tests in the presence of high CN EPSTB

The main goal is to provide insight into spinal tuberculosis from a Dutch perspective: to establish the size of the problem in the Netherlands, analyse the reasons for misdiagnosis, assess optimal treatment, verify if this is truly optimal, establish the effect of surgery, and find out when surgery is needed. We made an analysis of the increase in Bone and Joint Tuberculosis (BJTB) in the Netherlands during the recent years. Between 1993 and 2000 a total of 532 cases of BJTB were found. Univariate analysis showed that the increase in incidence was restricted to non-Dutch people from endemic areas. It is important to note that only 15% of BJTB patients in our series also suffered from pulmonary TB. In our study a lengthy delay by both patients and doctors was found for BJTB (mean period 32 weeks), probably explained by a low index of suspicion and declining expertise. We report a previously undescribed misdiagnosis and subsequent mistreatment with radiation for tuberculosis of the spine in two patients. Both patients were misdiagnosed as having malignancies, without sufficient material for histological and culture examination. Both received radiotherapy, both experienced growth of the lesion, and in one of the patients the neurological deficit increased and did not reverse after initiation of the proper TB treatment. The main reasons for misdiagnosis of spinal TB are low incidence, low index of suspicion, declined expertise, and accepted failed biopsy. Radiotherapy locally aggravates tuberculous spinal lesions. There is no uniform advice in the literature regarding the duration of chemotherapeutic treatment for spinal tuberculosis. A review of the literature from 1978 (after the introduction of Pyrazinamide) to 2000 was performed. The relapse rate of 2% for the patients that had > 6 months chemotherapy is low, as is the relapse rate of 0% for patients with 6 months treatment. We concluded that the duration of chemotherapy for spinal tuberculosis can be 6 months. Subtherapeutic concentrations intralesional may result in selection of a resistant bacterial population and lead to treatment failure. Intralesional drug concentrations were below Minimal Inhibitory Concentration (MIC) values in 0/15 patients for ISO, 2/13 for RIF, and 8/9 for PYR. In 5/8 patients receiving all three drugs both RIF and PYR had Cmax:MIC ratios < 4, indicating intralesional subtherapeutic drug levels. Drainage is advised as additional therapy for patients with pleural effusion or psoas abscesses; it reduces the intralesional bacterial load and shortens the time of resolution of the lesions. A Cochrane systematic review was performed with the aim to compare chemotherapy to chemotherapy plus surgery in the treatment of spinal TB. There were no statistically significant differences between the treatment and control group for kyphosis and bony fusion. There were no significant differences in neurology, but some patients from the control group had an operation (change of allocated treatment) for persisting deficit. Chemotherapy is the critical factor in the management of tuberculosis of the spine. Routine surgery is not indicated. Surgery has a role in subgroups of patients for orthopaedic or neurological reasons: large or progressive kyphosis, and progressive or persistent neurological deficit. We evaluated radiographic and clinical parameters as early predictors for the final kyphosis angle in spinal TB to identify the patients at risk for developing severe or progressive kyphosis. Univariate analysis revealed no significant independent predictors. Multivariate analysis showed that bone loss < 0.3 in combination with a thoracic localisation indicated 97% chance of favourable outcome. A simple and clinically useful algorithm for early prediction of kyphosis in spinal TB is presented

Introduction and Aims: Instrumentation in spinal tuberculosis is a controversial issue. The introduction of Pedicle screws in spinal fixation offered a new dimension to the management of this difficult problem. Method: We operated on 147 patients with spinal tuberculosis between 1990 and 2001. Between 1990 and 1995, we treated 45 patients in the traditional manner with anterior decompression and strut grafting. We encountered an unacceptably high rate of complications, such as graft collapse, progression of deformity and pseudoarthrosis. Between 1995 and 2001, we adopted the practice of anterior radical surgery combined with instrumentation (mesh cages and modem multi-segment hook/screw system), and employed this approach in 102 patients. Of these: 28 patients underwent surgery at dorsal vertebral level, 35 at dorsolumbar level, and 39 at lumbar level. Results: Our experience has enabled us to develop a protocol in the management of these patients depending on a) the level of vertebral involvement (cervicodorsal/dorsolumbar/lumbar); b) the presence of single or multilevel disease; and c) location of disease in the spinal columns. In dorsal lesions involving less than two consecutive levels with no deformity, we performed anterior procedure only. In multilevel dorsal lesions with no deformity we did anterior followed by posterior surgery. In dorsal lesions with deformity we performed Back-Front-Back procedure. In dorsolumbar lesions with single-level disease we did anterior procedure only. In the presence of multi-segment involvement with or without deformity we did Back-Front-Back procedure. In lumbar lesions with anterior and middle column involvement without deformity we performed anterior surgery only. In lumbar lesions with all column involvement with deformity we performed anterior and posterior surgery. With the use of instrumentation we achieved satisfactory results in terms of correction of deformity. We were also able to carry out extensive debridement (with anticipation of gaining stability with instrumentation), thereby clearing infection locally and effecting neurological improvement in all our cases. There were a few minor complications in our second (instrumented) group. No major complications (death, deep secondary infection or deterioration of the neurology) occurred in this group. Conclusion: We conclude that instrumentation in spinal tuberculosis is safe. It allows the surgeon to debride the tissues safely and to stabilise the spine and thus prevent deformity. Instrumentation also allows early mobilisation. The radical debridement leads to a reduction in recurrence of infection at the operative site

