Differentiation between Tuberculous Spondylitis and Pyogenic Spondylitis on MR Imaging

박종한,신혜선,박종태,김태영,엄기성 대한척추신경외과학회 2011 Neurospine Vol.8 No.4

Objective: The objective of this study was to compare the magnetic resonance(MR) imaging of tuberculous spondylitis with pyogenic spondylitis. Methods: MR images of the spines of 41 patients with infectious spondylitis at our institution over 8-years of period were retrospectively reviewed. Eighteen patients with infective spondylitis were excluded because their results on the marrow biopsy and culture were negative. MR imaging findings in 6 patients with tuberculous spondylitis(3 male, 3 female) were compared with those of 17 patients(10 male, 7 female) with pyogenic spondylitis. Results: Two MR imaging findings were statiscally significant in differentiating the tuberculous spondylitis from pyogenic spondylitis: a well defined paraspinal abnormal signal and a thin and smooth abscess wall. There were no significant diffe- rences in the following MR imaging findings: paraspinal abscess or intraosseous abscess, subligamentous spread to three or more vertebra, involvement of multiple vertebra, hyperintense signal on T2-weighted images, heterogenous low signal on T1-weighted images, involvement of posterior element, epidural extension, involvement of intervertebral disk, disk space narrowing, rim enhancement of the abscess, skip lesion, and endplate destruction. Conclusion: MR imaging is an appropriate modality for differentiation of tuberculous spondylitis from pyogenic spondylitis. Objective: The objective of this study was to compare the magnetic resonance(MR) imaging of tuberculous spondylitis with pyogenic spondylitis. Methods: MR images of the spines of 41 patients with infectious spondylitis at our institution over 8-years of period were retrospectively reviewed. Eighteen patients with infective spondylitis were excluded because their results on the marrow biopsy and culture were negative. MR imaging findings in 6 patients with tuberculous spondylitis(3 male, 3 female) were compared with those of 17 patients(10 male, 7 female) with pyogenic spondylitis. Results: Two MR imaging findings were statiscally significant in differentiating the tuberculous spondylitis from pyogenic spondylitis: a well defined paraspinal abnormal signal and a thin and smooth abscess wall. There were no significant diffe- rences in the following MR imaging findings: paraspinal abscess or intraosseous abscess, subligamentous spread to three or more vertebra, involvement of multiple vertebra, hyperintense signal on T2-weighted images, heterogenous low signal on T1-weighted images, involvement of posterior element, epidural extension, involvement of intervertebral disk, disk space narrowing, rim enhancement of the abscess, skip lesion, and endplate destruction. Conclusion: MR imaging is an appropriate modality for differentiation of tuberculous spondylitis from pyogenic spondylitis.

