BACKGROUND: Tuberculosis (TB) is caused by Mycobacterium tuberculosis (Mtb) and typically infects the lungs. However, extrapulmonary forms of TB can be found in approximately 20% of cases. It is suggested, that up to 10% of extrapulmonary TB affects the musculoskeletal system, in which spinal elements (spinal tuberculosis, STB) are involved in approximately 50% of the cases. STB is a debilitating disease with nonspecific symptoms and diagnosis is often delayed for months to years. In our Spinal TB X Cohort, we aim to describe the clinical phenotype of STB using whole-body 18 F-fluorodeoxyglucose positron emission tomography computed tomography (PET/CT) and to identify a specific gene expression profile for the different stages of dissemination on PET/CT. Here we report on the first patient recruited into our cohort who underwent PET/CT before treatment initiation, at 6-months and at 12-months - time of TB treatment completion.
METHODS: A 27-year-old immunocompetent male presented with severe thoracolumbar back pain for 9 months with severe antalgic gait and night sweats. Magnetic resonance imaging (MRI) of the whole spine revealed multilevel spinal disease (T5/6, T11/12, L3/4) in keeping with STB. After informed consent and recruitment into the Spinal TB X Cohort, the patient underwent PET/CT as per protocol, which revealed isolated multilevel STB (T4-7, T11/12, L3/4) with no concomitant lung or urogenital lesion. However, sputum and urine were Xpert MTB/RIF Ultra positive and Mtb was cultured from the urine sample. CT-guided biopsy of the T11/12 lesion confirmed drug-sensitive Mtb on Xpert MTB/RIF Ultra and the patient was started on TB treatment according to local guidelines for 12 months. The 6-month follow-up PET/CT revealed new and existing spinal lesions with increased FDG-uptake despite significant improvement of clinical features and laboratory markers. After 9 months of treatment, the patient developed an acute urethral stricture, most likely due to urogenital TB, and a suprapubic catheter was inserted. The 12-month PET/CT showed significantly decreased PET/CT values of all lesions, however, significant persistent spinal inflammation was present at the end of TB treatment. Clinically, the patient was considered cured by the TB control program and currently awaits urethroplasty.
CONCLUSIONS: In our case, PET/CT emerged as a valuable imaging modality for the initial assessment, surpassing MRI by revealing more comprehensive extensive disease. Subsequent PET/CT scans at 6-month uncovered new lesions and increased inflammation in existing ones, while by the end of TB treatment, all lesions exhibited improvement. However, the interpretation of FDG avidity remains ambiguous, whether it correlates with active infection and viable Mtb. or fibro- and osteoblast activity indicative of the healing process. Additionally, the absence of extraspinal TB lesions on PET/CT despite positive microbiology from sputum and urine maybe explained by paucibacillary, subclinical infection of extraspinal organs. The Spinal TB X Cohort endeavours to shed light on whole-body imaging patterns at diagnosis, their evolution midway through TB treatment, and upon treatment completion. Ultimately, this study aims to advance our understanding of the biology of this complex disease.

A 24-year-old immunocompetent woman underwent whole-body 18F-FDG PET/CT for the evaluation of MRI-suspicious tuberculous spinal lesions. The PET/CT results showed no pathological uptake in either lung, and there were no pathological changes on CT. There was increased uptake in the right psoas muscle, extending continuously down anterior to the right hip joint, posterior to and around the trochanteric region of the right femur, and into the right thigh, with an SUVmaxbw of 17.0. Subsequently, the patient underwent CT-guided biopsy as per protocol, which revealed drug-sensitive Mycobacterium tuberculosis, and the patient was started on standard tuberculosis treatment for 12 months.

Pott\'s spine, commonly known as spinal tuberculosis (TB), is an extrapulmonary form of TB caused by Mycobacterium TB. Pott\'s paraplegia occurs when the spine is involved. Spinal TB is usually caused by the hematogenous spread of infection from a central focus, which can be in the lungs or another location. Spinal TB is distinguished by intervertebral disc involvement caused by the same segmental arterial supply, which can result in severe morbidity even after years of approved therapy. Neurological impairments and spine deformities are caused by progressive damage to the anterior vertebral body. The clinical, radiographic, microbiological, and histological data are used to make the diagnosis of spinal TB. In Pott\'s spine, combination multidrug antitubercular therapy is the basis of treatment. The recent appearance of multidrug-resistant/extremely drug-resistant TB and the growth of human immunodeficiency virus infection have presented significant challenges in the battle against TB infection. Patients who come with significant kyphosis or neurological impairments are the only ones who require surgical care. Debridement, fusion stabilization, and correction of spinal deformity are the cornerstones of surgical treatment. Clinical results for the treatment of spinal TB are generally quite good with adequate and prompt care.

