BACKGROUND Tuberculosis is among the most devastating infectious diseases worldwide.Spinal tuberculosis is not easy to detect at an early stage,which without effective treatment often leads to spinal deformity and spi...BACKGROUND Tuberculosis is among the most devastating infectious diseases worldwide.Spinal tuberculosis is not easy to detect at an early stage,which without effective treatment often leads to spinal deformity and spinal cord damage which in turn cause complications such as paraplegia and quadriplegia.In this study,we established a model using three concentrations of bacteria and carried out a comprehensive evaluation of the model by imaging,general observations,and histopathological and bacteriological studies.AIM To establish a rabbit model of spinal tuberculosis and examine the effect on the model’s efficacy using different concentrations of Mycobacterium tuberculosis(M.tuberculosis)inoculum.METHODS New Zealand rabbits were randomly divided into experimental,control and blank groups.The experimental and control animals were sensitized with complete Freund′s adjuvant,a hole was drilled beneath the upper endplate of the L6 vertebral body and filled with gelfoam sponge.The experimental group was divided into three subgroups(experimental 1,experimental 2,experimental 3)and infused with M.tuberculosis suspension at various concentrations.The control group was inoculated with saline and the blank group received no treatment.The 12-week post-operative survival rates were 100%,80%and 30%in the experimental groups inoculated with concentrations of 106,107 and 108 CFU/mL bacteria,respectively.RESULTS The survival rate of the control and blank groups was 100%.Vertebral body destruction at 8 weeks in the three experimental groups as determined by X-ray analysis was 33.3%,62.5%and 66.7%,and by computed tomography(CT)and 3-dimensional CT 44.4%,75%and 100%,respectively.At 12 weeks,the figures were 44.4%,75%and 100%by X-ray analysis and 44.4%,100%and 100%by CT and 3-dimensional CT,respectively.All surviving rabbits of the experimental groups had vertebral destruction.The positive bacterial culture rates were 22.2%,75%and 66.7%,respectively,in the experimental groups.After being sensitized with complete Freund's adjuvant,large differences were observed in the extent of spinal tuberculosis after inoculation of the rabbits with different concentrations of H37RV standard M.tuberculosis.CONCLUSION The experimental 1 had a low success rate at establishing an infection.The experimental 3 resulted in high mortality and complication rates.The experimental 2 was optimum for establishing a spinal tuberculosis model based on the high level of symptoms observed and the low rabbit mortality.展开更多
This study examined the clinical outcomes of one-stage surgical treatment for patients with spinal tuberculosis via a posterior-only approach. Twenty-four patients with thoracic or lumbar spinal tuberculosis whose les...This study examined the clinical outcomes of one-stage surgical treatment for patients with spinal tuberculosis via a posterior-only approach. Twenty-four patients with thoracic or lumbar spinal tuberculosis whose lesions were confined to adjacent segments were admitted to our hospital and treated. The American Spinal Injury Association（ASIA） impairment scale was used to assess the neurological function. All patients were treated with one-stage surgical treatment via a posterior-only approach. The clinical efficacy was evaluated by the Japanese Orthopaedic Association（JOA） scores and oswestry disability index（ODI） of nerve function. Patients were evaluated preoperatively and postoperatively by measurement of spinal deformity using Cobb angle and radiological examination. All the patients were followed up for 13 to 27 months. They had significantly postoperative improvement in JOA score, ODI and ASIA classification scores. The kyphotic angles were significantly corrected and maintained at the final follow-up. Bone fusion was achieved within 4–12 months. It was concluded that one-stage surgical treatment via a posterior-only approach is effective and feasible for the treatment of spinal tuberculosis.展开更多
BACKGROUND Spinal tuberculosis(TB),also known as Pott’s spine,remains a significant global health issue,particularly in regions with a high TB burden.The disease presents complex challenges in diagnosis,management,an...BACKGROUND Spinal tuberculosis(TB),also known as Pott’s spine,remains a significant global health issue,particularly in regions with a high TB burden.The disease presents complex challenges in diagnosis,management,and treatment,prompting a growing interest in research over recent years.The advancements in imaging,diagnostics,and treatment strategies have driven an increased focus on publishing clinical outcomes,review articles,and case series related to spinal TB(STB).AIM To perform a bibliometric analysis of STB research published over the last 5 years(2019-2023)to identify trends in publication volume,contributions by country,and the nature of the research being conducted.METHODS A comprehensive bibliometric analysis was conducted using the PubMed database,focusing on research articles published between 2019 and 2023.Keywords such as“spine tuberculosis,”“spinal TB,”“TB spine,”and“Pott’s spine”were utilized to capture relevant publications.Articles were analyzed based on the type of research(e.g.,case reports,review articles,cohort studies,randomized controlled trials[RCTs]),number of citations,and country of origin based on the corresponding author's details.Further subgroup analysis was performed according to the TB burden in various countries to assess research trends in high-burden regions.RESULTS A total of 528 articles met the inclusion criteria for this bibliometric analysis.The majority of articles were published between 2020 and 2023(440/528;83.3%),while the lowest number was published in 2019(88/528;16.7%).India led the global contributions with 25.8%of the total publications,followed by China(19.9%)and the United States(10.4%).Combined,African countries contributed 6.8%of the research on STB.Regarding the type of articles,case reports and case series dominated the literature(353/528;66.9%),followed by review articles(120/528;22.7%)and cohort studies(45/528;8.5%).Only 1.9%(10/528)of the studies were RCTs.Countries such as the United States,Germany,the United Kingdom,and Japan have pioneered the use of artificial intelligence(AI)in the diagnostic processes for STB,while India,China,South Africa,and other countries have been pivotal in conducting clinical trials and improving clinical management strategies.CONCLUSION This bibliometric analysis revealed a significant increase in STB research over the last 5 years,with India and China being the leading contributors.However,most publications are case reports or case series,with a limited number of RCTs.The results highlighted the need for more high-quality research,especially in terms of RCTs and innovations in diagnostic technologies.Additionally,the application of AI to STB diagnostics shows promise in developed countries,while high-burden countries are focusing on clinical trials and management strategies.展开更多
