General principles of diagnosis of tuberculous spondylitis

G.G. Golka, V.V. Vesnin, O.G. Fadeev, V.V. Burlaka, A.A. Olejnik, M.A. Garkusha

Abstract


Background. Epidemiological situation with osteoarticular tuberculosis (OAT) is characterized by a significant number of non-diagnosed cases. The purpose of this study is to draw the attention of medical practitioners to the important problem of tuberculous spondylitis (TS) diagnosis and to increase its effectiveness. Materials and methods. The study included the assessment of examination protocols and medical documentation of 175 patients with active newly diagnosed TS, who underwent treatment from 2006 to 2015 at the department of osteoarticular tuberculosis of the Municipal Healthcare Institution “Regional Tuberculosis Hospital N 1” of Kharkiv Regional Council and at the department of surgery of the Municipal Healthcare Institution “Regional Antituberculosis Dispensary N 1” of Kharkiv Regional Council. All treated patients were divided into two groups. Group 1 consisted of 93 (53.1 %) persons, whose treatment included surgical intervention on vertebrae affected by a specific destructive process, and group 2 — of 82 (46.9 %) individuals, who received conservative treatment. The age of the patients was from 17 to 75 years. Results. Thorough history taking in patients under investigations allowed to determine previous contacts with tuberculosis patients, especially with bacterial excretion in 14 patients of group 1 (15.1 %) and in 16 patients of group 2 (19.5 %), and to receive data on previous diseases (tuberculosis of other localization) in 8 patients of group 1 (8.6 %) and in 10 patients of group 2 (12.2 %). Significant general hypothermia triggered the development of the disease in 3 patients of group 1 (3.2 %) and 2 patients in group 2 (2.4 %). Trauma and heavy physical load preceded the first TS signs in 9 patients of group 1 (9.7 %) and in 7 patients of group 2 (8.5 %). Assessing the database among the newly diagnosed TS cases, we selected and analyzed the triggering factors of the disease in patients under investigation. These factors were conventionally divided into two groups: A — organic (clinical), B — social. Organic factors were detected in 72 patients of group 1 (77.4 %) and in 68 patients of group 2 (82.9 %). Various combinations of these factors determined one of the three risk degrees, namely high, medium or low. Nosological TS diagnosis in all cases included a survey radiography in two planes, which was performed on the basis of the patient’s examination findings. Further diagnosis was extended according to the objectives of surgical treatment. A number of new technologies for imaging diagnosis of the spine have significantly extended the possibilities in diagnosis of exudative TS. Apart from the traditional X-ray method, the patient’s state can be assessed by contrast myelography, computed tomography and magnetic resonance imaging. In the absence of bacteriological, cytological and histological confirmation of the diagnosis, the latter was established for the whole set of examination findings. Use of the proposed principles of TS diagnosis taking into account risk group allowed to reduce significantly the number of advanced and complicated forms of the disease. If in 2005 the percentage of neglected and complicated forms among the patients admitted to specialized OAT departments with newly diagnosed active form was 77.6 %, then in 2012 it comprised 39.2 % (almost 2-fold decrease), which indicates a high efficiency of these diagnostic methods. Diagnosis of TS is based on a comparison of clinical, laboratory, bacteriological and radiographic data and new methods of imaging diagnosis. The study implied conside­ration of the nature of the disease development, usually gradual and prolonged, previous or concomitant tuberculous lesions of other organs or systems, the presence of conditions promoting contact with tuberculosis patients. Conclusions. Thus, diagnosis of spinal tuberculosis is relatively easy if rendered in a timely manner and includes initial examination within the diagnostic minimum and, if necessary, consultation of a relevant specialist.

Keywords


diagnosis of tuberculous spondylitis; laboratory, clinical, radiation research methods

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DOI: https://doi.org/10.22141/1608-1706.3.18.2017.105369

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