Search

Objective. To investigate the association of single-nucleotide polymorphisms (SNPs) in SP110 gene and TNF-α gene among pulmonary TB (PTB) and spinal TB (STB) patients. Methods. In a total of 190 PTB patients, 183 STB patients were enrolled as the case group and 362 healthy individuals at the same geographical region as the control group. The SP110 SNPs (rs722555 and rs1135791) and the promoter -308G>A (rs1800629) and -238G>A (rs361525) polymorphisms in TNF-α were genotyped. Results. TNF-α -238G>A polymorphism was involved in susceptibility to STB, but not to PTB. The TNF-α -238 A allele was a protective factor against STB (A versus G: OR [95% CI] = 0.331 [0.113–0.972], P=0.044). Furthermore, the presence of the -238 A allele was considered a trend to decrease the risk of STB (AG versus GG: P=0.062, OR [95% CI] = 0.352 [0.118–1.053]; AA + AG versus GG: P=0.050, OR [95CI%] = 0.335 [0.113–0.999]). However, SP110 SNPs (rs722555 and rs1135791) and TNF-α -308G>A (rs1800629) showed no association with PTB and STB in all genetic models. Conclusion. The TNF-α -238 A allele appeared a protective effect against STB, whereas the SP110 SNPs (rs722555 and rs1135791) and TNF-α -308G>A (rs1800629) showed no association with susceptibility to PTB and STB patients in southern China. [ABSTRACT FROM AUTHOR]

Purpose: Aged patients represent a high risk group for acquiring spinal tuberculosis, and it still remains a leading cause of kyphosis and paraplegia in developing nations. Aged patients often combined with cardiovascular and respiratory disease and single lung ventilation via anterior approach surgery could result in more post-operative complications. We aimed to analyze the efficacy and feasibility of surgical management of aged patients with lumbo-sacral spine tuberculosis using one-stage posterior focus debridement, interbody graft using titanium mesh cages, posterior instrumentation, and fusion.Methods: From March 2009 and July 2012, 17 aged patients with lumbo-sacral spinal tuberculosis were treated with one-stage posterior focus debridement, interbody graft using titanium mesh cages, posterior instrumentation, and fusion. There were eight male and nine female with a mean age of 63.3 years (range: 60-71 years). The mean follow-up was 46.5 months (range 38-70 months). Patients were evaluated before and after surgery in terms of ESR, neurological status, visual analog scale (VAS), and lumbosacral angle.Results: Spinal tuberculosis was completely cured and the grafted bones were fused in all 17 patients. There were no recurrent tuberculous infections. ESR became normal within three months in all patients. The ASIA neurological classification and VAS scores improved in all cases. The average preoperative lumbosacral angle was 20.6° (range 18.1°-22.5°) and became 29.4° (range 27.1°-32.5°) at final follow-up.Conclusions: Our results showed that one-stage posterior focus debridement, interbody graft using titanium mesh cages, posterior instrumentation, and fusion was an effective treatment for aged patients with lumbo-sacral spinal tuberculosis. It is characterized with minimum surgical trauma, good pain relief, good neurological recovery, and good reconstruction of the spinal stability. [ABSTRACT FROM AUTHOR]

