We performed a randomised, controlled clinical trial to compare ambulant short-course chemotherapy with anterior spinal fusion plus short-course chemotherapy for spinal tuberculosis without paraplegia. Patients with active disease of vertebral bodies were randomly allocated to one of three regimens: a) radical anterior resection with bone grafting plus six months of daily isoniazid plus
The aims of this study were to determine the diagnostic yield of image-guided biopsy in providing a final diagnosis in patients with suspected infectious spondylodiscitis, to report the diagnostic accuracy of various microbiological tests and histological examinations in these patients, and to report the epidemiology of infectious spondylodiscitis from a country where tuberculosis (TB) is endemic, including the incidence of drug-resistant TB. A total of 284 patients with clinically and radiologically suspected infectious spondylodiscitis were prospectively recruited into the study. Image-guided biopsy of the vertebral lesion was performed and specimens were sent for various microbiological tests and histological examinations. The final diagnosis was determined using a composite reference standard based on clinical, radiological, serological, microbiological, and histological findings. The overall diagnostic yield of the biopsy, and that for each test, was calculated in light of the final diagnosis.Aims
Methods
The surgical treatment of tuberculosis (TB) of the spine consists
of debridement and reconstruction of the anterior column. Loss of
correction is the most significant challenge. Our aim was to report
the outcome of single-stage posterior surgery using bone allografts
in the management of this condition. The study involved 24 patients with thoracolumbar TB who underwent
single-stage posterior spinal surgery with a cortical bone allograft
for anterior column reconstruction and posterior instrumentation
between 2008 and 2015. A unilateral approach was used for 21 patients
with active TB, and a bilateral approach with decompression and closing-opening
wedge osteotomy was used for three patients with healed TB.Aims
Patients and Methods
Many aspects of the surgical treatment of patients with tuberculosis
(TB) of the spine, including the use of instrumentation and the
types of graft, remain controversial. Our aim was to report the
outcome of a single-stage posterior procedure, with or without posterior
decompression, in this group of patients. Between 2001 and 2010, 51 patients with a mean age of 62.5 years
(39 to 86) underwent long posterior instrumentation and short posterior
or posterolateral fusion for TB of the thoracic and lumbar spines,
followed by anti-TB chemotherapy for 12 months. No anterior debridement
of the necrotic tissue was undertaken. Posterior decompression with
laminectomy was carried out for the 30 patients with a neurological
deficit.Aim
Patients and Methods
The lack of an accurate, rapid diagnostic test
for mycobacterium tuberculosis (TB) is a major handicap in the management
of spinal TB. GeneXpert, a new, rapid molecular diagnostic test
is recommended as the first line investigation for suspected pulmonary
TB in areas with a high prevalence of HIV or drug resistance, yet
it has not been validated for the diagnosis of musculoskeletal TB. The aim of this study was to assess the accuracy of GeneXpert
in diagnosing spinal TB. A prospective clinical study of 69 consecutive adults with suspected
spinal TB was conducted at a tertiary hospital in an area with the
highest incidence and prevalence of TB in the world. GeneXpert was
used on tissue samples of the enrolled patients and its diagnostic
accuracy compared with a reference standard of tissue in liquid culture.
A total of 71 spine samples from 69 patients (two re-biopsies) were
included in the study. The GeneXpert test showed a sensitivity of 95.6% and specificity
of 96.2% for spinal TB. The results of the GeneXpert test were available
within 48 hours compared with a median of 35 days (IQR 15 to 43)
for cultures. All cases of multi-drug resistant TB (MDR TB) were
diagnosed accurately with the GeneXpert test. The MDR TB rate was
5.8%. Cite this article:
To address the natural history of severe post-tuberculous (TB)
kyphosis, with focus upon the long-term neurological outcome, occurrence
of restrictive lung disease, and the effect on life expectancy. This is a retrospective clinical review of prospectively collected
imaging data based at a single institute. A total of 24 patients
of Southern Chinese origin who presented with spinal TB with a mean
of 113° of kyphosis (65° to 159°) who fulfilled inclusion criteria
were reviewed. Plain radiographs were used to assess the degree
of spinal deformity. Myelography, CT and MRI were used when available
to assess the integrity of the spinal cord and canal. Patient demographics,
age of onset of spinal TB and interventions, types of surgical procedure,
intra- and post-operative complications, and neurological status
were assessed. Aims
Patients and Methods
This study evaluates the long-term survival of
spinal implants after surgical site infection (SSI) and the risk
factors associated with treatment failure. A Kaplan-Meier survival analysis was carried out on 43 patients
who had undergone a posterior spinal fusion with instrumentation
between January 2006 and December 2008, and who consecutively developed
an acute deep surgical site infection. All were appropriately treated
by surgical debridement with a tailored antibiotic program based
on culture results for a minimum of eight weeks. A ‘terminal event’ or failure of treatment was defined as implant
removal or death related to the SSI. The mean follow-up was 26 months
(1.03 to 50.9). A total of ten patients (23.3%) had a terminal event.