결핵성 척추염과 화농성 척추염의 감별 진단

구기형,이혁진,염진섭,박건우,이춘기,장봉순 대한척추외과학회 2009 대한척추외과학회지 Vol.16 No.2

Study Design: This is a retrospective study Objectives: We wanted to make the early differential diagnosis between tuberculous spondylitis and pyogenic spondylitis according to the clinical and MRI findings. Summary of the Literature Review: Making an early differential diagnosis between tuberculous spondylitis and pyogenic spondylitis is essential to start prompt and proper treatment. However, the clinical symptoms and MRI findings of both these illnesses can vary considerably. Material and Method: Ninety-five patients (49 men and 46 women, mean age: 54.5) who were treated from January 2001 to February 2007 and whose diagnosis was confirmed by laboratory or pathological studies were retrospectively reviewed. 50 patients with tuberculous spondylitis and 45 patients with primary pyogenic spondylitis were included. The patients with combined infection or an uncertain diagnosis were excluded. We compared the medical records and MRI findings between the different groups of patients. Results: The patients with tuberculous spondylitis were younger (48.2 years vs. 61.5 years, respectively) and they had a longer symptom duration (4.3 months vs 1.8 months, respectively). The erythrocyte sedimentation rate (ESR) and the C-reactive protein (CRP) level were significantly higher in the patients with pyogenic spondylitis (71.3/49.6 mm/hr and5.74/2.98 mg/dl, respectively). A high fever above 38 degree was more frequent in the patients with pyogenic spondylitis. Intraosseous abscess, epidural abscess, a well-definded paraspinal abscess, focal enhancement and severe destruction of the vertebral body on MRI were more frequent in the patients with tuberculous spondylitis. Four parameters such as a symptom duration longer than 3 months, no fever higher than 38 degree, a well-defined paravertebral abscess and an intraosseous abscess were selected. 42 patients in the tuberculous group had 3 or more of these four parameters. The sensitivity and specificity of these combined 4 parameters were 84% and 97.8%, respectively, for making the differential diagnosis between these 2 maladies. Conclusion: These diagnostic criteria might be useful to discriminate between tuberculous spondylitis and pyogenic spondylitis even without definite laboratory or pathological results. 연구계획: 후향적 연구 연구목적: 결핵성 척추염과 화농성 척추염의 감별은 조기 진단 및 치료에 중요하나 임상 경과 및 방사선학적 소견이 다양하여 감별이 어려운 경우가 많다. 임상 소견 및 자기 공명 영상 소견을 비교 분석하여 이들을 감별하고자 하였다. 대상 및 방법: 2001년 1월부터 2007년 2월까지 감염성 척추염으로 수술적 치료를 시행하고 술 중 균배양 및 조직학 적 검사로 확진된 환자 95명을 대상으로 하였다. 남자가 49명, 여자가 46명이었고 평균 연령은 54.5(14~86)세이었다. 각 군에서 성별, 나이, 침범 추체수, 증상 발현 기간, 술전 임상 병리 검사 결과, 동통, 발열, 신경학적 증상 등의 임상 양상과 자기 공명 영상 소견을 비교하여 분석하였다. 결과: 결핵성 척추염이 50례, 화농성 척추염이 45례이었다. 결핵성 척추염에서 평균 연령이 48.2세로 화농성 척추염 의 61.5세에 비하여 조기에 발병하였으며, 평균 발병 기간은 4.3개월로 화농성 척추염의 1.8개월에 비하여 길었고, C 반응성 단백(CRP), 적혈구 침강 속도(ESR)는 화농성 척추염에서 5.74 mm/hr, 71.3 mg/이으로 결핵성 척추염의 2.98 mm/hr, 49.6 mg/이에 비하여 유의하게 높았고, 38도 이상의 고열도 화농성 척추염군에서 유의하게 많았다. 자기 공명 영상 소견에서 추체내 농양, 경막 주위 농양, 경계가 분명한 추체 주위 농양, 추체의 심한 파괴는 결핵성 척추염에서 유의하게 많았으며 조영 증강시 부분적이고 다양한 조영 증강 소견을 보이는 경우가 많았다. 3개월 이상의 이환 기 간, 38도 이상의 발열이 없는 경우의 임상 소견과 경계가 분명한 척추 주위 농양, 추체내 농양과 같은 방사선학적 소 견을 종합하여 이러한 4가지 항목 중 3가지 이상을 만족시키는 경우가 결핵성 척추염으로 진단된 50례 중 42례이었 고 진단의 민감도는 84%이었고, 특이도는 97.8%이었다. 결론: 이러한 진단 기준은 배양 검사나 조직학적 검사가 불확실한 상황에서의 감염성 척추염의 감별 진단에 유용하 게 이용될 수 있을 것으로 생각된다.

The Effect of Intervertebral Fusion using the Titanium Mesh Cage in Tuberculous Spondylitis

Ju-Ho Jeong,Dae-Yong Kim 고신대학교 의과대학 2009 고신대학교 의과대학 학술지 Vol.24 No.2

Background : The problems of tuberculous spondylitis are recurrence and loss of the correction of kyphotic deformity after surgical treatments. The maintenance of correction of kyphotic deformity is one of the difficult problem in tuberculous spondylitis. We here report that titanium mesh cage impacted with autogenous bone chip is an effective intervertebral fusion in surgical treatment for tuberculous spondylitis to maintain correction of kyphotic deformity without recurrence. Methods : Twenty nine patients treated with titanium mesh cage for tuberculous spondylitis were reviewed from January 1996 to June 2002. Fourteen patients were female, and 15 were male. Mean age was 52.2 years old. Mean follow-up period was 37.8 months. We analized the change of the correction of kyphotic deformity, change of ESR and CRP, fusion state and recurrence after intervertebral fusion with titanium mesh cage. Results : The infected vertebral bodies were 2.3 in average. Clinical symptoms were improved in all patients without any neurologic complications. The mean kyphotic angle corrected was 11.8 degrees immediately after operation, but the loss of correction of kyphotic angle was 3.6 degrees after 3 months, 4.4 degrees after 6 months, 4.8 degrees after 12 months and 4.9 degrees after more than 18 months. We found that the loss of correction of kyphotic deformity occurred mainly within the first 3 months after surgery. Conclusion : The surgical procedure of tuberculous spondylitis using titanium mesh cage with bone chip seems to be an effective procedure to minimize loss of the correction of kyphotic deformity without any aggravation inflammatory change and recurrence, when sufficient debridement and anti-tuberculous chemotherapy are achieved.

