Background: Spinal Tuberculosis is the most common and dangerous form\nof skeletal tuberculosis. It has the potential for serious morbidity, including\npermanent neurologic deficits and severe deformity. The aim of this study is\nto review spinal Tuberculosis (TB) cases in our tertiary care center and evaluate\nit from different aspects, which may provide great support to the clinical\ndecisions of this disease. Methods: The study was a retrospective charts review\nof all adult spinal TB patients who were evaluated at King Abdulaziz\nMedical City, Riyadh, from January 2001 to March 2015. The inclusion of\ncases will need to meet a specific case definition. Patients demography, presenting\nsymptoms and signs, and radiological and microbiological data for all\nthe patients were collected and reviewed. Results: A total of 61 cases screened\ncharts were included according to the case definition. 59% were female, and\nthe mean age was 51.3 years. The most presenting symptom was back pain\n(85%), followed by lower limbs weakness and lower limbs pain. The average\nduration of symptoms was 170 days. The average hospital stay was 41.4 days.\nOn physical examination, about half of the patients had bilateral lower limbs\nweakness. Acute phase reactants like C-reactive protein (CRP) and Erythrocyte\nsedimentation rate (ESR) were elevated, 97% and 92% respectively,\nhowever leukocytosis was not common. Out of all the patients who had a biopsy\ndone (59 patients), 51 patients (86%) had positive AFB culture. MTB\nPCR was done from spine biopsy in 16 patients, and 81% were positive. Out\nof 53 tissue specimens, histopathology showed 45% necrotizing granuloma,\n21% non-necrotizing granuloma, and 34% non-specific inflammation. Imaging\n(either CT scan or MRI) was performed on the patients at the time of\npresentation, and the most common signs seen in both were vertebral bone\ndestruction (95%, 80%) and perivertebral collections (70%, 84%). The thoracic\nand lumbar vertebrae were the most common involved locations. Thirty-one\npatients had both modalities done (CT and MRI), and spinal compression\nwas seen on MRI in 68% of the cases compared to 36% on the CT scan. All\nthe patients received the first line therapy with some individual adjustment\nand only 39% (27 patients) underwent surgery. Conclusion: Spinal Tuberculosis\nis a chronic presentation illness with a non-specific clinical picture. Interventional\ndiagnostics is the best current modality to reach a confirmatory\ndiagnosis. The gold standard for confirming TB diagnosis probably will remain\ncultures in addition to early utilization of molecular TB diagnostics.\nTime for diagnosis of Spinal Tuberculosis is delayed despite improvement in\ndiagnostics tests. Medical treatment is the major solution of uncomplicated\nspinal TB.
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