Differential diagnosis of tuberculous spondylitis under the conditions of a specialized sanatorium

A total of 477 patients admitted to hospital for tuberculous spondylitis were examined. Further studies revealed that the process in the vertebral column was regarded as degenerative and dystrophic changes in 140 patients, nonspecific osteomyelitis in 94, and cancer in 22. The basis of diagnostic errors was the similarity of some clinical and X-ray manifestations and the pathomorphosis of tuberculous spondylitis, older patients, the wide use of antibiotics, which changes the clinical course of spinal tuberculosis. The causes of great difficulties in the differential diagnosis of tuberculous spondylitis lie in the insufficient diagnostic capacities of district tuberculosis dispensaries and in the clinical and X-ray manifestations of spinal tuberculosis which have changed today.     

Causes of disabling forms of tuberculous spondylitis

To define the causes of disabling forms of tuberculous spondylitis, 218 patients with advanced complicated forms of tuberculosis of the vertebral column were examined. Their specific process was complicated by abscesses, fistulas, deformity, and instability of the affected portion of the vertebral column, and neurological disorders. Analysis of clinical findings has indicated that the main causes of complications are late diagnosis of the disease and general practitioners' poor special knowledge. Diagnostic errors may be also caused by a larger number of asymptomatic and atypical forms of tuberculous spondylitis. Diagnosis and differential diagnosis should be improved in order to prevent complications due to spinal tuberculous and as a result its disabling forms.     

Left lumbar subcutaneous cold abscess with tuberculous spondylitis

We report a 29-year-old man with a rare left lumbar subcutaneous cold abscess complicated by tuberculous spondylitis during the treatment of pulmonary tuberculosis. Pulmonary tuberculosis was rapidly improved by anti-tuberculous drugs, however curative operation for tuberculous spondylitis was necessary after 18 months because tuberculous spondylitis was overlooked. Imaging techniques are important in helping to establish a diagnosis of tuberculous spondylitis. It should be stressed that a high clinical index of suspicion for tuberculosis is needed to correctly diagnose this disease.     

Surgical treatment for tuberculous spondylitis; a case report]

A 64-year-old woman was admitted with the chief complaints of severe back pain. Chest X-ray film on admission showed an abnormal mass lesion in the right upper mediastinum. Chest tomography and chest CT films revealed destruction of thoracic vertebrae (Th 2 and 3) and paravertebral abscess. Chemotherapy containing RFP was started under diagnosis of active tuberculous spondylitis of thoracic vertebrae. Three months later, curative operation for spondylitis were performed. She underwent the resection of necrotic bone and the anterior spinal fusion using transplanted bone autograft. Her post-operative course was good and she discharged three months after curative operation. Tuberculous spondylitis is still important diseases at the differential diagnosis from metastatic vertebral tumors. This report describes a successful case of surgical treatment for tuberculous spondylitis of thoracic vertebrae.     

Primary disability as a consequence of tuberculosis and the factors that contribute to its development]

Analysis is given of a high level of invalidity in 508 patients in four regions to whom invalidity due to tuberculosis was first established in 1987-1989. The main factors responsible for invalidity included progress of a tuberculous process, ineffective chemotherapy, untimely diagnosis, the presence of serious attendant diseases, functional disorders of the affected organs, complication of the disease, asocial way of life (chronic alcoholism, narcomania), and insufficient material provision of large families. Most invalids had a combination of the above factors.     

The effect of reconstructive bone surgery in tubercular spondylitis on the development of the spinal column in young children

Long-term results of reconstructive osteoplastic operations on the vertebral column performed for tuberculous spondylitis in 116 children, aged from 1 year and 4 months to 6 years, are presented. All of them were practically cured, thus having a complete recovery of their vertebral column supporting function; in 65.5% of these patients, there was a reduction of a cyphotic deformity with age; 18.7% of the operated persons, including merely 13% of the disabled in their childhood, had resumed their work and 23% of the patients were taken off the dispensary record upon their recovery. Osteoplastic reconstructions for tuberculous spondylitis performed in early childhood failed to affect a future growth of the vertebral column. Besides, they ensure a complete recovery of a child and should have the lead in the whole system of the up-to-date management of spondylitis in children.     

Correction of kyphosis in tuberculous spondylitis in children]

Various modifications of radical reparative surgery were made in 145 children with tuberculous spondylitis were comparatively analyzed. Greatest correction of kyphosis was achieved by combining anterior spinal repair with posterior plunged contractors, in additional resection of the apical vertebral arch in particular. There is a direct correlation between the degree of compression of the dural sac and the severity of neurological disorders. Anterior decompression of the spinal cord is an obligatory surgical component in tuberculous spondylitis, eliminates central stenosis of the spinal canal; however, it is insufficient to eliminate neurological disorders caused by myelic ischemia.     