비 전형적 양상의 척추 결핵 - 증례 보고 -

민학진,유형곤,신성기 대한척추외과학회 2015 대한척추외과학회지 Vol.22 No.3

Study Design: Case study of two cases. Objectives: The aim of our study is to describe atypical patterns of tuberculous spondylitis. Summary of Literature Review: Few reports of tuberculous spondylitis have discussed atypical cases, which resulted in a poor prognosis due to the delay in early diagnosis and proper treatment. Materials and Methods: A 74-year-old female underwent an incision and drainage, and posterior decompression and fusion (PDF) due to tuberculous epidural abscess after vertebroplasty of a compression fracture at T12. A 52-year-old female underwent interbody fusion and posterior lateral fusion (PLF) because of aggravation of an abscess and neurologic symptoms following non-invasive intervention to treat atypical tuberculous spondylitis. Results: Clinical symptoms and serological tests of the patients were improved at postoperative 6 months. Conclusions: When a patient presents with focal bony or soft tissue abnormality on an image study, the possibility of non-typical tuberculous spondylitis has to be considered when infective spondylitis or a tumor is detected. Moreover, an invasive diagnosis tool such as biopsy will be needed for proper management. 연구 계획: 증례 보고적: 비 전형 양상의 척추 결핵에 대하여 보고한다. 선행 문헌의 요약: 비전형적 양상의 척추 결핵이 드물지만 보고 되고 있으며, 이는 빠른 진단 및 적절한 치료의 지연으로 인한 좋지 않은 예후를 보이는경향이 있다. 대상 및 방법: 74세 여자 환자로 제 12번 흉추 척추체 성형술 시행 뒤 고열이 발생하여 시행한 MRI상 척추염 및 경막외 농양이 관찰되었고 이에 대해배농술 및 후외방 추체간 유합술을 시행하였다. 병리학적 검사상 최종적으로 결핵으로 진단되었다. 52세 여자 환자로 우측 하지로의 방사통을 주소로시행한 MRI 검사상 경막외 농양 및 척추염 소견 관찰되어 농양의 배농을 하였고 결핵성 척추염으로 진단되어 항 결핵요법을 시작하였으나, 술 후 8주째염증 악화 및 신경학적 이상소견 보여 추체간 유합술 및 후 외방 고정술을 시행하였다. 결과: 수술 후 6개월째 임상 증상의 호전 및 혈청학적 검사에서도 정상의 결과를 얻었다. 결론: 척추의 영상 검사에서 뼈나 연부조직의 국소적 이상 소견으로 척추의 염증 혹은 종양을 감별해야 하는 경우 비 전형적 척추 결핵의 가능성도 고려해야 하며 적절한 치료를 위해 조직검사 등의 보다 적극적인 진단 방법이 필요할 것으로 생각된다.

결핵성 척추염의 수술적 치료

정성원,조봉수,이동열 대한신경외과학회 1997 Journal of Korean neurosurgical society Vol.26 No.3

The Effect of Intervertebral Fusion using the Titanium Mesh Cage in Tuberculous Spondylitis

정주호,김대용 고신대학교(의대) 고신대학교 의과대학 학술지 2009 고신대학교 의과대학 학술지 Vol.24 No.2

Background : The problems of tuberculous spondylitis are recurrence and loss of the correction of kyphotic deformity after surgical treatments. The maintenance of correction of kyphotic deformity is one of the difficult problem in tuberculous spondylitis. We here report that titanium mesh cage impacted with autogenous bone chip is an effective intervertebral fusion in surgical treatment for tuberculous spondylitis to maintain correction of kyphotic deformity without recurrence. s Methods : Twenty nine patients treated with titanium mesh cage for tuberculous spondylitis were reviewed from January 1996 to June 2002. Fourteen patients were female, and 15 were male. Mean age was 52.2 years old. Mean follow-up period was 37.8 months. We analized the change of the correction of kyphotic deformity, change of ESR and CRP, fusion state and recurrence after intervertebral fusion with titanium mesh cage. s Results : The infected vertebral bodies were 2.3 in average. Clinical symptoms were improved in all patients without any neurologic complications. The mean kyphotic angle corrected was 11.8 degrees immediately after operation, but the loss of correction of kyphotic angle was 3.6 degrees after 3 months, 4.4 degrees after 6 months, 4.8 degrees after 12 months and 4.9 degrees after more than 18 months. We found that the loss of correction of kyphotic deformity occurred mainly within the first 3 months after surgery. n Conclusion : The surgical procedure of tuberculous spondylitis using titanium mesh cage with bone chip seems to be an effective procedure to minimize loss of the correction of kyphotic deformity without any aggravation inflammatory change and recurrence, when sufficient debridement and anti-tuberculous chemotherapy are achieved.

