Infectious Diseases Unit, Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy.
Eur Rev Med Pharmacol Sci. 2020 Feb;24(3):1428-1434. doi: 10.26355/eurrev_202002_20201.
We propose a revised flow chart of spinal infection multidisciplinary management project (SIMP) aimed to standardize the diagnostic process and management of spinal tuberculosis (TB).
We reviewed data from all TB cases with osteoarticular involvement treated at a large tertiary teaching hospital in Bologna, Northern Italy, from January 2013 to December 2017. We cross-linked notified osteoarticular TB cases with SIMP database and we analysed clinical, diagnostic, and treatment data of all cases managed by SIMP.
Osteoarticular TB accounted for the 7.8% (n=40) of all TB cases notified between 2013 and 2017 (N=513). Among the identified cases, 52% (n=21/40) had spine involvement: all were enrolled and evaluated by SIMP multidisciplinary group. Females accounted for 57% (12/21) of patients, the median age was 52 years (range 24-82). In the 67% (n=14/21) of cases, the major clinical symptom of spinal TB was back pain reported for a median of 4.5 months (range 1-12 months) before hospital admission. The interferon gamma release assay was positive in 75% (n=16/21) of patients. All patients performed MRI with gadolinium, which indicated spondylodiscitis in 90%. 18F-FDG-PET/CT revealed average maximum standardized uptake value (SUV max) of 12.54 (range 5.3-22) in 17/19 (89.5%). Bacteriological confirmation of TB was obtained in 86% of cases (n=18/21). One-third of patients (7/21) underwent surgery and 95% successfully completed the anti-TB treatment.
Our data reveal that a multidisciplinary approach to spine tuberculosis facilitates early and accurate diagnosis and can improve medical and surgical management of this disease.
我们提出了修订后的脊柱感染多学科管理项目（SIMP）流程图，旨在规范脊柱结核（TB）的诊断流程和管理。
我们回顾了 2013 年 1 月至 2017 年 12 月在意大利北部博洛尼亚一家大型教学医院治疗的所有涉及骨关节炎的 TB 病例的数据。我们将 notified osteoarticular TB 病例与 SIMP 数据库进行交叉链接，并分析了所有由 SIMP 管理的病例的临床、诊断和治疗数据。
2013 年至 2017 年期间，骨关节炎性 TB 占所有 notified TB 病例的 7.8%（n=40）（N=513）。在确定的病例中，52%（n=21/40）有脊柱受累：所有病例均由 SIMP 多学科小组纳入并评估。女性占患者的 57%（12/21），中位年龄为 52 岁（范围 24-82 岁）。在 67%（n=14/21）的病例中，脊柱结核的主要临床症状是入院前中位数为 4.5 个月（范围 1-12 个月）的背痛。干扰素释放试验在 75%（n=16/21）的患者中呈阳性。所有患者均进行了 MRI 加钆造影，90%的患者显示为脊椎炎。18F-FDG-PET/CT 显示 17/19（89.5%）例患者的平均最大标准化摄取值（SUV max）为 12.54（范围 5.3-22）。在 86%的病例（n=18/21）中获得了 TB 的细菌学证实。三分之一的患者（7/21）接受了手术，95%的患者成功完成了抗 TB 治疗。
我们的数据表明，对脊柱结核采用多学科方法有助于早期准确诊断，并能改善该病的医疗和手术管理。