Spinal tuberculosis,as one of the most serious forms of extrapulmonary tuberculosis,is one of the primary causes of spinal deformity and paralysis in developing countries.It immensely affects people's quality of l...Spinal tuberculosis,as one of the most serious forms of extrapulmonary tuberculosis,is one of the primary causes of spinal deformity and paralysis in developing countries.It immensely affects people's quality of life with high incidences of deformity and disability.The onset of spinal tuberculosis is related to many factors such as gender,age,environment,habits and hereditary factor.As a genetic factor,gene polymorphism plays an important role in the occurrence and development of tuberculosis.This article reviews the research progress of the susceptibility of spinal tuberculosis and its related gene polymorphisms,in order to provide reference for early prevention and treatment of spinal tuberculosis.展开更多
Objective To discuss perioperative features,operative approach and surgical effects of spinal tuberculosis in older patients.Methods Retrospective analysis was conducted to analyze the clinical data of 45 patients wit...Objective To discuss perioperative features,operative approach and surgical effects of spinal tuberculosis in older patients.Methods Retrospective analysis was conducted to analyze the clinical data of 45 patients with spinal展开更多
Pott’s spine,commonly known as spinal tuberculosis(TB),is an extrapulmonary form of TB caused by Mycobacterium TB.Pott’s paraplegia occurs when the spine is involved.Spinal TB is usually caused by the hematogenous s...Pott’s spine,commonly known as spinal tuberculosis(TB),is an extrapulmonary form of TB caused by Mycobacterium TB.Pott’s paraplegia occurs when the spine is involved.Spinal TB is usually caused by the hematogenous spread of infection from a central focus,which can be in the lungs or another location.Spinal TB is distinguished by intervertebral disc involvement caused by the same segmental arterial supply,which can result in severe morbidity even after years of approved therapy.Neurological impairments and spine deformities are caused by progressive damage to the anterior vertebral body.The clinical,radiographic,microbiological,and histological data are used to make the diagnosis of spinal TB.In Pott’s spine,combination multidrug antitubercular therapy is the basis of treatment.The recent appearance of multidrug-resistant/extremely drug-resistant TB and the growth of human immunodeficiency virus infection have presented significant challenges in the battle against TB infection.Patients who come with significant kyphosis or neurological impairments are the only ones who require surgical care.Debride-ment,fusion stabilization,and correction of spinal deformity are the cornerstones of surgical treatment.Clinical results for the treatment of spinal TB are generally quite good with adequate and prompt care.展开更多
Objective： In the present study, spinal metastatic tumors, brucellar spondylitis and spinal tuberculosis werequantitatively analyzed using dynamic contrast-enhanced magnetic resonance imaging （DCE-MRI） to assess th...Objective： In the present study, spinal metastatic tumors, brucellar spondylitis and spinal tuberculosis werequantitatively analyzed using dynamic contrast-enhanced magnetic resonance imaging （DCE-MRI） to assess thevalue of DCE-MRI in the differential diagnosis of these diseases.Methods： Patients with brucellar spondylitis, spinal tuberculosis or a spinal metastatic tumor （30 cases of each）received conventional MRI and DCE-MRI examination. The volume transfer constant （Ktrans）, rate constant （Kep）,extravascular extracellular volume fraction （Ve） and plasma volume fraction （Vp） of the diseased vertebral bodieswere measured on the perfusion parameter map, and the differences in these parameters between the patients werecompared.Results： For pathological vertebrae in cases of spinal metastatic tumor, brucellar spondylitis and spinaltuberculosis, respectively, the Ktrans values （median ＋ quartile pitch） were 0.989±0.014, 0.720±0.011 and0.317±0.005 min-1; the Kep values were 2.898±0.055, 1.327±0.017 and 0.748±0.006 min-1; the Ve values were0.339±0.008, 0.542±0.013 and 0.428±0.018; the Vp values were 0.048±0.008, 0.035±0.004 and 0.028±0.009; thecorresponding H values were 50.25 （for Ktrans）, 52.47 （for Kep）, 48.33 （for Ve） and 46.56 （for Vp）, and all differenceswere statistically significant （two-sided P〈0.05）.Conclusions： The quantitative analysis of DCE-MRI has a certain value in the differential diagnosis of spinalmetastatic tumor, brucellar spondylitis and spinal tuberculosis.展开更多
BACKGROUND: Spinal tuberculosis is a common disease in orthopedic clinical practice; however, it is seldom reported after organ transplantation. The aim of this study was to investigate the diagnosis and treatment of ...BACKGROUND: Spinal tuberculosis is a common disease in orthopedic clinical practice; however, it is seldom reported after organ transplantation. The aim of this study was to investigate the diagnosis and treatment of spinal tuberculosis after organ transplantation. METHOD: Two cases were diagnosed as spinal tuberculosis after liver transplantation and were treated with socarboxazide, rifampicin, streptomycin and ethambutol for more than one year. RESULTS: After treatment with anti-tuberculosis drugs for several months, the symptoms of both patients clearly improved. Back pain disappeared, and erythrocyte sedimentation and body temperature returned to normal. CONCLUSIONS: We should highly suspect spinal tuberculosis if notalgia and night sweats are present after organ transplantation. Anti-tuberculosis therapy is an effective treatment for spinal tuberculosis after organ transplantation.展开更多