Pott\'s disease is a form of extrapulmonary tuberculosis (TB) and has a global increase in incidence. The diagnosis should be made early to avoid neurological deficiency or deformity of the spine.
UNASSIGNED: A 2-year-old and 6-month-old boy was admitted with fever and unspecific generalized pain, the examination revealed mild hyperreflexia in the lower extremities, isotope scan showed increased uptake in the T8 vertebra. MRI demonstrated destruction in the T8 vertebra with kyphotic deformity and abscess anterior to T7, T8, and T9 levels with an epidural abscess at the T8 level extending to the spinal canal and compressing the spinal cord. The patient underwent a surgical procedure with a transthoracic approach, the decompression of the spinal canal was performed through T8 corpectomy, the reduction of kyphosis was performed and the internal fixation with a dynamic cylinder and lateral titanium plate was carried out. Microbiologic examination suggests Mycobacterium tuberculosis.
UNASSIGNED: Pott\'s disease (spinal TB) is extremely rare in the young children population, and surgical treatment is reported only in a few reports, and it is considered a technical challenge. There are several surgical approaches during childhood, for upper thoracic spinal TB, the posterior approach is easy, minimally invasive, safe, reliable, and effective. But it had the worst outcomes. In contrast, the anterior approach provides direct access to the lesions.
UNASSIGNED: More research are needed to detect the best choice in the management of thoracic spinal TB in children.

Tuberculosis (TB) prevalence is increasing in developed nations and continuing to cause significant mortality in low- and middle-income countries. As a result of the uptick in cases, there also exists an increased prevalence of extrapulmonary TB. TB is caused by Mycobacterium tuberculosis (M. tb). When M. tb disseminates to the vertebral column, it is called Pott\'s disease or spinal TB. The frequency, symptoms, and severity of the disease range by the location of the spine and the region of the affected vertebrae. While the current literature shows that timely diagnosis is crucial to reduce the morbidity and mortality from Pott\'s disease, there is a lack of specific clinical diagnostic criteria for Pott\'s disease, and the symptoms may be very non-specific. Studies have shown that novel molecular diagnostic methods are effective and timely choices. Research has implicated the risk factors for the susceptibility and severity of Pott\'s disease, such as HIV and immunosuppression, poverty, and malnutrition. Based on the current literature available, our group aims to summarize the pathogenesis, clinical features, diagnostic challenges, as well as the known risk factors for Pott\'s disease within this literature review.

METHODS: Systematic Review and Meta-analysis.
OBJECTIVE: This systematic review and meta-analysis is aimed to assess effectiveness, safety, clinical, functional and radiological outcome of either combined anteroposterior or posterior-only approach in the surgical management of active tubercular disease of paediatric thoracolumbar spine.
METHODS: A systematic literature search through PubMed, Scopus, Web of Science and Cochrane Library database was performed. Data extraction was undertaken following methodological quality assessment.
RESULTS: 9 out of the 182 publications identified, were included for analysis. A total of 247 patients were analysed. Two amongst the 9 studies were retrospective comparative studies evaluating posterior approach with combined anteroposterior approach and were considered for comparative meta-analysis. Blood loss and duration of surgery was significantly higher in the anteroposterior group, as compared to the posterior-only group. There was no significant difference between the 2 groups in terms of post-operative kyphosis angles, final kyphosis angles, number of complications, functional outcome and spinal fusion time. However, all the included studies were non-randomised and retrospective. Only 2 of them had a control group with a high heterogeneity amongst these 2 studies.
CONCLUSIONS: The inference from the studies included in this review suggests that equivalent results can be achieved with posterior-only approach for thoracolumbar tuberculosis in children as compared to anteroposterior approach, with much lower complexity, reduced blood loss and shorter surgical time. However, due to the high risk of bias and considerable heterogeneity among the studies included, we cannot conclude whether one approach is better than the other.

BACKGROUND: Spinal tuberculosis (TB), or Pott\'s disease, is the most common form of osteoarticular TB. Early diagnosis and anti-TB drug therapy are the mainstays of treatment. However, in advanced stages, surgery is essential to correct spinal deformities and avoid neurological damage. Very few cases in young children requiring surgical treatment have been described. We present 2 cases of surgically treated thoracic spinal TB in patients under 2 years of age and review the literature on this entity in young children.
METHODS: Two male toddlers, aged 21 (patient 1) and 23 (patient 2) months, were admitted due to insidious systemic deterioration associated with neck stiffness and nonspecific abdominal pain in patient 1 and limping in patient 2. The findings of laboratory tests were unremarkable despite an increase in acute-phase reactants. After an extensive workup, results of a magnetic resonance imaging were consistent with spinal TB in both patients. Patient 1 underwent costotransversectomy of the left third and fourth ribs, debridement, T3-T4 corpectomy, and T2-T6 posterior fusion, to which an anterior rib autograft was added. Patient 2 had a right-sided thoracotomy performed at the apex in addition to debridement and T8 corpectomy; the resected rib was used as anterior structural autograft. Several samples of purulent, caseous material were sent for study. On follow-up, progression of proximal junctional kyphosis was evidenced in patient 1, requiring revision surgery to restore sagittal alignment; the patient was asymptomatic at 2-year follow-up. Patient 2 evolved satisfactorily without neurological sequelae and was asymptomatic at 4-year follow-up.
CONCLUSIONS: Spinal TB in young children requires appropriate surgical treatment when presenting at advanced stages or having severe deformity or neurological compromise. Despite the challenges associated with young age and ongoing growth, surgery can be performed safely provided proper surgical expertise. After extensive debridement and decompression, priority should be given to restoring sagittal alignment and balance with stable and durable spinal reconstructions.
METHODS:

