Differentiated Approach to the Diagnosis and Treatment of Tuberculous Spondylitis in Adults

Abstract

The purpose of this study is to generalize the results of a complex clinical-laboratory, radiological and immunological study of patients with spinal tuberculosis. A comprehensive examination analysis was carried out in 192 patients with tuberculous spondy litis who were in the department of surgery for osteoarticular tuberculosis of the Republican Specialized Scientific and Practical Medical Center of Tuberculosis and Pulmonology in Tashkent, Uzbekistan. Severe degrees of spinal disorders were found in 48.7% of patients. Magnetic resonance imaging (MRI) and multi-slice spiral computed tomography (MSCT) allow establishing the stage and activity of a specific process in the spine, as well as complications. Spinal column instability was detected in 143 (74.5%) patients, paravertebral abscesses in 116 (60.4%) patients, and epidural abscesses in 75 (39.0%) patients. Changes in immunological parameters in patients with spinal tuberculosis were associated both with impaired regulation of immunogenetic and with the direct influence of the immune system at various stages of the process. The detection of certain patterns of immune system disorders in patients with tuberculous lesions of the spine allowed us to make a differentiated approach to their treatment in order to increase the effectiveness of the treatment. It can be concluded that at present, tuberculosis of bones and joints, especially the spine, is detected in an advanced stage in 50-80% of cases and has a widespread and complicated character with profound anatomical and functional changes and the presence of severe spinal disorders in 48.7% patients in Uzbekistan. Regarding spondylitis, it is immensely important to make an accurate diagnosis based on the clinical presentations, laboratory, radiological and immunological findings and by periodic assessment of the response to treatment, which is essential in atypical cases.