Our Experience in Diagnosing Tuberculous Spondylitis

Objective — to increase the efficiency of diagnosis in patients with tuberculous spondylitis (TS). Materials and methods. The clinical material of this research consisted of protocols of clinical and radiological examination, and analysis of the results of the study of 30 patients with active TS (the main group). Criteria for inclusion of patients in the study: TS in the active phase (verified pathomorphologically and/or bacteriologi­cally). The diagnostic group included 20 patients who were also referred to our hospitals with suspected TS, but the diagnosis was not confirmed during an in-depth examination. The average age of patients in the main and diagnostic groups was (38.2 ± 9.6) and (40 ± 10.8) years, respectively (p > 0.05). Results and discussion. In total, we examined 45 patients from both groups who were admitted to hospital with suspected spondylitis using surgical biopsy (30 patients in the main group and 15 in the diagnostic group). Surgical biopsy diagnostic methods included abscess puncture, puncture and trepana­tion biopsy of the vertebral bodies. Punctures of paravertebral abscesses were performed in 21 patients. Puncture and trepanation biopsy of the vertebral bodies was used in 24 patients. Through biopsy study using surgical techniques, the diagnosis of TS in the main group was confirmed in 30 patients. Bacteriological confirmation of the diagnosis was obtained by us in 12 (39.96 %) patients: in 6 (19.98 %) patients Mycobacterium tuberculosis (MTB) was isolated only by the culture method, in the others only by the bacterioscopy method and in 2 (6.72 %) cases positive results were obtained by both methods. The diagnosis of a spinal tumour was established in 4 patients in the diagnostic group; another 4 patients from this group were diagnosed with non-specific spondylitis, and 7 with osteochondrosis of the spine was identified. In no case of puncture and trepanation biopsy did we observe any complications. DNA of the MTB complex was detected by polymerase chain reaction (PCR) in 40 (88.8 %) of 45 samples of surgical material from patients with a histologically confirmed diagnosis of TS. Overall, confirmation of the diagnosis of TS by PCR and culture methods was obtained in 93.7 % of cases. Conclusions. Assessment of the results of bacteriological examination of patients showed a relatively low efficiency of bacteriological diagnostic methods for TS and a high efficiency of PCR. Biopsy findings indicate the high efficiency of this method and its in conducting aetiological diagnosis with mandatory testing of the sensitivity of MTB to antibacterial drugs. Improving the diagnosis of TS is an important factor in achieving better treatment outcomes for this disease.