This paper reviews 46 consecutive spinal tuberculosis patients who underwent spinal surgery at a state facility over 2.5 years. The 21 male and 25 female patients ranged in age from 18 months to 67 years, with 19 patients under the age of 18 years. On presentation the mean ESR was 69 (15 to 140) and the white cell count normal. Axial pain and weakness were the most common complaints. There was often a delay of more than a month to presentation. Five patients were HIV positive. Histological and microbiological examination confirmed tuberculosis in 40 patients. There were seven cervical cases, eight lumbar and 31 thoracic. Six patients had additional non-contiguous spinal involvement. There was one radicular syndrome and 30 patients had neurological deficits. Anterior and posterior surgery was done on 22 patients. There were eight anterior only procedures, seven posterior only, six costotransversectomies and three biopsies. In addition two revision anteriors were done. Allograft struts were used in 16 and autograft in 13. Anterior instrumentation was employed in 11, posterior in six and none in 11. There were two deaths. Two grafts required early revision and one rotated but was accepted. Postoperative neurological recovery was noted from one day to 3 months, and typically by one month. All children regained normal neurological status. Spinal tuberculosis is a common cause of neurological deficit and surgery has to suit the specific case. There is still a valuable role for surgery without instrumentation, especially in the paediatric group. Despite extensive destruction, one can expect full neurological recovery

Introduction and aims: Instrumentation in Spinal Tuberculosis is a controversial issue. The introduction of Pedicle screws in spinal fixation offered a new dimension to the management of this difficult problem. Method: We have operated on 147 patients with Spinal Tuberculosis between 1990 and 2001. Between 1990 and 1995 we treated 45 patients in the traditional manner with anterior decompression and strut grafting. During this period we encountered an unacceptably high rate of complications, such as graft collapse, progression of deformity and pseudoarthrosis. Between 1995 and 2001 we adopted the practice of anterior radical surgery combined with instrumentation (mesh cages and modern multisegment hook/screw system), and employed this approach in 102 patients. Of these: 28 patients underwent surgery at dorsal vertebral level, 35 at dorsolumbar level, and 39 at lumbar level. Our experience has enabled us to develop a protocol in the management of these patients depending on:. The level of vertebral involvement (cervico-dorsal/ dorsolumbar/lumbar),. The presence of single or multilevel disease and. Location of disease in the spinal columns. In dorsal lesions involving less than two consecutive levels with no deformity, we performed anterior procedure only. In multilevel dorsal lesions with no deformity we did anterior followed by the posterior surgery. In dorsal lesions with deformity we performed Back-Front-Back procedure. In dorsolumbar lesions with single level disease we did anterior procedure only. In presence of multisegment involvement with or without deformity we did Back-Front-Back procedure. In lumbar lesions with anterior and middle column involvement without deformity we performed anterior surgery only. In lumbar lesions with all column involvement with deformity we performed anterior and posterior surgery. Results: With the use of instrumentation we achieved satisfactory results in terms of correction of deformity. We were also able to carry out extensive debridement (with anticipation of gaining stability with instrumentation), thereby clearing infection locally and effecting neurological improvement in all our cases. There were a few minor complications in our second (instrumented) group. No major complications (death, deep secondary infection or deterioration of the neurology), occurred in this group. Conclusion: We conclude that Instrumentation in Spinal Tuberculosis is safe. It allows the surgeon to debride the tissues safely and to stabilise the spine and thus prevent deformity. Instrumentation also allows early mobilisation. The radical debridement leads to a reduction in recurrence of infection at the operative site

