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Tuberculosis of the spine and drug resistance: a review article

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Abstract

Pott’s spine is tuberculosis of spine caused due to hematogenous spread of mycobacterium from a primary focus. It constitutes about 50% of skeletal tuberculosis cases. Paradiscal type is the most common type of spinal tuberculosis. Untreated cases can lead to complications like a cold abscess, paraplegia, and deformity which may require surgical intervention. Rapid molecular methods have made the diagnosis of spinal tuberculosis and drug resistance faster and easier but it still remains a problem due to difficulties in sample collection and the paucibacillary nature of the Pott spine. Antitubercular drug therapy forms the mainstay of management. The emergence of MDR TB and XDR TB has posed a big challenge in the management of spinal tuberculosis. The literature regarding drug resistance in spinal tuberculosis and its management is lacking. We conducted a literature review of 29 studies and presented information on pathogenesis, diagnosis, and management of spinal tuberculosis and drug resistance. New shorter regimens for MDR and XDR TB are under trial in different parts of the world. We believe this article will provide information on spinal tuberculosis and drug resistance and help clinicians outline important research areas.

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References

  1. Ansari S, Amanullah MF, Ahmad K, Rauniyar R (2013) Pott’s spine: diagnostic imaging modalities and technology advancements. N Am J Med Sci 5:404–411

    Article  Google Scholar 

  2. Bhosale S, Prabhakar A, Srivastava S, Raj A, Purohit S, Marathe N. Pattern of drug resistance in primary spinal tuberculosis: a single-center study From India. Global Spine J. 2020.

  3. Cormican L, Hammal R, Messenger J, Milburn HJ (2006) Current difficulties in the diagnosis and management of spinal tuberculosis. Postgrad Med J 82:46–51

    Article  CAS  Google Scholar 

  4. Garg D, Goyal V (2020) Spinal tuberculosis treatment: an enduring bone of contention. Ann Indian Acad Neurol 23:441–448

    Article  Google Scholar 

  5. Goel M (1967) Treatment of Pott’s paraplegia by operation. J Bone Joint Surg Br 49:674–681

    Article  CAS  Google Scholar 

  6. Hayes A, Choksey M, Barnes N, Sparrow OC (1996) Spinal tuberculosis in developed countries: difficulties in diagnosis. J R Coll Surg Edinb 41:192–196

    CAS  PubMed  Google Scholar 

  7. HodgsonA, Stock F, Fang H, Ong G. Anterior spinal fusion. The operative approach and pathological findings in 412 patients with Pott’s disease of the spine.Br J Surg. 1960;48:172–8

  8. Javed H, Bakula Z, Plen M, Hashmi H, Tahir Z, Jamil N et al (2018) Evaluation of genotype MTBDRplus and MTBDRsl assays for rapid detection of drug resistance in extensively drug-resistant mycobacterium tuberculosis isolates in Pakistan. Front Microbiol 9:2265

    Article  Google Scholar 

  9. Li L, Zhang Z, Luo F, Xu J, Cheng P, Wu Z et al (2012) Management of drug-resistant spinal tuberculosis with a combination of surgery and individualised chemotherapy: a retrospective analysis of thirty-five patients. Int Orthop 36:277–283

    Article  Google Scholar 

  10. Liu Q, Yang D, Qiu B, Martinez L, Ji Y, Song H et al (2021) Drug resistance gene mutations and treatment outcomes in MDR-TB: a prospective study in Eastern China. PLoS Negl Trop Dis 15(1):10

    Article  Google Scholar 

  11. Millar T, McGrath P, McConnachie C (2007) Tuberculosis of the spine presenting with a cold abscess through the lumbar triangle of Petit. Clin Anat 20:329–331

    Article  Google Scholar 

  12. Mohan K, Rawall S, Pawar U, Sadani M, Nagad P, Nene A et al (2013) Drug resistance patterns in 111 cases of drug-resistant tuberculosis spine. Eur Spine J 22(4):647–652

    Article  Google Scholar 

  13. Moon M, Ha K, Sun D, Moon J, Moon Y, Chung J (1996) Pott’s paraplegia 67 cases. Clin Orthop Relat Res 323:122–128

    Article  Google Scholar 

  14. Nayak S, Achariya B (2012) Mantoux test and its interpretation. Indian Dermatol Online J 3:2–6

    Article  Google Scholar 

  15. Nerlich A., LöschS. Paleopathology of human tuberculosis and the potential role of climate. Climate change and infectious dis. 2009;437187

