Articles

Differentiated Approach to the Diagnosis and Treatment of Tuberculous Spondylitis in Adults

Abstract

The purpose of this study is to generalize the results of a complex clinical-laboratory, radiological and immunological study of patients with spinal tuberculosis. A comprehensive examination analysis was carried out in 192 patients with tuberculous spondylitis who were in the department of surgery for osteoarticular tuberculosis of the Republican Specialized Scientific and Practical Medical Center of Tuberculosis and Pulmonology in Tashkent, Uzbekistan. Severe degrees of spinal disorders were found in 48.7% of patients. Magnetic resonance imaging (MRI) and multi-slice spiral computed tomography (MSCT) allow establishing the stage and activity of a specific process in the spine, as well as complications. Spinal column instability was detected in 143 (74.5%) patients, paravertebral abscesses in 116 (60.4%) patients, and epidural abscesses in 75 (39.0%) patients. Changes in immunological parameters in patients with spinal tuberculosis were associated both with impaired regulation of immunogenetic and with the direct influence of the immune system at various stages of the process. The detection of certain patterns of immune system disorders in patients with tuberculous lesions of the spine allowed us to make a differentiated approach to their treatment in order to increase the effectiveness of the treatment. It can be concluded that at present, tuberculosis of bones and joints, especially the spine, is detected in an advanced stage in 50-80% of cases and has a widespread and complicated character with profound anatomical and functional changes and the presence of severe spinal disorders in 48.7% patients in Uzbekistan. Regarding spondylitis, it is immensely important to make an accurate diagnosis based on the clinical presentations, laboratory, radiological and immunological findings and by periodic assessment of the response to treatment, which is essential in atypical cases.

1. Dobson J, Percivall Pott. Ann R Coll Surg Engl. 1972;50:54-65.
2. Osmanagic A, Emamifar A, Bang JC, Hansen IMJ. A rare case of Pott’s disease (Spinal Tuberculosis) mimicking metastatic disease in the southern region of Denmark. Am J Case Rep 2016;17:384-8.
3. Garg RK, Somvanshi DS. Spinal tuberculosis: A review. J Spinal Cord Med 2011;34:440-54.
4. Chen H, Chen YM, Lee CW, Chang YJ, Cheng CY, Hung JK. Early diagnosis of spinal tuberculosis. J Form Med Assoc 2016;115:825-36.
5. Ringshausen FC, Tannapfel A, Nicolas V, Weber A, Duchna HW, Schultze-Werninghaus G, et al. A fatal case of spinal tuberculosis mistaken for metastatic lung cancer: recalling ancient Pott’s disease. Ann Clin Microbiol Antimicrob 2009;8:32.
6. Batirov FA, Khomenko VN, Shmakova LN. Epidemiology of extrapulmonary tuberculosis. Probl Tuberk Bolezn Legk 2003;8:49-50.
7. Bellendir EN. The importance of extrapulmonary localization of tuberculosis for modern phthisiology. Probl Tuberc 2001;6:47-8.
8. Smith AS, Weinstein MA, Mizushima A. Coughlin B, Hayden SP, Lakin MM, et.al. MR imaging characteristics of tuberculous spondylitis is Vertebral osteomyelitis. Am J Radiol 2009;153:399-405.
9. Pigrau-Serrallach C, Rodr’ıguez-Pardo D. Bone and joint tuberculosis. Eur Spine J 2013;22:556-66.
10. McLain RF, Isada C. Spinal tuberculosis deserves a place on the radar screen. Cleve Clin J Med 2004;71:537-9.
11. Pellis’e F. Tuberculosis and Pott’s disease, still very relevant health problems. Eur Spine J 2013;22:527-8.
12. Leibert E, Haralambou G. Spinal tuberculosis. In: Rom WN, Garay SM, eds. Tuberculosis. Philadelphia: Lippincott Williams & Wilkins, 2014:565-76.
13. Akhmedov TG. Major risk factors for tuberculosis. Med J Uzbekistan 2003;2:16-7.
14. Akhmetov AA. Diagnosis and treatment of tuberculosis spondylitis complicated by spinal disorders. Probl Tuberc 2000;3:16-8.
15. Garbuz AE. Status and development prospects of surgery of bones, joints and spine in adults. Probl Tuberc 2001;4:57-8.
16. Guseva VN. The immune status of patients with active tuberculosis spondylitis. Probl Tuberc 2003;6:13-5.
17. Merino P, Candel FJ, Gestoso I, Baos E, Picazo J. Microbiological diagnosis of spinal tuberculosis. Int Orthop 2012;36:233-8.
18. Singh R, Magu NK, Rohilla RK. Clinicoradiologic Profile of Involvement and Healing in Tuberculosis of the Spine. Ann Med Health Sci Res 2016;6:311-27.
19. Batirel A, Erdem H, Sengoz G, Pehlivanoglu F, Ramosaco E, Gülsün S, et al. The course of spinal tuberculosis (Pott disease): results of the multinational, multicentre Backbone-2 study. Clinic Microbiol Infect 2015;21:1008.e9-1008.e18.
20. Kostov K, Petrov K. Tuberculous spondylitis: analysis of 22 cases. Acta Neurol Belg 2009;109:127-31.
21. Tehranzadeh J, Wang F, Mesgarzaden M. Magnetic resonance imaging on osteomyelitis. Crit Rev Diagn Imaging 2012;33:495-534.
22. Sovetova NA, Savin IB, Mal’chenko OV, Nekachalova AZ, Buchatskaia LA, Roslova EV, et al. Current radiotherapy for extrapulmonary tuberculosis. Probl Tuberk Bolezn Legk 2006;11:6-9.
23. Baybus GI, Garbuz AE. Classification of neurological disorders in tuberculosis spondylitis. Probl Tuberk 2001;4:50-1.
24. Bellendir EN. Immunopathogenesis features of extrapulmonary tuberculosis of various localizations according to experimental and clinical studies. Conference proceedings: Extrapulmonary Tuberculosis - an Urgent Public Health Problem: All-Russian Scientific and Practical Conference. Russia. Saint Petersburg: Pavlov First State Medical University of St. Petersburg, 1997:25.
25. Aguiar LMZ, Antonangelo L, Vargas-Francisco SZ, Zerbini MCN, Sales MM, Uip DE, et al. Malignant and tuberculous pleural effusions: immunophenotypic cellular characterization. Clinics 2008;63:637-44.
26. Lighaam LC, Rispens T. The Immunobiology of Immunoglobulin G4. Semin Liver Dis 2016;36: 200-15.
27. Mancini G, Carbonara AO, Heremans JF. Immunochemical quantitation of antigens by single radial immunodiffusion. Immunochemistry 1965;2: 235-54.
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IssueVol 59, No 4 (2021) QRcode
SectionArticles
DOI https://doi.org/10.18502/acta.v59i4.6216
Keywords
Tuberculosis Spondylitis Neurology Immunology
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Creative Commons License This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
How to Cite
1.
Nazirov P, Fakhridinova A, Makhmudova Z, Djuraev B. Differentiated Approach to the Diagnosis and Treatment of Tuberculous Spondylitis in Adults. Acta Med Iran. 2021;59(4):191-196.