Purpose of the study: Pott’s disease of the cervical spine is exceptional. We collected 27 cases over a period of 30 years. Material and methods: Mean patient age was 21 years. Male gender predominated. Most patients consulted because of cervical pain and 50% presented neurological disorders. Mean duration of symptoms was 14 months. A peri-spinal abscess was found in ten patients. The posterior cervical spine was affected in most patients and four presented suboccipital involvement. There was associated lung disease in two-thirds of the patients. Standard anti-tuberculosis chemotherapy was given associated with traction alignment in twelve patients to correct for kyphosis or associated spinal dislocation. Surgery was reserved for major bone destruction leading to instability or neurological disorders resistant to medical treatment. Results: Mean follow-up was five years. The anatomic result after medical or surgical treatment was characterized by vertebral fusion in all patients. There were three serious neurological complications after surgery. Improvement was achieved in eleven of the twelve patients with inaugural neurological complications

Objective: To compare the presentation, diagnosis and treatment of spinal tuberculosis in two cities, one in the UK, and one in Malaysia. Design: Retrospective comparison over a five-year period from June 1995. The Centres studied were the Royal Orthopaedic and Queen Elizabeth Hospitals, Birmingham (UK), and the Kuala Lumpur General Hospital (KL), Malaysia. Subjects: There were 80 patients (29 females, mean age 42) in the KL group, and 19 patients (8 females, mean age 45) in the UK group. Outcome measures: Frankel grading before and after treatment were measured for both groups. Results: KL patients had higher rates of immunocompromise, and had fewer spinal levels involved, 2.1 compared with 2.6 (p-−0.04). There were 65 procedures, 58 positive ZN stains, and 65 positive cultures as compared with 24, 2 and 9 in Birmingham respectively. Improvement in Frankel grading was seen in four patients in UK (5 grades), and in 17 patients in KL (29 grades). Conclusions: Although the two groups exhibited similar demographics, the rate of immunocompromise-related tuberculosis, severity of neurological deficit, and type of surgery undertaken differed significantly. Reasons for the difficulty in identifying the tubercle bacillus in Birmingham are discussed

Introduction and aim:. With up to 70% of adults with tuberculosis in Sub-Saharan Africa infected with human immunodeficiency virus (HIV), severe spinal tuberculosis presents a different set of clinical and surgical challenges. To overcome the disadvantages of various traditional techniques, particularly in patients who are HIV-positive with opportunistic pulmonary pathology, and to obviate the need to violate the diaphragm in the lower thoracic and upper lumbar spine, a posterior vertebral column resection through a single posterior approach was proposed. The aim of this study is to report on the early results of the single-stage posterior only vertebral column resection. Method:. A total of 12 patients (10 females and 2 males) seen at CMJAH between January 2007 and January 2011 underwent a single-stage posterior only posterior vertebral column resection, and were retrospectively reviewed. The indications for PVCR are essentially the same as those for 360 degrees decompression and fusion. The mean follow-up period was 15.8 months (range 5 to 44 months). Results:. Eleven allografts and 1 autograft were placed centrally and secured. The kyphosis correction averaged 17.83 degrees (range 0 to 45 degrees); with no loss of correction at last follow-up. The mean number of vertebrae removed was 1.325 (0.75 to 2) with the mean instrumented levels of 3.8 (2 to 7). The mean duration of surgery was 266.6 minutes (140 to 415 mins), the mean intra-operative blood loss was 712.5 mls (350–2100 mls). No loosening or breakage of screws occurred. The mean Frankel neurology grading at last follow-up was D (B to E). Conclusion:. Early results of single-stage only PVCR are gratifying, particularly in patients with decreased pulmonary functions who will not withstand to adverse effects of anterior surgery and 2 stage-surgery. It is an effective surgical technique but technically demanding procedure with possible risks of major complications

Tuberculosis continues to increase in England. London accounted for a substantial proportion of cases in 2005 (43%) and had the highest rate of disease. Spinal TB is the most common skeletal manifestation. The diagnostic evaluation of spinal TB is hampered by the difficulty of MRI interpretation and failing to keep a high index of suspicion.

The mode of presentation of spinal tuberclosis, surgical procedures and outcome of patients were highlighted. Various dermographic parameters were evaluated.

A prospective cohort study was conducted. Cross sectional sampling of patients presented with spinal TB between the years of 1999–2006 in two main hospitals covering large population of East London, Royal London Hospital and King George Hospital.