  16. Nunn A, Phillips P, Meredith S, Chiang CC, Dalai D et al (2019) A trial of a shorter regimen for rifampin-resistant tuberculosis. N Engl J Med 380(13):1201–13

    Article  CAS  Google Scholar 

  17. Pawar U, Kundnani V, Agashe V, Nene A (2009) Multidrug-resistant tuberculosis of the spine--is it the beginning of the end? A study of twenty-five culture proven multidrug-resistant tuberculosis spine patients. Spine (Phila Pa 1976) 34(22):806–10

    Article  Google Scholar 

  18. Puig GJ (1947) The formation and significance of vertebral ankylosis in tuberculous spines. J Bone JointSurg 29:136–148

    Google Scholar 

  19. Rajasekaran S, Shanmugasundaram TK, Dheenadhayalan J, Shetty DK (1999) Tuberculosis lesions of the lumbosacral region: a 15 year follow up of patients treated by ambulant chemotherapy. Spine 23:1163–1167

    Article  Google Scholar 

  20. Rajasekaran S (2002) The problem of deformity in spinal tuberculosis. Clin Orthop Relat Res 398:85–92

    Article  Google Scholar 

  21. Rasouli M, Mirkoohi M, Vaccaro A, Yarandi K, Movaghar V (2012) Spinal tuberculosis: diagnosis and management. Asian spine J 6:294–308

    Article  Google Scholar 

  22. Rossau R, Traore H, Beenhouwer H, Mijs W, Jannes G, Rijk P et al (1997) Evaluation of the INNO-LiPA Rif. TB assay, a reverse hybridization assay for the simultaneous detection of Mycobacterium tuberculosis complex and its resistance to rifampin. Antimicrob Agents Chemother 41(10):2093 8

    Article  Google Scholar 

  23. Schirmer P, Renault C, Holodniy M (2010) Is spinal tuberculosis contagius? Int J infect Dis 14:659–666

    Article  Google Scholar 

  24. Smith I (2003) Mycobacterium tuberculosis pathogenesis and molecular determinants of virulence. Clin Microbiol Rev 16:463–496

    Article  CAS  Google Scholar 

  25. Smith T, Wolff K, Nguyen L (2013) Molecular biology of drug resistance in Mycobacterium tuberculosis. Curr Top Microbiol Immunol 374:53–80

    CAS  PubMed  PubMed Central  Google Scholar 

  26. Trecarichi E, Meco E, Mazzotta V, Fantoni M (2012) Tuberculous spondylodiscitis: epidemiology, clinical features, treatment, and outcome. Eur Rev Med Pharmacol Sci 16(suppl 2):58–72

    PubMed  Google Scholar 

  27. Tuli S (2014) Multidrug resistant tuberculosis: a challenge in clinical orthopedics. Indian J Orthop 48(3):235–237

    Article  Google Scholar 

  28. Umubyeyi A, Shamputa I, Rigouts L, Dediste A, Struelens M, Portaels F (2007) Evidence of ‘amplifier effect’ in pulmonary multidrug-resistant tuberculosis: report of three cases. Int J Infect Dis 11(6):508–512

    Article  CAS  Google Scholar 

  29. Velayati A, Masjedi M, Farnia P, Tabarsi P, Ghanavi J, ZiaZarifi A et al (2009) Emergence of new forms of totally drug-resistant tuberculosis bacilli: super extensively drug-resistant tuberculosis or totally drug-resistant strains in Iran. Chest 136(2):420–425

    Article  Google Scholar 

  30. World Health Organization. Global tuberculosis report 2020. 2020

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Authors

Contributions

Vishal Kumar: final approval of the version to be published.

Deepak Neradi: critical analysis and revision of content

Balwinder Sherry: drafting of the report

Ankit Gaurav: drafting of the report

Sarvdeep Singh Dhatt: critical analysis and revision of content

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Correspondence to Sarvdeep Singh Dhatt.

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Kumar, V., Neradi, D., Sherry, B. et al. Tuberculosis of the spine and drug resistance: a review article. Neurosurg Rev 45, 217–229 (2022). https://doi.org/10.1007/s10143-021-01595-1

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