Objective: To evaluate the clinical feasibility and efficacy in treatment of thoracic tuberculosis via paraspinal approach. Methods: From June 2011 to August 2016, 24 patients with mono-segmental thoracic spine tuberc...Objective: To evaluate the clinical feasibility and efficacy in treatment of thoracic tuberculosis via paraspinal approach. Methods: From June 2011 to August 2016, 24 patients with mono-segmental thoracic spine tuberculosis were treated by transfacet debridement combined with bone grafting and internal fixation through paraspinal approach. There were 11 males and 13 females with age ranging from 21 to 63 years (average, 39.5). There were 3 patients in T4/5, 2 patients in T5/6, 3 patients in T7/8, 3 patients in T8/9, 4 patients in T9/10, 3 patients in T10/11, and 6 patients in T11/12. Patients had different degraded local kyphosis deformity shown on X-ray, and different degraded bone destruction and abscess in thoracic spine shown on CT and MRI before the operation. All of the patients before the regular anti tuberculosis treatment for 2 to 4 weeks, the surgical approach used by paraspinal muscle approach, postoperative regular anti tuberculosis treatment for 9 to 12 weeks. Record the clinical symptoms of patients before and after surgery, preoperative Frankel functional classification of spinal cord injury, the operative time, intraoperative blood loss, postoperative ESR, CRP, complications, VAS score, ODI score and Cobb angle changes, imaging check regularly to evaluate the fusion and follow-up of nerve functional recovery. Results: The average operation time was 198 min. The average blood loss was 436 ml. There were no severe complications during and after operation. All patients were followed up for 1 year to 2 years, average 1.5 years of follow-up, the clinical symptoms improved significantly after operation and last follow-up ESR, CRP, VAS score, ODI score and Cobb angle were significantly improved after operation (P < 0.05), grade I Eck fusion, the fusion rate was 100% and the neurological function were improved. Conclusion: on the basis of strict anti tuberculosis chemotherapy, the use of paraspinal muscle gap approach for the treatment of thoracic tuberculosis is less invasive, less destructive to spinal stability, and can achieve obvious curative effect. It is worthy of clinical application.展开更多
Objective:To investigate the effect of intensive psycho1ogical nursing on the mood and coping ways of spinal tuberculosis patients.Methods:The clinical data of 102 patients undergoing spinal tuberculosis surgery in ou...Objective:To investigate the effect of intensive psycho1ogical nursing on the mood and coping ways of spinal tuberculosis patients.Methods:The clinical data of 102 patients undergoing spinal tuberculosis surgery in our hospital from February 2017 to January 2020 were retrospectively analyzed.A11 the cases were grouped according to different nursing plans,patients who received routine care were included in the control group(n=50),and the ones with intensive psychological care were included in the observation group(n=52).Compare negative emotions after nursing[assessment using self-assessment scale of anxiety(SAS),depression self-assessment scale(SDS)]and solutions[assessment using medical response questionnaire(MCMQ)]of the two groups.Results:After nursing,the SAs,SDs scores,avoidance and yield scores of the two groups were reduced,and the coping scores were increased,and the change of the observation group was greater than that of the control group,the difference was statistically significant(P<0.05).Conclusion:Spinal tuberculosis surgery patients were treated with intensive psychological care,which can relieve patients'negative emotions,improve solutions and are worthy of clinical use.展开更多
Objective: to explore and analyze the clinical value of CT and MRI in the diagnosis of spinal tuberculosis. Methods: a total of 48 patients with spinal tuberculosis admitted to our hospital from January to December 20...Objective: to explore and analyze the clinical value of CT and MRI in the diagnosis of spinal tuberculosis. Methods: a total of 48 patients with spinal tuberculosis admitted to our hospital from January to December 2020 were selected for the study. All patients received CT and MRI imaging diagnosis successively, and the results of the two imaging examinations were compared and analyzed. Results: the diagnosis results of the two methods for bone disc loss and paravertebral mass are exactly the same, P > 0.05. The detection rate of ligament diffusion, dural cyst and meningeal enhancement by MRI was significantly higher than that by CT, while the detection rate of calcification was significantly lower than that by CT, P<0.05. Conclusion: in the clinical diagnosis of spinal tuberculosis, both CT and MIR have high application value and the diagnostic accuracy of MIR is relatively higher.展开更多
BACKGROUND Tuberculosis is a chronic infectious disease and an important public health pro-blem.Despite progress in controlling tuberculosis,the incidence of tuberculosis in China is still very high,with 895000 new ca...BACKGROUND Tuberculosis is a chronic infectious disease and an important public health pro-blem.Despite progress in controlling tuberculosis,the incidence of tuberculosis in China is still very high,with 895000 new cases annually.This case report des-cribes the investigation of a case of severe disseminated tuberculosis in a young adult with normal immune function,conducted to ascertain why a Mycobacterium tuberculosis(M.tuberculosis)strain caused such severe disease.CASE SUMMARY A previously healthy 28-year-old woman presented to our hospital with a 1-mo-nth history of fever and fatigue.She was diagnosed with severe disseminated pulmonary tuberculosis,spinal tuberculosis with paravertebral abscesses,and tuberculous meningitis.M.tuberculosis was isolated from bronchoal-veolar lavage fluid.She was treated with standard antituberculous therapy and underwent debridement,bone graft,and internal fixation surgery for spinal tuberculosis.She responded to therapy and regained her ability to walk following the surgery.We analysed the whole-genome sequence of the strain and designated it BLM-A21.Additional M.tuberculosis genomes were selected from the Virulence Factor Database(http://www.mgc.ac.cn/cgi-bin/VFs/genus.cgi?Genus=Mycobacterium)for comparison.An evolutionary tree of the BLM-A21 strain was built using PhyML maximum likelihood software.Further gene analysis revealed that,except for the pks1 gene,BLM-A21 had similar virulence genes to the CDC 1551 and H37Rv strains,which have lower dissemination.CONCLUSION We speculate that the pks1 virulence gene in BLM-A21 may be the key virulence gene responsible for the wide-spread dissemination of M.tuberculosis infection in this previously healthy adult with normal immune function.展开更多