Surgical treatment for spinal tuberculosis includes focal tuberculosis debridement, segmental stability reconstruction, neural decompression and kyphotic deformity correction. For the lesions mainly involved anterior and middle column of the spine, anterior operation of debridement and fusion with internal fixation has been becoming the most frequently used surgical technique for the spinal tuberculosis. However, high risk of structural damage might relate with anterior surgery, such as damage in lungs, heart, kidney, ureter and bowel, and the deformity correction is also limited. Due to the organs are in the front of spine, there are less complications in posterior approach. Spinal pedicle screw passes through the spinal three-column structure, which provides more powerful orthopedic forces compared with the vertebral body screw, and the kyphotic deformity correction effect is better in posterior approach. In this paper, we report a 68-year-old male patient with thoracic tuberculosis who underwent surgical treatment by debridement, interbody fusion and internal fixation via posterior approach only. The patient was placed in prone position under general anesthesia. Posterior midline incision was performed, and the posterior spinal construction was exposed. Then place pedicle screw, and fix one side rod temporarily. Make the side of more bone destruction and larger abscess as lesion debridement side. Resect the unilateral facet joint, and retain contralateral structure integrity. Protect the spinal cord, nerve root. Clear sequestrum, necrotic tissue, abscess of paravertebral and intervertebral space. Specially designed titanium mesh cages or bone blocks were implanted into interbody. Fix both side rods and compress both sides to make the mesh cages and bone blocks tight. Reconstruct posterior column structure with allogeneic bone and autologous bone. Using this technique, the procedures of debridement, spinal cord decompression, deformity correction, bone grafting, and internal fixation can be completed with only one incision and surgical position, and the deformity correction efficiency is higher than anterior surgery. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study is to compare the clinical outcomes of surgical management by one-stage posterior debridement, transforaminal lumbar interbody fusion (TLIF) and instrumentation and combined posterior and anterior approaches for lumbar spinal tuberculosis, and determine the clinical effectiveness of the posterior only surgical treatment for lumbar spinal TB at the same time. Methods: Thirty-seven patients who suffered lumbar tuberculosis were treated by two different surgical procedures in our center from May 2004 to June 2012. All the cases were divided into two groups: 19 cases in Group A underwent one-stage posterior debridement, TLIF and instrumentation, and 18 cases in Group B underwent posterior instrumentation, anterior debridement and bone graft in a single-stage procedure. The operation time, blood loss, lumbar kyphotic angle, recovery of neurological function and fusion time were, respectively, compared between Group A and Group B. Results: The average follow-up period for Group A was 46.6 ± 16.7 months, and for Group B, 47.5 ± 15.0 months. It was obvious that the average operative duration and blood loss of Group A was less than those of Group B. Lumbar tuberculosis was completely cured and the grafted bones were fused in 10 months in all patients. There was no persistence or recurrence of infection and no differences in the radiological results in both groups. The kyphosis was significantly corrected after surgical management. The average pretreatment ESR was 60.7 ± 22.5 mm/h, which became normal (9.0 ± 2.8 mm/h) within 3 months in all patients. Conclusions: Surgical management by one-stage posterior debridement, TLIF and instrumentation for lumbar tuberculosis is feasible and effective. This approach obtained better clinical outcomes than combined posterior and anterior surgeries. [ABSTRACT FROM AUTHOR]

Background and Aims: Studies have shown that the vitamin D receptor (VDR) gene polymorphisms may be associated with pulmonary tuberculosis (TB) and play important roles in the regulation of calcium in a variety of tissues including bone. To our knowledge, however, whether FokI polymorphism in VDR gene is associated with susceptibility to spinal TB is still unknown. We undertook this study to investigate the association between FokI polymorphism in VDR gene and susceptibility to spinal TB in Chinese Han population. Methods: This study included 110 patients with spinal TB and 102 volunteers as controls. FokI polymorphism in VDR gene was analyzed by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) in the spinal TB group and the control group. The frequencies of VDR-FokI genotypes in the two groups were compared using χ2 test. Results: There was a significant difference between groups in regard to the frequencies of the VDR-FokI genotypes (p <0.05). In the spinal TB group, the frequency of the ff genotype was 46.36%, which was significantly higher than the corresponding value for the control group (28.43%). Furthermore, the odds ratio (OR) was 2.176 (p <0.05), and the 95% confidence interval (CI) ranged from 1.236–3.832. Conclusions: FokI polymorphism in VDR gene may be associated with the susceptibility to spinal TB in Chinese Han population. Furthermore, the ff genotype may be the susceptible genotype of spinal TB. [Copyright &y& Elsevier]