A case of SAPHO syndrome with destructive spondylodiscitis suspicious of tuberculous spondylitis

We report a rare case of synovitis, acne, pustulosis, hyperostosis, osteitis (SAPHO) syndrome in which the differential diagnosis included tuberculous spondylitis and the patient ultimately required reconstructive spinal surgery. The patient was a 60-year-old woman who presented with severe low-back and leg pain after treatment for tuberculosis. Roentgenography and magnetic resonance imaging of the lumbar spine revealed destructive changes suggestive of tuberculous spondylitis. [¹⁸F]-fluoro-2-deoxyglucose positron emission tomography/computed tomography showed uptake in the cervical spines, lumbar spines, and sacroiliac joints from which she was suspected of having SAPHO syndrome without skin manifestations. However, as her symptoms did not respond to conservative treatment, we performed reconstructive surgery of the lumbar spine. Spinal specimens obtained surgically showed nonspecific inflammation and fibrous hypertrophy of the bone marrow, confirming a diagnosis of the SAPHO syndrome. Her symptoms improved markedly after surgery, although she required occasional prednisolone for moderate polyarthralgia and leg pain.     

Tuberculous spondylitis syndrome

The authors conducted a comprehensive study of 482 patients with suspected tuberculous spondylitis. The commonest diagnostic signs of some spinal diseases, similar to the clinical ones, were defined on clinical, X-ray, laboratory, and thermographic findings. This enabled a differentially diagnostic syndrome including 58 signs to be developed. The proposed syndrome is to facilitate the differential diagnosis of tuberculous spondylitis from spinal tumors, degenerative and dystrophic processes, and nonspecific osteomyelitis of the vertebral column.     

Manual therapy in complex treatment of patients with secondary osteochondrosis after sustained tuberculosis spondylitis

The treatment results relating to 57 patients with neurological signs of osteochondrosis secondary to sustained tuberculous spondylitis with the pain syndrome prevailing in the clinical picture were studied. The majority of the patients (50) had limited affections of 1 or 2-3 adjoining vertebrae and 7 patients had extended processes (4-6 adjoining vertebrae). The treatment procedure was based on manual therapy: hand strength applied to the vertebral column, joints and muscles for eliminating pain and other neurological signs of the disease. The treatment should be complex and differential in regard to the clinical signs, the disease process and stage, the degree of functional disorders and of the pain syndrome. The manual therapy was the most efficient in patients with osteochondrosis secondary to sustained tuberculous spondylitis or the muscular tonic syndrome and moderate deformations of the vertebral column, as well as in those operated on for the main disease at the early stages.     

Diagnosing tuberculous spondylitis: patients with back pain referred to a rheumatology outpatient department

The onset of tuberculous spondylitis is insidious in nature, with various clinical presentations, slow development of radiographic abnormalities, and nonspecific constitutional symptoms. This lack of specific symptoms causes delays in diagnosis. Magnetic resonance imaging demonstrates osteitis, intraosseous abscesses, paravertebral and epidural soft tissue extensions and abscesses, discitis, multilevel involvement of spinal cord or nerve root compression, and scoliosis. We present six patients with tuberculous spondylitis referred to our outpatient department with back pain resistant to medical therapy. All of them were women aged from 25 to 58 years (mean 44.6). The diagnosis of tuberculous spondylitis was based on clinical presentation, radiographic and/or MRI evidence of focal destructive vertebral lesions (with paravertebral mass), and positive bacteriological findings of Mycobacterium tuberculosis. The combined antituberculous chemotherapy consisted of 1.0 g/day streptomycin for 1 month, 25 mg/kg ethambutol or 25 mg/kg pyrazinamide, 600 mg/day rifampicin, and 300 mg/day isoniazid. The duration of therapy was 12 months. All the patients recovered without any sequelae. The mean follow-up period was 28 months (range 12–48). Magnetic resonance imaging is considered the main imaging modality for patients with suspected tuberculous spondylitis; it must be included in differential diagnosis of back pain and, if it is diagnosed in early stages, antituberculous chemotherapy enables satisfactory outcome.     

Multidrug-resistant tuberculosis spondylitis

We report a case of multidrug-resistant spinal tuberculosis complicated by epiduritis and paraspinal abscess in a 68-year-old black woman. Multidrug-resistant tuberculous spondylitis is still rare in Belgium. Two others cases were reported from 1992 to 1997. The optimal therapy is not standardized and the mandatory duration of treatment is not known. Clinical presentation, radiological findings, and treatment are presented. The need for prompt diagnosis and optimal therapy is emphasized.     