Background and Objectives:To explore the effect of nutrition management under ERAS concept in patients with spinal tuberculosis.Methods and Study Design:The study was conducted in an orthopedic ward of a tertiary grad...Background and Objectives:To explore the effect of nutrition management under ERAS concept in patients with spinal tuberculosis.Methods and Study Design:The study was conducted in an orthopedic ward of a tertiary grade A special hospital in Beijing.The patients admitted from January 1,2021 to June 27,2023 were screened for inclusion.The qualified patients were randomized into experimental group or control group.The experimental group received perioperative nutrition management under the concept of ERAS while the control group received routine perioperative management in hospital.The data was collected on the next day of admission,the next day and the sixth day after operation,including laboratory indicators(lymphocyte count,hemoglobin level,etc),intraoperative bleeding volume,postoperative exhaust,defecation time,drainage volume,albumin infusion amount,nutritional risk score,length of stay,hospitalization costs,etc.Univariate analysis and multivariate analysis correcting for gender,age,and baseline values were performed using SPSS24.0.Results:A total of 127 patients with spinal tuberculosis completed the study.Compared with the control group,the intraoperative blood loss(p=0.028)in the experimental group was significantly reduced,the postoperative exhaust time(p=0.012)and defecation time(p=0.012)were significantly shortened,and the nutritional status(p<0.001)was significantly improved.Besides,the results of multivariate analysis are robust after correcting potential confounding factors.Conclusions:Nutrition management under the concept of ERAS is helpful to reduce intraoperative bleeding,promote postoperative flatus and defecation,and improve nutritional status in patients with spinal tuberculosis,which may further improve their clinical outcome and prognosis.展开更多
<b style="line-height:1.5;"><span style="font-family:Verdana;">Objective:</span></b><span style="font-family:'';line-height:1.5;"><span style=&quo...<b style="line-height:1.5;"><span style="font-family:Verdana;">Objective:</span></b><span style="font-family:'';line-height:1.5;"><span style="font-family:Verdana;"> To evaluate the prevalence of spinal infection in a hospital located in the eastern region of Saudi Arabia through a retrospective review and to identify the associated etiological agents in terms of clinical picture, treatment, and outcomes. </span><b><span style="font-family:Verdana;">Design: </span></b><span style="font-family:Verdana;">Retrospective cross-sectional study. </span><b><span style="font-family:Verdana;">Setting:</span></b><span style="font-family:Verdana;"> Single hospital in Dhahran, Saudi Arabia. </span><b><span style="font-family:Verdana;">Patients:</span></b><span style="font-family:Verdana;"> Patients with any type of spinal infection and/or who had undergone neurosurgical intervention for spinal infection between January 2006 and December 2018. </span><b><span style="font-family:Verdana;">Methods:</span></b><span style="font-family:Verdana;"> We collected data on all patients with an established diagnosis of spinal infection from January 2006 to December 2018 in the King Fahad Military Medical Complex in Dhahran, Saudi Arabia. A validated and structured checklist was used for data collection. Spinal infection diagnosis was based on the clinical manifestation, microbiological evidence, radiological findings, and antimicrobial therapy response. </span><b><span style="font-family:Verdana;">Results:</span></b><span style="font-family:Verdana;"> Seventeen patients were included in this study, and their mean age was 54.93 years. Twelve of the patients were male and four were female. The approximate time from symptom onset to diagnosis was 2</span></span><span style="line-height:1.5;font-family:Verdana;"> - </span><span style="line-height:1.5;font-family:Verdana;">6 months. Most of the patients experienced back pain, with lumbosacral spondylitis being the most commonly cited type (61.11%), followed </span><span style="line-height:1.5;font-family:Verdana;">by thoracolumbar spondylodiscitis (25%) and cervical spondylodiscitis (6.25%). The most frequently isolated organism was </span><i style="font-family:'';line-height:1.5;"><span style="font-family:Verdana;">Mycobacterium tuberculosis</span></i><span style="line-height:1.5;font-family:Verdana;"> (8 patients, 50%), followed by extended-spectrum beta lactamase (ESBL)-producing </span><i style="font-family:'';line-height:1.5;"><span style="font-family:Verdana;">Escherichia coli</span></i><span style="line-height:1.5;font-family:Verdana;"> (4 patients, 25%), </span><i style="font-family:'';line-height:1.5;"><span style="font-family:Verdana;">Brucella</span></i><span style="line-height:1.5;font-family:Verdana;"> spp (3 patients, 18.75%), </span><i style="font-family:'';line-height:1.5;"><span style="font-family:Verdana;">Staphylococcus aureus</span></i><span style="line-height:1.5;font-family:Verdana;"> (1 patient, 6.25%), and </span><i style="font-family:'';line-height:1.5;"><span style="font-family:Verdana;">Quambalaria cyanescens</span></i><span style="line-height:1.5;font-family:Verdana;"> (1 patient, 6.25%). Totally, in 50% of the patients with thoracolumbar and lumbosacra site involvement, tuberculosis spondylodiscitis was observed, while another 50% of the cases showed complications associated with paravertebral abscess that required surgical drainage. </span><b style="font-family:'';line-height:1.5;"><span style="font-family:Verdana;">Conclusion:</span></b><span style="font-family:'';line-height:1.5;"> </span><i style="font-family:'';line-height:1.5;"><span style="font-family:Verdana;">M. tuberculosis</span></i><span style="line-height:1.5;font-family:Verdana;"> was found to be the major cause of infectious spondylodiscitis. Additionally, </span><i style="font-family:'';line-height:1.5;"><span style="font-family:Verdana;">Quambalaria cyanescens</span></i><span style="line-height:1.5;font-family:Verdana;"> was isolated;this is the second reported case of the organism being isolated and the first associated with spinal infection.展开更多
Background: Tuberculosis of the spine is common in Nigeria. It commonly causes neurological deficit especially when the lesions are higher up in the spine. Objective: To report a case of a young man who had C4 quadrip...Background: Tuberculosis of the spine is common in Nigeria. It commonly causes neurological deficit especially when the lesions are higher up in the spine. Objective: To report a case of a young man who had C4 quadriplegia from tuberculous destruction of C3 to C5 vertebral bodies and their intervening discs, aretropharyngeal prevertebral abscess and associated segmental kyphosis. He had received prior antituberculous therapy with no improvement. Results: He recovered completely neurologically when he had adequate decompression and 360°;instrumented fusiondone in a 3-stage surgery that involved drainage and debridement of the retropharyngeal prevertebral abscess, anterior corpectomy of C3 and C4 with fusion using a titanium mesh cage, and posterior fusion of C3 to C6 using titanium rods and lateral mass screws. Surgical treatment was supported with skull traction and antituberculous therapy. Conclusion: This case shows that complete neurologic recovery is feasible in spinal quadriplegia that fails to respond to antituber-culous therapy when adequate decompression and fusion are done.展开更多
基金Supported by Lanzhou City Science and Technology Development Guiding Plan Project,No.2023-ZD-170Lanzhou Science and Technology Plan Project,No.2023-2-11High-Level Talent Training Project At the 940th Hospital of the Joint Logistics Force,No.2024-G3-5.
