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

We are presenting a case of cervical (C4) aneurysmal bone cyst in a 13-year-old girl, came to the outpatient department with neck pain and stiffness since 6 months and normal neurology. We did an en bloc excision of locally aggressive tumor through anterior plus posterior approach and stabilization by lateral mass screw fixation and anterior cervical instrumentation. Involvement of several adjacent cervical vertebrae by an aneurysmal bone cyst is rare, and conventional treatment with curettage and bone grafting is most likely to carry a high rate of recurrence and spinal instability. We recommend complete excision of the tumor and instrumentation in a single stage to avoid instability.

https://www.science-open.com/document_file/ed580b9f-2590-4d3b-9ec5-7903caa3e5f0/PubMedCentral/ed580b9f-2590-4d3b-9ec5-7903caa3e5f0.pdf

Locally aggressive aneurysmal bone cyst of C4 vertebra treated by total en bloc excision and anterior plus posterior cervical instrumentation.

Background: The non-union of bones is a multifactorial phenomenon. In this study, it was emphasized to evaluate the efficacy and safety of bone morphogenetic protein-2 (BMP-2) as a bone-stimulating agent in the treatment of non-unions. Methods: Fifteen patients [5 males, mean age 51.06 years (range: 21—75)] with sixteen non-unions were treated with BMP-2. There were eleven femoral non-union, three humerus, one ulna, one distal fibula non-union. The mean follow-up was 22.06 months. Results: Both clinical and radiological union occurred in 15 (93.75%) non unions cases. Radiological union achieved within a mean time of 15.75 weeks. The remaining one show incomplete union with recalcitrant formation was asymptomatic and having good pain free range of movement, declines further intervention. No complications or adverse effects from the use of BMP-2 were encountered. Conclusion: In this study, it was observed that BMP-2 is a powerful adjunct and one of the safe armamentarium for the surgeon to handle difficult and challenging clinical conditions.

http://aimdrjournal.com/pdf/vol2Issue5/OR9_OA_Sanjay_2_5_11C.pdf

Vinod Agrawal

Papers

Tuberculosis of spine

Locally aggressive aneurysmal bone cyst of C4 vertebra treated by total en bloc excision and anterior plus posterior cervical instrumentation.

Recombinant Human Bone Morphogenic Protein-2 (BMP- 2): A Newer & Novel Osteoinductive Treatment Modality for Non-union of Bones.