Etiological diagnosis of tuberculous spondylitis
Background. One of the main conditions for successful treatment of tuberculous spondylitis is the timely diagnosis of this disease before the development of such severe complications as neurological deficiency, congestive abscesses, fistulas, spinal deformation, etc. The purpose of the study was to improve diagnostic efficiency in patients with tuberculous spondylitis. Materials and methods. The protocols of clinical and radiological examination, assessment of the findings and treatment of 30 patients with active tuberculous spondylitis served as clinical materials for this article. The average age of patients was 38.2 ± 9.6 years. The vast majority of patients had lesions of two vertebral bodies: 25 (83.25 %). Thoracolumbar spine was the most often affected area. It should be noted that when destructive specific process was located in thoracic part of the spine, three bodies of vertebrae were involved in the inflammation more often. Results. Bacteriological confirmation of the diagnosis was obtained in 12 (39.96 %) patients, of whom Mycobacterium tuberculosis were identified only by culture in 6 (19.98 %), in others - only by bacterioscopy and in 2 (6.72 %) cases, positive results were obtained by both methods. Assessment of information content of different pathological material showed that the highest number of positive results, both by culture and bacterioscopy, was obtained from the abscess contents - 9 (30 %) cases, pus in tampons and secretion from the fistulas were detected significantly less frequently - only in 2 (6.66 %) patients. Moreover, the frequency of Mycobacterium tuberculosis detection in the operating material, including granulations and caseous masses, was low - 5 cases (16.65 %). Biopsy using surgical techniques was applied to confirm tuberculous spondylitis in 30 patients in the study group. The diagnosis of spine tumors was established in 9 persons, and other 7 patients were diagnosed with nonspecific spondylitis. Fine-needle aspiration of congestive abscesses was positive in 11 patients (52 %). Fine-needle aspiration allowed diagnosing metastasis of the vertebral cancer in one case, the primary tumor of the spine in three cases, tuberculosis in 9 patients and non-specific vertebral osteomyelitis in 4 cases. If puncture biopsy was ineffective, percutaneous core-needle biopsy of the vertebral bodies was performed. This method allowed diagnosing tuberculous spondylitis in 5 patients, primary tumor of the spine in one and cancer metastasis in another patient. The use of fine-needle and core-needle biopsy did not result in any complications. Core-needle biopsy was performed under electronic image converter guidance in posterior approach through the root of the arc of the affected segment. Conclusions. The conducted analysis of bacteriological findings in patients showed a relatively low effectiveness of bacteriological methods of diagnosis in tuberculous spondylitis and high efficiency of polymerase chain reaction. The results of biopsy studies indicate the high efficiency and expediency of etiological diagnosis with obligatory research of Mycobacterium tuberculosis sensitivity to anti-bacterial agents. Improvement of etiological diagnosis of tuberculous spondylitis is an important factor in improving the treatment outcomes in this disease.