Classification of neurological disorders in tuberculous spondylitis

The paper summarizes surveys of over 2500 patients with tuberculous spondylitis complicated by neurological disorders of the spinal cord. The authors identified 5 grades of these disorders: from reflex disorders to limb plegia and pelvic dysfunctions. The classification proposed made it possible to clearly systematize spinal cord disorders in patients with tuberculous spondylitis, to establish a topical diagnosis and the severity of spinal cord lesions, to choose surgical accesses and method for stabilizing the spine, and to make a research processing of clinical and neurological data.     

Prognostic value of functional methods of the study of respiration and blood circulation in surgery of tuberculous spondylitis

Prognostic value of the basic indices of the external respiration function and central hemodynamics in view of predicting the nature of an early postoperative period in tuberculous spondylitis patients is demonstrated. Such indices, as vital capacity, ventilation and hemodynamic supply indices, and mean pressure in the pulmonary artery have the greatest prognostic value. One-dimensional analysis of variance of the functional examination data obtained from 209 patients with tuberculous spondylitis was used in this study.     

Bronchial fistula caused by Pott's abscesses. Report of 3 cases

The authors report 3 cases of intrabronchial fistulisation of paravertebral abscesses due to tuberculous spondylitis of the thoracic spine. This complication is relatively rare (these 3 cases were in a series of 178 cases of Pott's disease) and is easy to diagnose due to its characteristic radio-clinical features. As mentioned in old publications, this type of fistulisation does not seem to have serious consequences. There are no particular aspects of treatment.     

Clinical and radiographic manifestations of tuberculous spondylitis in adults

Data on 348 adult patients with tuberculous spondylitis treated in 1994-1999 are analyzed. The radiation manifestations of spondylitis first occurring in maturity, which amount to 82.3% in the clinical setting were studied in 112 patients. In 50% of cases, spondylitis was a manifestation of multiorgan tuberculosis. The proportion of those with onset in youth increased (27.9). Isolated lesions of the corpus vertebrae were more frequently detected. The processes involving 2 vertebrae were predominant (61.2%), but complicated by foci at new levels. There was a drastic increase in the proportion of disseminated and multi-levelled spondylitis involving 3-9 vertebrae (36.9%). The exudative component of the inflammation was much pronounced, abscesses were extensive in all forms of spondylitis. Spinal cord deficit was noted in 68% of cases of thoracic and cervical spondylitis. MRI should be used for early diagnosis and determination of the extent of a process.     

Spinal lesions in generalized and multiple organ forms of tuberculosis

The paper presents the results of examination of 152 patients with generalized and multiorgan lesions, mainly involving the vertebral column. The tuberculous process is defined in 64.4% of the patients as a generalized one by virtually simultaneously involving several organs and primarily the spine and respiratory organs and in 35.6% as a multiorgan one when symptoms of tuberculous spondylitis or tuberculosis of other organs rather than the lung appear some period (3 years or more) after organ involvement. Recommendations are given for pre- and postoperative treatment. All the patients with a preserved pathological process in the lung underwent operations on the spine in early periods (1-3 months) after admission to hospital.     

Pott's disease occurring after percutaneous vertebroplasty: an unusual illustration of the principle of locus minoris resistentiae

We report an unusual case of a multifocal tuberculous spondylitis that has been diagnosed after several percutaneous vertebroplasty. This event supports the theory that surgical or radiological intervention such as a percutaneous vertebroplasty should be considered as an intentional traumatism that can lead to the initiation of a locus minoris resistentiae, probably by reactivating an inactive tuberculous lesion.     

Tuberculous spondylitis: a cause for paraplegia in lupus

Summary A case of systemic lupus erythematosus (SLE) with paraplegia due to tuberculous spondylitis is presented.     

Magnetic resonance tomography in the diagnosis of tuberculous spondylitis in children]

The experience of using magnetic++-resonance tomography to diagnose tuberculous spondylitis in 15 children admitted to a hospital for surgical treatment is described. The method proved to be highly effective for evaluating the condition of the spine and spinal medulla and for establishment of early diagnosis of the attendant neurotrophic changes in healthy vertebrae. The examination findings serve to determine the volume of surgical intervention, character of postoperative restorative management and allow the prognosis of treatment outcome. In this respect, magnetic++-resonance tomography is a valuable supplementary diagnostic method.