Spinal tuberculosis is a destructive form of tuberculosis. It accounts for approximately half of all cases of musculoskeletal tuberculosis. Spinal tuberculosis is more common in children and young adults. The incidence of spinal tuberculosis is increasing in developed nations. Genetic susceptibility to spinal tuberculosis has recently been demonstrated. Characteristically, there is destruction of the intervertebral disk space and the adjacent vertebral bodies, collapse of the spinal elements, and anterior wedging leading to kyphosis and gibbus formation. The thoracic region of vertebral column is most frequently affected. Formation of a ‘cold’ abscess around the lesion is another characteristic feature. The incidence of multi-level noncontiguous vertebral tuberculosis occurs more frequently than previously recognized. Common clinical manifestations include constitutional symptoms, back pain, spinal tenderness, paraplegia, and spinal deformities. For the diagnosis of spinal tuberculosis magnetic resonance imaging is more sensitive imaging technique than x-ray and more specific than computed tomography. Magnetic resonance imaging frequently demonstrates involvement of the vertebral bodies on either side of the disk, disk destruction, cold abscess, vertebral collapse, and presence of vertebral column deformities. Neuroimaging-guided needle biopsy from the affected site in the center of the vertebral body is the gold standard technique for early histopathological diagnosis. Antituberculous treatment remains the cornerstone of treatment. Surgery may be required in selected cases, e.g. large abscess formation, severe kyphosis, an evolving neurological deficit, or lack of response to medical treatment. With early diagnosis and early treatment, prognosis is generally good.

/pdf/spinal-tuberculosis-a-review-c996lhzpsx.pdf

Spinal tuberculosis: A review

The dismal outcome of tuberculosis of the spine in the pre-antibiotic era has improved significantly because of the use of potent antitubercular drugs, modern diagnostic aids and advances in surgical management. MRI allows the diagnosis of a tuberculous lesion, with a sensitivity of 100% and specificity of 88%, well before deformity develops. Neurological deficit and deformity are the worst complications of spinal tuberculosis. Patients treated conservatively show an increase in deformity of about 15°. In children, a kyphosis continues to increase with growth even after the lesion has healed. Tuberculosis of the spine is a medical disease which is not primarily treated surgically, but operation is required to prevent and treat the complications. Panvertebral lesions, therapeutically refractory disease, severe kyphosis, a developing neurological deficit, lack of improvement or deterioration are indications for surgery. Patients who present with a kyphosis of 60° or more, or one which is likely to progress, require anterior decompression, posterior shortening, posterior instrumented stabilisation and anterior and posterior bone grafting in the active stage of the disease. Late-onset paraplegia is best prevented rather than treated. The awareness and suspicion of an atypical presentation of spinal tuberculosis should be high in order to obtain a good outcome. Therapeutically refractory cases of tuberculosis of the spine are increasing in association with the presence of HIV and multidrug-resistant tuberculosis.

/pdf/tuberculosis-of-the-spine-a-fresh-look-at-an-old-disease-yfo66tak14.pdf

Tuberculosis of the spine: a fresh look at an old disease.

Introduction
Bone and joint tuberculosis has increased in the past two decades in relation with AIDS epidemics.

Bone and joint tuberculosis.

Study Design:Review article.Objectives:A review of literature on the epidemiology, diagnosis, and management of spinal tuberculosis (TB).Methods:A systematic computerized literature search was perf...

https://journals.sagepub.com/doi/pdf/10.1177/2192568218769053

Spinal Tuberculosis: Current Concepts:

Purpose
The objective of this systematic review was to characterise the methodological issues, as well as clinical, diagnosis, microbiological and treatment characteristics of patients with spinal tuberculosis.

Tuberculosis of the spine. A systematic review of case series

Tuberculosis of the spine is one of the most common spine pathology in India. Over last 4 decades a lot has changed in the diagnosis, medical treatment and surgical procedures to treat this disorder. Further developments in diagnosis using molecular genetic techniques, more effective antibiotics and more aggressive surgical protocols have become essential with emergence of multidrug resistant TB. Surgical procedures such as single stage anterior and posterior stabilization, extrapleral dorsal spine anterior stabilization and endoscopic thoracoscopic surgeries have reduced the mortality and morbidity of the surgical procedures. is rapidly progressing. It is a challenge to treat MDR-TB Spine with late onset paraplegia and progressive deformity. Physicians must treat tuberculosis of spine on the basis of Culture and sensitivity.

/pdf/tuberculosis-of-spine-2mnv66cdar.pdf

Tuberculosis of spine

Background  Prospective evaluation of the effect of physical parameters like height, weight and abdominal girth on different skin entry points in transforaminal endoscopic lumbar discectomy (TELD) in lower lumbar discs. Methods  This prospective study involved 174 patients with unilateral radicular pain or discogenic back pain, central, paracentral disc herniations and lateral canal stenosis at the level from L3 to S1 radiologically confirmed by magnetic resonance imaging (MRI) and failed conservative trial for 6 weeks. All patients underwent measurements of height, weight, body mass index (BMI), and abdominal girth preoperatively. All the four possible entry points, i.e., 45 to 45, posterolateral (PL), tip of spinous process (TOSP), and dorsum of the facet joint, were marked and point midway between PL and TOSP (PL-TOSP) skin entry was used. Results  The change in the value, i.e., distance from midline of all the entry points with physical parameters like height, weight, BMI, and abdominal circumference was statistically significant. The visual analog scale score decreased from a preoperative value of 7.98 to 1.84 at 6 months follow-up. The Oswestry disability index score improved from 72.53 to 16.26. Conclusion  The entry point in TELD is not a fixed value as it varies with the physical parameters like weight and abdominal girth of the patient. PL-TOSP is a safe entry point for common pathologies like central, paracentral herniations and lateral canal stenosis in lower lumbar levels and can be predicted preoperatively by proposed formula.

/pdf/impact-of-body-weight-height-and-obesity-on-selection-of-2166tyh9.pdf

Impact of Body Weight, Height, and Obesity on Selection of Skin Entry Point for Transforaminal Endoscopic Lumbar Discectomy

An algorithm for selection of full endoscopic approach for symptomatic nerve root decompression

Kambin's triangle is a safe corridor for transforaminal endoscopic approach as it is devoid of any neurovascular structure. We came across an interesting case where we encountered a large conjoined lumbosacral nerve root (CNR) in Kambin's triangle during transforaminal endoscopic spine surgery. Patient had intraoperative sympathetic shock which recovered after administering atropine. A 50-year-old female presented with low back pain with bilateral lower limb radiculopathy for 3 years. Magnetic resonance imaging revealed left L4-5 foraminal annular fissure. Radiculopathy was in L5 dermatomal pattern which was confirmed by diagnostic discography and lateral recess block. Left-sided L4-5 transforaminal endoscopic lumbar discectomy was done where we encountered a large CNR in safe zone of Kambin's triangle. Transforaminal endoscopic spine surgery done under monitored anesthesia care with patient in awake and aware state allows identification, diagnosis, and prevention of injury to anomalous neural structure in Kambin's triangle to avoid incidence of failed back syndrome.

P R Patgaonkar

Papers

Tuberculosis of spine

Impact of Body Weight, Height, and Obesity on Selection of Skin Entry Point for Transforaminal Endoscopic Lumbar Discectomy

An algorithm for selection of full endoscopic approach for symptomatic nerve root decompression

Sympathetic conjoined lumbosacral nerve root in kambin's triangle during transforaminal endoscopy