文摘BACKGROUND Tuberculosis is among the most devastating infectious diseases worldwide.Spinal tuberculosis is not easy to detect at an early stage,which without effective treatment often leads to spinal deformity and spinal cord damage which in turn cause complications such as paraplegia and quadriplegia.In this study,we established a model using three concentrations of bacteria and carried out a comprehensive evaluation of the model by imaging,general observations,and histopathological and bacteriological studies.AIM To establish a rabbit model of spinal tuberculosis and examine the effect on the model’s efficacy using different concentrations of Mycobacterium tuberculosis(M.tuberculosis)inoculum.METHODS New Zealand rabbits were randomly divided into experimental,control and blank groups.The experimental and control animals were sensitized with complete Freund′s adjuvant,a hole was drilled beneath the upper endplate of the L6 vertebral body and filled with gelfoam sponge.The experimental group was divided into three subgroups(experimental 1,experimental 2,experimental 3)and infused with M.tuberculosis suspension at various concentrations.The control group was inoculated with saline and the blank group received no treatment.The 12-week post-operative survival rates were 100%,80%and 30%in the experimental groups inoculated with concentrations of 106,107 and 108 CFU/mL bacteria,respectively.RESULTS The survival rate of the control and blank groups was 100%.Vertebral body destruction at 8 weeks in the three experimental groups as determined by X-ray analysis was 33.3%,62.5%and 66.7%,and by computed tomography(CT)and 3-dimensional CT 44.4%,75%and 100%,respectively.At 12 weeks,the figures were 44.4%,75%and 100%by X-ray analysis and 44.4%,100%and 100%by CT and 3-dimensional CT,respectively.All surviving rabbits of the experimental groups had vertebral destruction.The positive bacterial culture rates were 22.2%,75%and 66.7%,respectively,in the experimental groups.After being sensitized with complete Freund's adjuvant,large differences were observed in the extent of spinal tuberculosis after inoculation of the rabbits with different concentrations of H37RV standard M.tuberculosis.CONCLUSION The experimental 1 had a low success rate at establishing an infection.The experimental 3 resulted in high mortality and complication rates.The experimental 2 was optimum for establishing a spinal tuberculosis model based on the high level of symptoms observed and the low rabbit mortality.
文摘This study examined the clinical outcomes of one-stage surgical treatment for patients with spinal tuberculosis via a posterior-only approach. Twenty-four patients with thoracic or lumbar spinal tuberculosis whose lesions were confined to adjacent segments were admitted to our hospital and treated. The American Spinal Injury Association（ASIA） impairment scale was used to assess the neurological function. All patients were treated with one-stage surgical treatment via a posterior-only approach. The clinical efficacy was evaluated by the Japanese Orthopaedic Association（JOA） scores and oswestry disability index（ODI） of nerve function. Patients were evaluated preoperatively and postoperatively by measurement of spinal deformity using Cobb angle and radiological examination. All the patients were followed up for 13 to 27 months. They had significantly postoperative improvement in JOA score, ODI and ASIA classification scores. The kyphotic angles were significantly corrected and maintained at the final follow-up. Bone fusion was achieved within 4–12 months. It was concluded that one-stage surgical treatment via a posterior-only approach is effective and feasible for the treatment of spinal tuberculosis.
文摘BACKGROUND Spinal tuberculosis(TB),also known as Pott’s spine,remains a significant global health issue,particularly in regions with a high TB burden.The disease presents complex challenges in diagnosis,management,and treatment,prompting a growing interest in research over recent years.The advancements in imaging,diagnostics,and treatment strategies have driven an increased focus on publishing clinical outcomes,review articles,and case series related to spinal TB(STB).AIM To perform a bibliometric analysis of STB research published over the last 5 years(2019-2023)to identify trends in publication volume,contributions by country,and the nature of the research being conducted.METHODS A comprehensive bibliometric analysis was conducted using the PubMed database,focusing on research articles published between 2019 and 2023.Keywords such as“spine tuberculosis,”“spinal TB,”“TB spine,”and“Pott’s spine”were utilized to capture relevant publications.Articles were analyzed based on the type of research(e.g.,case reports,review articles,cohort studies,randomized controlled trials[RCTs]),number of citations,and country of origin based on the corresponding author's details.Further subgroup analysis was performed according to the TB burden in various countries to assess research trends in high-burden regions.RESULTS A total of 528 articles met the inclusion criteria for this bibliometric analysis.The majority of articles were published between 2020 and 2023(440/528;83.3%),while the lowest number was published in 2019(88/528;16.7%).India led the global contributions with 25.8%of the total publications,followed by China(19.9%)and the United States(10.4%).Combined,African countries contributed 6.8%of the research on STB.Regarding the type of articles,case reports and case series dominated the literature(353/528;66.9%),followed by review articles(120/528;22.7%)and cohort studies(45/528;8.5%).Only 1.9%(10/528)of the studies were RCTs.Countries such as the United States,Germany,the United Kingdom,and Japan have pioneered the use of artificial intelligence(AI)in the diagnostic processes for STB,while India,China,South Africa,and other countries have been pivotal in conducting clinical trials and improving clinical management strategies.CONCLUSION This bibliometric analysis revealed a significant increase in STB research over the last 5 years,with India and China being the leading contributors.However,most publications are case reports or case series,with a limited number of RCTs.The results highlighted the need for more high-quality research,especially in terms of RCTs and innovations in diagnostic technologies.Additionally,the application of AI to STB diagnostics shows promise in developed countries,while high-burden countries are focusing on clinical trials and management strategies.