One hundred and twenty three patients (mean age: 34 years) were identified. Asians represent the highest group affected (63%), then appear Afrocarribean (28%). White British represent only 6.5%. Frequency of occurence was as follows: dorsal spine 45%, lumbar spine 33%, multiple regions 11%. Delayed diagnosis was made in 34% of patients, 44% of whom were over 6/12.

Backpain or neckpain was the presenting complaint in all of the patients (100%), whereas neurological signs were found in 37%. Systemic manifestations presented in 38%. Spinal surgical procedures were needed in 44% of cases. Approximately 30% of them had partial recovery and 9% had complete recovery.

The incidence of spinal TB is on the increase. A high index of suspecion is required to avoid delay in the diagnosis. Knowledge of the patients’ background may help making appropriate early referral for MRI.

Background:

Tuberculosis (TB) is endemic in the sub-saharan Africa (SSA), and up to 70% of adults with TB are infected with Human Immunodeficiency Virus (HIV). In clinical practice, where extra-pulmonary TB (i.e spine) is suspected, treatment is often empirically initiated on clinical and radiological features as access to resources is not always easy. If it looks like TB, is it always TB?

Introduction: Tuberculosis (TB) continues to cause a significant burden of disease in the United Kingdom (UK). A total of 8113 cases were diagnosed in England, Wales and Northern Ireland in 2005, demonstrating a 28% increase since 2000. The incidence of TB in London is four times greater than the national average, with 43% of cases of TB in 2005 being identified in the capital (n= 3,479). 47% of TB cases in the UK have extra pulmonary involvement and 2–3% of all cases of TB involve the spine (n= 107)

Methods: We reviewed 109 patients treated for spinal TB in East London, UK, between 1997–2006. 59 were male and 50 were female. Their mean age was 39 (range 4–89). 63 patients were Asian (3 UK born), 30 African, 8 UK born Caucasian, 4 Caribbean (1 UK born), 3 patients from Eastern Europe and 1 from the Middle East. Of those patients born outside the UK, the mean time they had been in the country pre diagnosis was 9.6 years (range 0–50 years). They were followed up for a minimum of 1 year post completion of treatment (range 14 to 48 months).

95% of patients presented with back pain, with or without neurological compromise.

All patients were imaged with MRI or CT. 90 (86%) patients had microbiological and/or histological confirmation of TB. The majority of patients (52%) had two vertebral levels affected. The Thorocolumbar junction was the area most commonly affected. 4% of patients had paravertebral abscesses with no bony involvement seen on imaging. 29 patients (26%) had associated psoas abscess.

Combination chemotherapy, according to NICE guidelines, was the main modality of treatment. 67 (61%) patients were managed with combination chemotherapy alone. Surgery was performed for certain indications: deteriorating neurology, instability and post tubercular kyphosis. 42(39%) of patients required surgery.

Results: There were no deaths related to TB or our intervention. Most patients had a full neurological recovery but 21 patients (19%) suffered permanent neurological deficit. (4%) suffered permanent paraplegia or paraparesis severe enough to prevent walking.(out of this anybody had surgery and if so how delayed was that) There was a high incidence of persistent chronic back pain (62%) in our group of patients and was not related to any deformity.

Conclusion: Medical management is the mainstay of treatment for spinal TB, but there are certain instances where surgical intervention will be required.

Because of the high incidence of spinal TB in East London and in order to standardise treatment of these patients we set up dedicated multidisciplinary spinal TB clinic and are managed jointly by respiratory and orthopaedic teams.

Introduction:

Skeletal TB has a paucibacillary nature. It is often found in poorly accessible areas for biopsy purposes. Retrieved samples may have a poor representation of the underlying disease process. Additionally, patients have normally commenced anti-tubercular medication that further decreases the number of bacilli. This has resulted in poor sensitivity and specificity outcomes for the tests that are traditionally done.

The polymerase chain reaction (PCR) has been proven to be a useful test for the demonstration of extrapulmonary TB. It has a high specificity and sensitivity.

Introduction: The progress of post tubeculous kyphosis in children during ‘growth spurt’ is unpredictable and has not been clearly documented in literature.

Methods: The progression of deformity in 63 children treated conservatively and belonging to a controlled clinical trial was studied over 15 years.