We aimed to compare the clinical efficacy of titanium mesh cage with that of allogeneic bone graft to reconstruct the anterior column through posterior approach for the surgical management of patients with thoracolumbar spinal tuberculosis with kyphosis. From January 2011 to March 2013, 57 patients with single-segment or two-segments thoracolumbar spinal tuberculosis with kyphosis were treated by debridement, interbody graft, posterior instrumentation, and fusion via a posterior-only procedure. Twenty-four patients in group A were treated with allogeneic bone graft to reconstruct the anterior column, whereas 33 patients in group B were treated with titanium mesh cage. The clinical efficacy was evaluated by visual analog scale (VAS), erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), neurologic function recovery, kyphotic Cobb angle, and postoperative complications. The mean follow-up was 72.4 months. Neurologic function was significantly improved after surgery in all cases. There were significant differences of VAS, ESR, and CRP between preoperation and postoperation at the final follow-up, with no significant difference between the two groups. The kyphotic Cobb correction was significantly improved when compared with those in preoperation, but there was no significant difference between the two groups. One patient in group A with two segments involved experienced graft fracture. He had anterior bone graft with titanium mesh cage. Minimum 5-year follow-up outcomes showed that one-stage posterior focus debridement, interbody graft using titanium mesh cages, posterior instrumentation, and fusion is an effective treatment for patients with thoracolumbar spinal tuberculosis accompanied by kyphosis. It may obtain better clinical efficacy than allogeneic bone graft for treating two-segments thoracolumbar spinal tuberculosis. [ABSTRACT FROM AUTHOR]

Spinal tuberculosis (TB) accounts for 1%–5% of all TB infections. Host genetic variation influences susceptibility to Mycobacterium tuberculosis (MTB). P2X7 receptor (P2X7R) expressed on cells has been identified as a regulatory molecule in cell death/apoptosis, killing of intercellular pathogens, and bone turnover. This study investigated the P2X7 gene polymorphisms and protein levels in spinal TB. P2X7 gene -762C>T and 489C>T polymorphisms were genotyped. The expression of P2X7R in bone or intervertebral disc (ID) tissues was analyzed by Western blot assay. The -762C>T and 489C>T polymorphisms were associated with susceptibility to spinal TB. Having the -762CC genotype and -762C allele increased the risk of developing spinal TB (CC vs. TT: P = 0.031, OR [95%CI] = 1.865 [1.053–3.304]; C vs. T: P = 0.028, OR [95%CI] = 1.355 [1.034–1.775]). The presence of the 489T allele was associated with an increased risk of developing spinal TB (TT vs. CC: P = 0.004, OR [95%CI] = 2.248 [1.283–3.939]; CT vs. CC: P = 0.044, OR [95%CI] = 1.755 [1.011–3.047]; T vs. C: P = 0.004, OR [95%CI] = 1.482 [1.134–1.936]; TT + CT vs. CC: P = 0.010, OR [95%CI] = 1.967 [1.171–3.304]; TT vs. CT + CC: P = 0.037, OR [95%CI] = 1.489 [1.023–2.167]). The expression of P2X7R in TB-induced bone lesions increased significantly among spinal TB patients ( t = 0.011). Carrying the P2X7 -762CC genotype and 489T allele is associated with an increased risk of developing spinal TB in a Southern Chinese Han population. [ABSTRACT FROM AUTHOR]

Purpose: To analyse the efficacy and feasibility of surgical management for elderly patients with multilevel non-contiguous spinal tuberculosis(MNSTB)by using one-stage posterior focus debridement, interbody graft using titanium mesh cages, posterior instrumentation and fusion.Methods: From September 2009 to October 2013, 15 elderly patients with MNSTB were treated with one-stage posterior focus debridement, interbody graft using titanium mesh cages, posterior instrumentation and fusion. There were 10 males and 5 females with a mean age of 63.2 years (range: 60-68 years) at the time of surgery. The mean follow-up time was 40 months(range 26-68 months). Patients were evaluated before and after surgery in terms of erythrocyte sedimentation rate(ESR), neurological status, pain and kyphotic angle.Results: The spinal tuberculosis was completely cured, and the grafted bones were fused in all 15 patients. There were no recurrent tuberculous infections. The ESR reached a normal level within 3 months in all patients. The ASIA neurological classification improved in all cases, and pain relief was reported by all patients. The average preoperative kyphosis was 20.1° (range 8-38°) and decreased to 7.6° (range 1-18°) postoperatively. There was no significant loss of the correction at the latest follow-up.Conclusions: Our results showed that one-stage posterior focus debridement, interbody graft using titanium mesh cages, posterior instrumentation and fusion was an effective treatment for elderly patients with MNSTB. It is characterized by minimum surgical trauma, good neurological recovery, and good correction of kyphosis. [ABSTRACT FROM AUTHOR]