基金Fund Project:Traditional Chinese Medicine Research Project of Hubei Provincial Health Commission(ZY2019F025)the Clinical Research Supported by Wu Jieping Medical Foundation(No.320.6750.17566)。
文摘Spinal tuberculosis,as one of the most serious forms of extrapulmonary tuberculosis,is one of the primary causes of spinal deformity and paralysis in developing countries.It immensely affects people's quality of life with high incidences of deformity and disability.The onset of spinal tuberculosis is related to many factors such as gender,age,environment,habits and hereditary factor.As a genetic factor,gene polymorphism plays an important role in the occurrence and development of tuberculosis.This article reviews the research progress of the susceptibility of spinal tuberculosis and its related gene polymorphisms,in order to provide reference for early prevention and treatment of spinal tuberculosis.
文摘Objective To discuss perioperative features,operative approach and surgical effects of spinal tuberculosis in older patients.Methods Retrospective analysis was conducted to analyze the clinical data of 45 patients with spinal
文摘Pott’s spine,commonly known as spinal tuberculosis(TB),is an extrapulmonary form of TB caused by Mycobacterium TB.Pott’s paraplegia occurs when the spine is involved.Spinal TB is usually caused by the hematogenous spread of infection from a central focus,which can be in the lungs or another location.Spinal TB is distinguished by intervertebral disc involvement caused by the same segmental arterial supply,which can result in severe morbidity even after years of approved therapy.Neurological impairments and spine deformities are caused by progressive damage to the anterior vertebral body.The clinical,radiographic,microbiological,and histological data are used to make the diagnosis of spinal TB.In Pott’s spine,combination multidrug antitubercular therapy is the basis of treatment.The recent appearance of multidrug-resistant/extremely drug-resistant TB and the growth of human immunodeficiency virus infection have presented significant challenges in the battle against TB infection.Patients who come with significant kyphosis or neurological impairments are the only ones who require surgical care.Debride-ment,fusion stabilization,and correction of spinal deformity are the cornerstones of surgical treatment.Clinical results for the treatment of spinal TB are generally quite good with adequate and prompt care.
基金funded by the National Natural Science Foundation of China (No. 81460259)
文摘Objective： In the present study, spinal metastatic tumors, brucellar spondylitis and spinal tuberculosis werequantitatively analyzed using dynamic contrast-enhanced magnetic resonance imaging （DCE-MRI） to assess thevalue of DCE-MRI in the differential diagnosis of these diseases.Methods： Patients with brucellar spondylitis, spinal tuberculosis or a spinal metastatic tumor （30 cases of each）received conventional MRI and DCE-MRI examination. The volume transfer constant （Ktrans）, rate constant （Kep）,extravascular extracellular volume fraction （Ve） and plasma volume fraction （Vp） of the diseased vertebral bodieswere measured on the perfusion parameter map, and the differences in these parameters between the patients werecompared.Results： For pathological vertebrae in cases of spinal metastatic tumor, brucellar spondylitis and spinaltuberculosis, respectively, the Ktrans values （median ＋ quartile pitch） were 0.989±0.014, 0.720±0.011 and0.317±0.005 min-1; the Kep values were 2.898±0.055, 1.327±0.017 and 0.748±0.006 min-1; the Ve values were0.339±0.008, 0.542±0.013 and 0.428±0.018; the Vp values were 0.048±0.008, 0.035±0.004 and 0.028±0.009; thecorresponding H values were 50.25 （for Ktrans）, 52.47 （for Kep）, 48.33 （for Ve） and 46.56 （for Vp）, and all differenceswere statistically significant （two-sided P〈0.05）.Conclusions： The quantitative analysis of DCE-MRI has a certain value in the differential diagnosis of spinalmetastatic tumor, brucellar spondylitis and spinal tuberculosis.
文摘BACKGROUND: Spinal tuberculosis is a common disease in orthopedic clinical practice; however, it is seldom reported after organ transplantation. The aim of this study was to investigate the diagnosis and treatment of spinal tuberculosis after organ transplantation. METHOD: Two cases were diagnosed as spinal tuberculosis after liver transplantation and were treated with socarboxazide, rifampicin, streptomycin and ethambutol for more than one year. RESULTS: After treatment with anti-tuberculosis drugs for several months, the symptoms of both patients clearly improved. Back pain disappeared, and erythrocyte sedimentation and body temperature returned to normal. CONCLUSIONS: We should highly suspect spinal tuberculosis if notalgia and night sweats are present after organ transplantation. Anti-tuberculosis therapy is an effective treatment for spinal tuberculosis after organ transplantation.
