Diagnosis and surgical treatment of atypical thoracic and lumbar spinal tuberculosis

English Keywords:Spinal tuberculosis  Atypical tuberculosis  Diagnosis  Surgery

English Abstract:

  【Abstract】 Objectives: To analyze and summarize the clinical diagnosis and surgical treatment features of atypical thoracic and lumbar spinal tuberculosis. Methods: Patients with spinal tuberculosis who were surgically treated from December 2013 to December 2018 were reviewed. A total of 13 patients with atypical spinal tuberculosis were selected according to the imaging features, including 8 males and 5 females. The clinical features, diagnosis and treatment procedures, follow-up results were analyzed. The average age of patients was 44.2±18.7 years old(ranged 20 to 71 years old). As the initial symptoms, the inguinal mass occurred in 2 patients, fever and cough occurred in 2 patients, back pain occurred in the remaining patients. Visual analogue scale(VAS) for preoperative pain was 5-8, with an average of 6.2±0.8. Frankel′s grade for neurological function was C in 1 case, D in 3 cases, and E in 9 cases. All patients were investigated by X-rays, CT and MRI. There was no radiological collapse of intervertebral disc or spinal kyphosis. CT showed various vertebral bone destruction, cystic change, sclerosis at the edge of the lesion, and glass-like opacity. MRI showed vertebral bone destruction, edema signal and abscess. Positron emission tomography-computer tomography(PET-CT) was performed in 4 patients. Enzyme-linked immuno spot(ELISPOT) was performed in 10 patients, and all of whom were positive. Preoperative biopsy was performed in 4 patients. Quadruple anti-tuberculosis drugs were used in all the patients for at least 1-2 weeks preoperatively. Seven patients underwent posterior surgery and six underwent anterior combined posterior surgery. Standard course of chemotherapy was performed postoperatively. Results: There were 13 patients in 64 cases with spinal tuberculosis were atypical cases in the same period, with the rate of 20.3%, 6 cases of thoracic tuberculosis, 5 cases of lumbar tuberculosis, and 2 cases of thoracolumbar tuberculosis. Classification of atypical spinal tuberculosis according to imaging features: 2 cases of single vertebral involvement, 1 case of intervertebral disc involvement, and 10 cases of multiple vertebral involvement. The operation time lasted for 130-260min(177.7±43.0min), and the bleeding volume was 400-1000ml(638.5±198.1ml). The pathological reports of lesion tissue were granulomatous lesion and/or coagulative necrosis. There was 1 patient of positive tissue smears, and 1 patient of positive tissue culture of tuberculosis bacteria. There was no obvious intraoperative complication. One patient had postoperative wound infection, which was healed after debridement. The follow-up time was 45.1±22.2 months(ranged, 12-72 months). One patient had titanium mesh displacement during follow-up, who was kept under observation because of no clinical symptom. And there was no internal fixation displacement and rupture at the last follow-up of 32 months. Bone graft fusion was observed at 3-6 months. There was no other failure of internal fixations or recurrence of tuberculosis. The VAS score at the last follow-up was 1-4, with an average of 1.8±0.9. Frankel′s grade returned to E at the last follow-up. Conclusions: Multiple diagnostic methods are required for atypical spinal tuberculosis. Surgery combined with anti-tuberculosis drugs can achieve satisfactory results.