Results: The average Kyphosis increased from 35.2 degrees to 41.3 degrees in the ‘Active Stage’ (Phase I), there was an increase in all patients. In the ‘Healed stage’ (Phase II), a variable progress continued which was more prominent during the ‘growth spurt’. In Type I, there was a worsening which occured either continuously (Type 1a; n=19.30%), or suddently after a gap of few years (Type 1b;n=6.9%). In Type II, an improvement occured either after an initial increase or a plateau (Type IIa; n=18.29%), or continuously after disease cure (Type IIb; n=9.15%). In Type III, the deformity was static (n=11.17%). The average increase in Type Ia was 24.2 degrees, Type IIb was 20;5 degrees, Type Ib was 58.4 degrees; the decrease in Type IIa was 4.9 degrees, Type IIb was 20.5 degrees and the decrease in Type III was 1.7 degrees. Overall, the growth spurt sresulted in an increase in deformity in 25 (39%) children, a decrease in 27 (44%) and no change in 11 (17%).

Conclusion:

Post-tuberculous kyphosis in children is a ‘Dynamic deformity’ which changes till skeletal maturity.

Introduction: Tuberculosis (TB) continues to cause a sig-nificant burden of disease in the United Kingdom (UK). The incidence of TB in London is four times greater than the national average, with almost half of the 7000 cases/year seen nationwide being found in the capital. Although the majority of cases are pulmonary, extra-pulmonary infection is not uncommon.

Methods: We reviewed 107 patients treated for spinal TB in East London, UK, between 1997–2006. 59 were male and 48 were female. Their mean age was 39.9 (6–89). 69 patients were Asian, 26 African, 10 UK-born Caucasian, 1 other European and 1 Middle Eastern. Rates of HIV co-infection are inexact as many declined to be tested.

All patients presented with symptomatic back pain, with or without neurological compromise.

All patients had appropriate pre and post treatment imaging. 100 had microbiological and/or histological confirmation of TB. The disease was predominantly in the thoraco-lumbar spine, although cervical involvement was seen in 5%. All patients presented with anterior column involvement, with psoas abscesses in 30%.

Combination chemotherapy, according to British Thoracic Society guidelines, was the main modality of treatment. Surgery was performed for certain indications: deteriorating neurology, instability and post tubercular kyphosis. 15% of the 107 patients treated required surgical intervention.

Results: There were no deaths related to TB or our intervention. Most patients had full neurological recovery, but a small percent had permanent neurological compromise. There was a high incidence of persistent chronic back pain for which patients continued to seek medical advice.

Conclusion: Medical management is the mainstay of treatment for spinal TB, but there are certain circumstances where surgical intervention will be required. Because of the high incidence of spinal TB in East London and in order to standardise treatment of these patients, 2 years ago we set up what we believe to be the only dedicated multidisciplinary spinal TB clinic in the UK. Patients are managed jointly by the respiratory and orthopaedic teams.

The August 2012 Spine Roundup. 360. looks at: neural tissue and polymerising bone cement; a new prognostic score for spinal metastases from prostatic tumours; recovery after spinal decompression; spinal tuberculosis; unintended durotomy at spinal surgery; how carrying a load on your head can damage the cervical spine; and how age changes your lumbar spine

Abstract. Objectives. to evaluate the efficacy and safety of topically applied tranexamic acid (TXA) in thoracolumbar spinal tuberculosis surgery, posterior approach. Methods. Thoracolumbar spine tuberculosis patients who requiring debridement, pedicle screw fixation and fusion surgery were divided into two groups. In the TXA group (n=50), the wound surface was soaked with TXA (1 g in 100 mL saline solution) for 3 minutes after exposure, after decompression, and before wound closure, and in the control group (n=116) using only saline. Intraoperative blood loss, drain volume 48 hours after surgery, amount of blood transfusion, transfusion rate, the haemoglobin, haematocrit after the surgery, the difference between them before and after the surgery, incision infection and the incidence of deep vein thrombosis between the two groups. Results. EBL for the control group was 783.33±332.71 mL and for intervention group 410.57±189.72 mL (p<0.001). The operative time for control group was 3.24±0.38 hours and for intervention group 2.99±0.79 hours (p<0.695). Hemovac drainage on days1 and 2 for control group was 167.10±53.83mL and 99.33±37.5 mL, respectively, and for intervention group 107.03±44.37mL and 53.38±21.99mL, respectively (p<0.001). The length of stay was significantly shorter in the intervention group (4.8±1.1 days) compared to control group (7.0±2.3 days). There was bo different in incision side infection and DVT. Conclusions. Topical TXA is a viable, cost-effective method of decreasing perioperative blood loss in major spine surgery with fewer overall complications than other methods. Further studies are required to find the ideal dosage and timing