文摘Objective: To evaluate the clinical feasibility and efficacy in treatment of thoracic tuberculosis via paraspinal approach. Methods: From June 2011 to August 2016, 24 patients with mono-segmental thoracic spine tuberculosis were treated by transfacet debridement combined with bone grafting and internal fixation through paraspinal approach. There were 11 males and 13 females with age ranging from 21 to 63 years (average, 39.5). There were 3 patients in T4/5, 2 patients in T5/6, 3 patients in T7/8, 3 patients in T8/9, 4 patients in T9/10, 3 patients in T10/11, and 6 patients in T11/12. Patients had different degraded local kyphosis deformity shown on X-ray, and different degraded bone destruction and abscess in thoracic spine shown on CT and MRI before the operation. All of the patients before the regular anti tuberculosis treatment for 2 to 4 weeks, the surgical approach used by paraspinal muscle approach, postoperative regular anti tuberculosis treatment for 9 to 12 weeks. Record the clinical symptoms of patients before and after surgery, preoperative Frankel functional classification of spinal cord injury, the operative time, intraoperative blood loss, postoperative ESR, CRP, complications, VAS score, ODI score and Cobb angle changes, imaging check regularly to evaluate the fusion and follow-up of nerve functional recovery. Results: The average operation time was 198 min. The average blood loss was 436 ml. There were no severe complications during and after operation. All patients were followed up for 1 year to 2 years, average 1.5 years of follow-up, the clinical symptoms improved significantly after operation and last follow-up ESR, CRP, VAS score, ODI score and Cobb angle were significantly improved after operation (P < 0.05), grade I Eck fusion, the fusion rate was 100% and the neurological function were improved. Conclusion: on the basis of strict anti tuberculosis chemotherapy, the use of paraspinal muscle gap approach for the treatment of thoracic tuberculosis is less invasive, less destructive to spinal stability, and can achieve obvious curative effect. It is worthy of clinical application.
文摘Objective:To investigate the effect of intensive psycho1ogical nursing on the mood and coping ways of spinal tuberculosis patients.Methods:The clinical data of 102 patients undergoing spinal tuberculosis surgery in our hospital from February 2017 to January 2020 were retrospectively analyzed.A11 the cases were grouped according to different nursing plans,patients who received routine care were included in the control group(n=50),and the ones with intensive psychological care were included in the observation group(n=52).Compare negative emotions after nursing[assessment using self-assessment scale of anxiety(SAS),depression self-assessment scale(SDS)]and solutions[assessment using medical response questionnaire(MCMQ)]of the two groups.Results:After nursing,the SAs,SDs scores,avoidance and yield scores of the two groups were reduced,and the coping scores were increased,and the change of the observation group was greater than that of the control group,the difference was statistically significant(P<0.05).Conclusion:Spinal tuberculosis surgery patients were treated with intensive psychological care,which can relieve patients'negative emotions,improve solutions and are worthy of clinical use.
文摘Objective: to explore and analyze the clinical value of CT and MRI in the diagnosis of spinal tuberculosis. Methods: a total of 48 patients with spinal tuberculosis admitted to our hospital from January to December 2020 were selected for the study. All patients received CT and MRI imaging diagnosis successively, and the results of the two imaging examinations were compared and analyzed. Results: the diagnosis results of the two methods for bone disc loss and paravertebral mass are exactly the same, P > 0.05. The detection rate of ligament diffusion, dural cyst and meningeal enhancement by MRI was significantly higher than that by CT, while the detection rate of calcification was significantly lower than that by CT, P<0.05. Conclusion: in the clinical diagnosis of spinal tuberculosis, both CT and MIR have high application value and the diagnostic accuracy of MIR is relatively higher.
基金Supported by the Research on Intelligent Recommendation Decision Model of Geriatrics Based on Big Data,No.2021CX01010136.
文摘BACKGROUND Tuberculosis is a chronic infectious disease and an important public health pro-blem.Despite progress in controlling tuberculosis,the incidence of tuberculosis in China is still very high,with 895000 new cases annually.This case report des-cribes the investigation of a case of severe disseminated tuberculosis in a young adult with normal immune function,conducted to ascertain why a Mycobacterium tuberculosis(M.tuberculosis)strain caused such severe disease.CASE SUMMARY A previously healthy 28-year-old woman presented to our hospital with a 1-mo-nth history of fever and fatigue.She was diagnosed with severe disseminated pulmonary tuberculosis,spinal tuberculosis with paravertebral abscesses,and tuberculous meningitis.M.tuberculosis was isolated from bronchoal-veolar lavage fluid.She was treated with standard antituberculous therapy and underwent debridement,bone graft,and internal fixation surgery for spinal tuberculosis.She responded to therapy and regained her ability to walk following the surgery.We analysed the whole-genome sequence of the strain and designated it BLM-A21.Additional M.tuberculosis genomes were selected from the Virulence Factor Database(http://www.mgc.ac.cn/cgi-bin/VFs/genus.cgi?Genus=Mycobacterium)for comparison.An evolutionary tree of the BLM-A21 strain was built using PhyML maximum likelihood software.Further gene analysis revealed that,except for the pks1 gene,BLM-A21 had similar virulence genes to the CDC 1551 and H37Rv strains,which have lower dissemination.CONCLUSION We speculate that the pks1 virulence gene in BLM-A21 may be the key virulence gene responsible for the wide-spread dissemination of M.tuberculosis infection in this previously healthy adult with normal immune function.
