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Utility of clinicoradiological, microbiological, histopathological, and molecular methods in the diagnosis of spinal tuberculosis

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Abstract

Purpose

The diagnosis of STB is mainly based on clinicoradiological observations substantiated by bacterial culture, staining, Gene Xpert, and histopathology. The purpose of the study was to correlate these methods to evaluate the effectiveness in the diagnosis of STB.

Methods

A total of 178 clinicoradiologically suspected cases of STB were included in the study. The specimens for diagnostic workup were collected either during surgery or by CT-guided biopsy. All these specimens were tested for tuberculosis through ZN staining, solid culture, histopathology, and PCR. The sensitivity, specificity, PPV, and NPV of each test were calculated using histopathology as a gold standard.

Results

Out of the 178 cases, a total of 15 cases were excluded from this study. Among the remaining 163 cases, TB was diagnosed in 143 [87.73%] on histopathology, 130 [79.75%] on Gene Xpert, 40 [24.53%] on culture, and 23 [14.11%] on ZN stain. The sensitivity, specificity, PPV, and NPV of Gene Xpert were 86.71, 70, 95.38, and 42.42%, respectively. The sensitivity, specificity, PPV, and NPV of AFB culture were 27.97, 100, 100, and 16.26%, respectively. The sensitivity, specificity, PPV, and NPV of AFB stain were 16.08, 100, 100, and 14.29%, respectively. Gene Xpert showed a moderate agreement [Ƙc = 0.4432] with histopathology.

Conclusion

No single diagnostic modality can ascertain the diagnosis, and it is desirable to have a combination of diagnostic batteries for better results. A combination of Gene Xpert and histopathology aids in early and reliable diagnosis of STB.

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Data availability

Masterchart of the study is available with the first author.

Abbreviations

STB:

Spinal tuberculosis

ZN staining:

Ziehl–Neelsen staining

PCR:

Polymerase chain reaction

PPV:

Positive predictive value

NPV:

Negative predictive value

AFB:

Acid-fast bacilli

Ƙc:

Kappa coefficient

EPTB:

Extrapulmonary tuberculosis

MRI:

Magnetic resonance imaging

MTB/RIF:

Mycobacterium tuberculosis/rifampicin resistance

PLR:

Positive likelihood ratio

NLR:

Negative likelihood ratio

SD:

Standard deviation

IQR:

Interquartile range

LJ:

Lowenstein–Jensen media

HPE:

Histopathological examination

CRS:

Composite reference standard

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Acknowledgments

Not applicable.

Funding

No funding was received for conducting this study.

Author information

Authors and Affiliations

  1. Department of Orthopaedics, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India

    Akash Jain, Pankaj Kandwal, Vishal Verma & Vikas Maheshwari

  2. Department of Trauma Surgery, All, India Institute of Medical Sciences, Rishikesh, Uttarakhand, India

    Bhaskar Sarkar

  3. BLK MAX Superspeciality Hospital, Rajinder Nagar, New Delhi, Delhi, India

    Samarth Mittal

  4. Max Healthcare Dehradun, Dehradun, India

    Vanya Singh

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  1. Akash Jain
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  5. Vanya Singh
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  6. Vishal Verma
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  7. Vikas Maheshwari
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by [Pankaj Kandwal], [Samarth Mittal], [Vanya], [Bhaskar Sarkar] and [Vishal Verma]. The first draft of the manuscript was written by [Aakash Jain] and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Pankaj Kandwal.

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Conflict of interests

All authors declare that they do not have any competing interest, concerning this research, authorship, and/or publication of this article.

Ethical approval

This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Ethics Committee of AIIMS Rishikesh (No. 53/IEC/PGM/2021) (Date: 12/02/2021).

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Informed consent was obtained from all individual participants included in the study.

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Jain, A., Kandwal, P., Sarkar, B. et al. Utility of clinicoradiological, microbiological, histopathological, and molecular methods in the diagnosis of spinal tuberculosis. Eur Spine J 32, 4229–4237 (2023). https://doi.org/10.1007/s00586-023-07683-8

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  • DOI: https://doi.org/10.1007/s00586-023-07683-8

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