METHODS: Modified Delphi Consensus and Observational Study.
OBJECTIVE: Instability in spinal tuberculosis (STB) leads to disabling spinal deformity and neurodeficit. Identifying and estimating instability remains subjective, mainly based on experience. This study aims to develop an objective scoring system to determine instability in STB.
METHODS: The study included 4 phases. (1) A panel of 10 experienced spine surgeons developed a questionnaire based on literature. (2) 68 spine surgeons from 12 countries opined on the importance of each factor in a survey. Five factors deemed important by >70% of participants were further analyzed (3) 60 representative cases of STB were analyzed for instability. A preliminary scoring system was developed, a threshold score for determining instability was derived, and (4) Results were validated.
RESULTS: All the 5 factors (\"Spine at risk\" signs, severity of vertebral body loss, Cervicothoracic/Thoracolumbar junction involvement, age ≤15, and kyphotic deformity ≥30°) considered important by >70% of participants were associated with instability and included in scoring: age ≤15 years (P-value, 0.05), cervicothoracic/thoracolumbar junction involvement (P-value, 0.028), sagittal deformity angle ratio (DAR) ≥ 15° (P-value, <.001), vertebral body loss-segmental ratio ≥.5 (P-value, <.001), and presence of spine at risk signs (P-value, <.001). A total score of ≥3/09 indicated definite instability with good sensitivity (77%) and excellent specificity (100%). Repeatability assessment showed a good agreement (.9625), and Cohen\'s kappa coefficient was strong (.809).
CONCLUSIONS: A simple objective scoring system for predicting instability in STB has been developed using 5 main factors; young age, junctional involvement, severity of the deformity, vertebral body loss, and presence of spine at risk signs.

Edward Hickling Bradford (1848-1926) is considered as 1 of the most important figures in American and world orthopedics during 19th and early 20th century. His teaching ability, his gifted surgical skills and his innovations in orthopedics attracted the interest of the world orthopedic\'s community and gave him a long lasting reputation. But most of all he is considered as the founder of pediatric orthopedics in America.

UNASSIGNED: Retrospective cohort.
UNASSIGNED: To report the demographic characteristics, clinico-radiological presentation, laboratory findings, and outcomes of \"middlepath\" treatment in patients with spinal tuberculosis from a single public healthcare facility in a developing country.
UNASSIGNED: Tuberculosis is a global health problem that is endemic in developing countries and undergoing resurgence in developed ones. Spinal tuberculosis can cause disabling back pain, progressive deformity, and neurological involvement. However, there is a lack of large-scale epidemiological studies quantifying the size and severity of the problem of spinal tuberculosis.
UNASSIGNED: Hospital records of spinal tuberculosis patients treated at a single center over a period of 5 years were retrospectively reviewed. A diagnosis of spinal tuberculosis was based on standard clinical, radiological, microbiological, and histopathological evidence. Patients were treated in accordance with the \"middle-path\" regimen; surgery was reserved for selective indications.
UNASSIGNED: A total of 1,652 patients were included. Their median age was 32.4 years, with 53% being male. Axial pain (98%) was the most common presenting symptom; 19% of patients had neurological deficit. Lumbar spine (37%) was the most common site of involvement, with a paradiscal pattern (82%) of involvement predominating. Multi-level involvement was seen in 19% of patients; skip lesions were noted in 2.8%. Transpedicular biopsy was performed in 667 patients; at least one tissue test was diagnostic of tuberculosis in 65% of patients. Forty-four patients had drug resistance to rifampicin. Surgery was required in 10.5% of patients. The \"middle-path\" regimen was associated with high compliance and significant improvements in pain (Visual Analog Scale score) and function (36-Item Short Form Health Survey).
UNASSIGNED: Our findings confirm the widespread prevalence of spinal tuberculosis and describe various epidemiological characteristics of a large sample of spinal tuberculosis patients. Adoption of the \"middle-path\" regimen is associated with high compliance and favorable outcomes in spinal tuberculosis.