文摘Background and Objectives:To explore the effect of nutrition management under ERAS concept in patients with spinal tuberculosis.Methods and Study Design:The study was conducted in an orthopedic ward of a tertiary grade A special hospital in Beijing.The patients admitted from January 1,2021 to June 27,2023 were screened for inclusion.The qualified patients were randomized into experimental group or control group.The experimental group received perioperative nutrition management under the concept of ERAS while the control group received routine perioperative management in hospital.The data was collected on the next day of admission,the next day and the sixth day after operation,including laboratory indicators(lymphocyte count,hemoglobin level,etc),intraoperative bleeding volume,postoperative exhaust,defecation time,drainage volume,albumin infusion amount,nutritional risk score,length of stay,hospitalization costs,etc.Univariate analysis and multivariate analysis correcting for gender,age,and baseline values were performed using SPSS24.0.Results:A total of 127 patients with spinal tuberculosis completed the study.Compared with the control group,the intraoperative blood loss(p=0.028)in the experimental group was significantly reduced,the postoperative exhaust time(p=0.012)and defecation time(p=0.012)were significantly shortened,and the nutritional status(p<0.001)was significantly improved.Besides,the results of multivariate analysis are robust after correcting potential confounding factors.Conclusions:Nutrition management under the concept of ERAS is helpful to reduce intraoperative bleeding,promote postoperative flatus and defecation,and improve nutritional status in patients with spinal tuberculosis,which may further improve their clinical outcome and prognosis.
文摘<b style="line-height:1.5;"><span style="font-family:Verdana;">Objective:</span></b><span style="font-family:'';line-height:1.5;"><span style="font-family:Verdana;"> To evaluate the prevalence of spinal infection in a hospital located in the eastern region of Saudi Arabia through a retrospective review and to identify the associated etiological agents in terms of clinical picture, treatment, and outcomes. </span><b><span style="font-family:Verdana;">Design: </span></b><span style="font-family:Verdana;">Retrospective cross-sectional study. </span><b><span style="font-family:Verdana;">Setting:</span></b><span style="font-family:Verdana;"> Single hospital in Dhahran, Saudi Arabia. </span><b><span style="font-family:Verdana;">Patients:</span></b><span style="font-family:Verdana;"> Patients with any type of spinal infection and/or who had undergone neurosurgical intervention for spinal infection between January 2006 and December 2018. </span><b><span style="font-family:Verdana;">Methods:</span></b><span style="font-family:Verdana;"> We collected data on all patients with an established diagnosis of spinal infection from January 2006 to December 2018 in the King Fahad Military Medical Complex in Dhahran, Saudi Arabia. A validated and structured checklist was used for data collection. Spinal infection diagnosis was based on the clinical manifestation, microbiological evidence, radiological findings, and antimicrobial therapy response. </span><b><span style="font-family:Verdana;">Results:</span></b><span style="font-family:Verdana;"> Seventeen patients were included in this study, and their mean age was 54.93 years. Twelve of the patients were male and four were female. The approximate time from symptom onset to diagnosis was 2</span></span><span style="line-height:1.5;font-family:Verdana;"> - </span><span style="line-height:1.5;font-family:Verdana;">6 months. Most of the patients experienced back pain, with lumbosacral spondylitis being the most commonly cited type (61.11%), followed </span><span style="line-height:1.5;font-family:Verdana;">by thoracolumbar spondylodiscitis (25%) and cervical spondylodiscitis (6.25%). The most frequently isolated organism was </span><i style="font-family:'';line-height:1.5;"><span style="font-family:Verdana;">Mycobacterium tuberculosis</span></i><span style="line-height:1.5;font-family:Verdana;"> (8 patients, 50%), followed by extended-spectrum beta lactamase (ESBL)-producing </span><i style="font-family:'';line-height:1.5;"><span style="font-family:Verdana;">Escherichia coli</span></i><span style="line-height:1.5;font-family:Verdana;"> (4 patients, 25%), </span><i style="font-family:'';line-height:1.5;"><span style="font-family:Verdana;">Brucella</span></i><span style="line-height:1.5;font-family:Verdana;"> spp (3 patients, 18.75%), </span><i style="font-family:'';line-height:1.5;"><span style="font-family:Verdana;">Staphylococcus aureus</span></i><span style="line-height:1.5;font-family:Verdana;"> (1 patient, 6.25%), and </span><i style="font-family:'';line-height:1.5;"><span style="font-family:Verdana;">Quambalaria cyanescens</span></i><span style="line-height:1.5;font-family:Verdana;"> (1 patient, 6.25%). Totally, in 50% of the patients with thoracolumbar and lumbosacra site involvement, tuberculosis spondylodiscitis was observed, while another 50% of the cases showed complications associated with paravertebral abscess that required surgical drainage. </span><b style="font-family:'';line-height:1.5;"><span style="font-family:Verdana;">Conclusion:</span></b><span style="font-family:'';line-height:1.5;"> </span><i style="font-family:'';line-height:1.5;"><span style="font-family:Verdana;">M. tuberculosis</span></i><span style="line-height:1.5;font-family:Verdana;"> was found to be the major cause of infectious spondylodiscitis. Additionally, </span><i style="font-family:'';line-height:1.5;"><span style="font-family:Verdana;">Quambalaria cyanescens</span></i><span style="line-height:1.5;font-family:Verdana;"> was isolated;this is the second reported case of the organism being isolated and the first associated with spinal infection.
文摘Background: Tuberculosis of the spine is common in Nigeria. It commonly causes neurological deficit especially when the lesions are higher up in the spine. Objective: To report a case of a young man who had C4 quadriplegia from tuberculous destruction of C3 to C5 vertebral bodies and their intervening discs, aretropharyngeal prevertebral abscess and associated segmental kyphosis. He had received prior antituberculous therapy with no improvement. Results: He recovered completely neurologically when he had adequate decompression and 360°;instrumented fusiondone in a 3-stage surgery that involved drainage and debridement of the retropharyngeal prevertebral abscess, anterior corpectomy of C3 and C4 with fusion using a titanium mesh cage, and posterior fusion of C3 to C6 using titanium rods and lateral mass screws. Surgical treatment was supported with skull traction and antituberculous therapy. Conclusion: This case shows that complete neurologic recovery is feasible in spinal quadriplegia that fails to respond to antituber-culous therapy when adequate decompression and fusion are done.