The rate of survival after the first debridement was 90.7% (95%
confidence interval (CI) 82.95 to 98.24) at six months, 85.4% (95%
CI 74.64 to 96.18) at one year, and 73.2% (95% CI 58.70 to 87.78)
at two, three and four years. Four of nine patients required re-instrumentation
after implant removal, and two of the four had a recurrent infection
at the surgical site. There was one recurrence after implant removal
without re-instrumentation. Multivariate analysis revealed a significant risk of treatment
failure in patients who developed sepsis (hazard ratio (HR) 12.5
(95% confidence interval (CI) 2.6 to 59.9); p <
0.001) or who
had >
three fused segments (HR 4.5 (95% CI 1.25 to 24.05); p = 0.03).
Implant survival is seriously compromised even after properly treated
surgical site infection, but progressively decreases over the first
24 months. Cite this article:
There are few reports of the treatment of lumbar tuberculous spondylitis using the posterior approach. Between January 1999 and February 2004, 16 patients underwent posterior lumbar interbody fusion with autogenous iliac-bone grafting and pedicle screw instrumentation. Their mean age at surgery was 51 years (28 to 66). The mean follow-up period was 33 months (24 to 48). The clinical outcome was assessed using the Frankel neurological classification and the Kirkaldy-Willis criteria. On the Frankel classification, one patient improved by two grades (C to E), seven by one grade, and eight showed no change. The Kirkaldy-Willis functional outcome was classified as excellent in eight patients, good in five, fair in two and poor in one. Bony union was achieved within one year in 15 patients. The mean pre-operative lordotic angle was 27.8° (9° to 45°) which improved by the final follow-up to 35.8° (28° to 48°). Post-operative complications occurred in four patients, transient root injury in two, a superficial wound infection in one and a deep wound infection in one, in whom the implant was removed. Our results show that a posterior lumbar interbody fusion with autogenous iliac-bone grafting and pedicle screw instrumentation for tuberculous spondylitis through the posterior approach can give satisfactory results.
An eight-week-old boy developed severe thoracic
spondylodiscitis following pneumonia and septicaemia. A delay in
diagnosis resulted in complete destruction of the T4 and T5 vertebral
bodies and adjacent discs, with a paraspinal abscess extending into
the mediastinum and epidural space. Antibiotic treatment controlled
the infection and the abscess was aspirated. At the age of six months,
he underwent posterior spinal fusion Spondylodiscitis should be included in the differential diagnosis
of infants who present with severe illness and atypical symptoms.
Delayed diagnosis can result in major spinal complications with
a potentially fatal outcome.
Anterior debridement, grafting of the defect and posterior instrumentation as a single-stage procedure is a controversial method of managing pyogenic vertebral osteomyelitis. Between 1994 and 2005, 37 patients underwent this procedure at our hospital, of which two died and three had inadequate follow-up. The remaining 32 were reviewed for a mean of 36 months (12 to 66). Their mean age was 48 years (17 to 68). A significant pre-operative neurological deficit was present in 13 patients (41%). The mean duration of surgery was 285 minutes (240 to 360) and the mean blood loss was 900 ml (300 to 1600). Pyogenic organisms were isolated in 21 patients (66%). All patients began to mobilise on the second post-operative day. The mean hospital stay was 13.6 days (10 to 20). Appropriate antibiotics were administered for 10 to 12 weeks. Early wound infection occurred in four patients (12.5%), and late infection in two (6.3%). At final follow-up, the infection had resolved in all patients, neurological recovery was seen in ten of 13 (76.9%) and interbody fusion had occurred in 30 (94%). The clinical outcome was excellent or good in 30 patients according to Macnab’s criteria. This surgical protocol can be used to good effect in patients with pyogenic vertebral osteomyelitis when combined with appropriate antibiotic therapy.
