The course of spinal tuberculosis (Pott disease): results of the multinational, multicentre Backbone-2 study
The course of spinal tuberculosis (Pott disease): results of the multinational, multicentre Backbone-2 study
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DOI：
10.1016/j.cmi.2015.07.013
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发表时间：
2015-11-01
影响因子：
14.2
通讯作者：
Vahaboglu, H.
中科院分区：
文献类型：
--
作者：
Batirel, A.;Erdem, H.;Vahaboglu, H.
我们的目的是描述脊柱结核 (ST)（也称为 Pott 病）的临床、实验室、诊断和治疗特征。共有来自土耳其、埃及、阿尔巴尼亚和希腊 35 个中心的 314 名 ST 患者被纳入研究。从最初出现症状到诊断的中位持续时间为 78 天。诊断前最常见的并发症是脓肿（69%）、神经功能缺损（40%）、脊柱不稳定（21%）和脊柱畸形（16%）。腰椎（56%）、胸椎（49%）和胸腰椎（13%）是最常受感染的部位。尽管 51% 的患者有多个椎体受累，但 8% 的患者有多个椎体非连续受累。 41% 的病例已查出病原体。对 200 名患者（64%）进行了组织病理学检查，74% 符合结核病。 103 名患者（33%）仅接受了药物治疗，211 名患者（67%）接受了诊断和/或治疗性手术干预。百分之十的患者需要不止一次手术干预。 7 名患者（2%）死亡，77 名患者（25%）出现后遗症。治疗后后遗症分布如下：后凸畸形11%，弓背畸形6%，脊柱侧凸5%，截瘫5%，截瘫5%，感觉丧失4%。年龄较大、神经功能缺损和脊柱畸形是不良结果的预测因素。 ST 因其病程隐匿而导致显着的发病率，并且由于诊断和治疗的挑战而延迟诊断。椎体骨髓炎患者的鉴别诊断应考虑ST，特别是在结核病流行地区。早期确定明确的病因诊断和适当的治疗对于预防后遗症的发展至关重要。临床微生物学和感染 (C) 2015 年欧洲临床微生物学和传染病学会。由爱思唯尔有限公司出版。保留所有权利。
We aimed to describe clinical, laboratory, diagnostic and therapeutic features of spinal tuberculosis (ST), also known as Pott disease. A total of 314 patients with ST from 35 centres in Turkey, Egypt, Albania and Greece were included. Median duration from initial symptoms to the time of diagnosis was 78 days. The most common complications presented before diagnosis were abscesses (69%), neurologic deficits (40%), spinal instability (21%) and spinal deformity (16%). Lumbar (56%), thoracic (49%) and thoracolumbar (13%) vertebrae were the most commonly involved sites of infection. Although 51% of the patients had multiple levels of vertebral involvement, 8% had noncontiguous involvement of multiple vertebral bodies. The causative agent was identified in 41% of cases. Histopathologic examination was performed in 200 patients (64%), and 74% were consistent with tuberculosis. Medical treatment alone was implemented in 103 patients (33%), while 211 patients (67%) underwent diagnostic and/or therapeutic surgical intervention. Ten percent of the patients required more than one surgical intervention. Mortality occurred in 7 patients (2%), and 77 (25%) developed sequelae. The distribution of the posttreatment sequelae were as follows: 11% kyphosis, 6% Gibbus deformity, 5% scoliosis, 5% paraparesis, 5% paraplegia and 4% loss of sensation. Older age, presence of neurologic deficit and spinal deformity were predictors of unfavourable outcome. ST results in significant morbidity as a result of its insidious course and delayed diagnosis because of diagnostic and therapeutic challenges. ST should be considered in the differential diagnosis of patients with vertebral osteomyelitis, especially in tuberculosis-endemic regions. Early establishment of definitive aetiologic diagnosis and appropriate treatment are of paramount importance to prevent development of sequelae. Clinical Microbiology and Infection (C) 2015 European Society of Clinical Microbiology and Infectious Diseases. Published by Elsevier Ltd. All rights reserved.