결핵성 척추염의 수술적 치료

이동열,정성원,조봉수 침례병원 1998 浸禮病院學術誌 Vol.14 No.-

혈액 투석 환자에서 발생한 결핵성 척추염 치료

유혜영 ( Yu Hye Yeong ),신영신 ( Sin Yeong Sin ),우영식 ( U Yeong Sig ),최강현 ( Choe Gang Hyeon ),이정록 ( Lee Jeong Log ),이소영 ( Lee So Yeong ),박철휘 ( Park Cheol Hwi ),안명임 ( An Myeong Im ),장윤식 ( Jang Yun Sig ),방병기 ( 대한신장학회 2001 Kidney Research and Clinical Practice Vol.20 No.6

Patients undergoing maintenance dialysis show an increased susceptibility to tuberculosis because host immunity is decreased secondary to malnutrition, impaired cellular immunity, acidosis and etc. Extrapulmonary tuberculosis is more prevalent in patients with end stage renal disease than in normal subjects. Among the extrapulmonary tuberculosis in patients receiving hemodialysis, the diagnosis of tuberculous spondylitis is difficult because the symptoms are non specific and attributable to uremia, and the appearance of plain radiographs is often normal during the early phase of the disease. We experienced a case of tuberculous spondylitis in a hemodialysis patient. A 55 years old female admitted with fever, weight loss and back pain. Conventional radiograph of T-spine showed no definite abnormal finding. However, chest CT revealed heterogeneously enhancing soft tissue around the T8 vertebral body and T-spine MRI showed compatible finding to tuberculous spondylitis. She received radical excision of involved vertebra and confirmed tuberculous spondylitis with histologic finding from a surgical specimen. Following the administration of anti-tuberculosis medication(isoniazid, rifampin, pyraziamide, ethambutol) and radical excision, patient`s symptom and sign were improved. The patient is maintaining dialysis with anti-tuberculosis medication for 5 months.

Preoperative Gadolinium-enhanced Magnetic Resonance Images on Infectious Spondylitis

Kim, Seok-Won,Lee, Seung-Myoung,Shin, Ho The Korean Neurosurgical Society 2005 Journal of Korean neurosurgical society Vol.38 No.5

Objective : The purpose of this study is to analyze the patterns of intervertebral disc enhancement seen in infectious spondylitis, differentiate between two groups[tuberculous vs pyogenic spondylitis]. Methods : Between January 1994 and December 2002, 83patients underwent operative procedure with confirmed to histopathologic evaluation. Magnetic resonance[MR] images were obtained in all patients and were analyzed retrospectively. 57patients had tuberculosis and 26patients were infected by pyogens. The patterns of gadolinium enhancement of disc were classified into 4 types[post's classification] : Type I, non-enhancing; Type II, enhancement of the peripheral rim; Type III, Type II with central area and partial endplate; Type IV, general enhancement. Results : The enhancement patterns observed were as follows : Common pattern of tuberculous spondylitis was Type II, and pyogenic spondylitis was Type III. [p < 0.01] This difference may result from pathophysiologic varieties of organisms. Conclusion : Careful preoperative MR analysis of the patterns of disc enhancement occuring in infectious spondylitis can be useful for differentiating between the tuberculous and pyogenic spondylitis.

결핵성 척추염에 대한 한․양방 병행치료 1례

이정희,이윤규,임성철,이현종,김재수 대한침구의학회 2015 대한침구의학회지 Vol.32 No.3

Objectives : The purpose of this study is to report the clinical effects of Integrated Medicine Therapy on Tuberculous Spondylitis. Methods : The patient was diagnosed with Tuberculous Spondylitis by MRI. Despite taking antituberculous drugs for one month the back pain remained. As a result the patient was hospitalized shortly thereafter in our hospital, and was treated with acupuncture, pharmacopuncture, and herbal medication during the admission period. The clinical effects of these treatments are measured by the verbal rating scale(VRS), the range of motion(ROM) and the Korean oswestry disability index(KODI). Results : VRS is changed from 10 to 3.5, limited lumbar ROM recovered, KODI changed from 85.71 to 28.57. Conclusions : These results suggest that integrated medicine therapy may be effective for tuberculous spondylitis.