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Background. Most information on bone-joint (BJ)-tuberculosis is based on data from high-incidence areas. We conducted a nationwide register-based analysis of BJ-tuberculosis in Denmark from 1994 to 2011. Methods. We linked data from the national tuberculosis surveillance system on BJ-tuberculosis, hospital records, the Danish Hospital and Civil Registration System. Results. We identified 282 patients with BJ-tuberculosis, 3.6% of all tuberculosis cases (n = 7936). Spinal tuberculosis was found in 153 of 282 patients (54.3%); 83.3% of all cases were immigrants. Danes were older and had higher Charlson comorbidity index scores than immigrants (P < .01). C-reactive protein and erythrocyte sedimentation rates were elevated in most cases. Median time to diagnosis after first hospital contact was 19.5 days for spinal tuberculosis and 28 days for other forms of BJ-tuberculosis (P = .01). Of patients with spinal tuberculosis, 54/133 (40.6%) had neurologic deficits at admission and 17.3% presented with cauda equina. Diagnosis was culture verified in 87%. (Resistance to any drug was found in 10.2%). Median time on antituberculous treatment for patients with spinal and other forms of BJ-tuberculosis was 9 months and 7 months, respectively (P < .01). Surgery was required in 44.4% patients with spinal tuberculosis and in 32.6% patients with other forms of BJ-tuberculosis (P = .04). Sequelae were reported in 57.5% of patients with spinal tuberculosis and 29.1% of patient with other forms of BJ-tuberculosis (P < .01). One-year mortality was 25.5% among Danes compared with 1.3% among immigrants (P < .01). Conclusions. BJ-tuberculosis was rare and seen mainly in younger immigrants in Denmark. More than half of cases were spinal tuberculosis, presenting with more severe symptoms and worse outcome, compared with other forms of BJ-tuberculosis.

Spinal tuberculosis is the most common extrapulmonary tuberculosis, characterized by intervertebral disc destruction, which seriously affects people’s quality of life. Recent studies have suggested that the TGF-β1/SMADs signaling pathway plays an important regulatory role in the process of intervertebral disc destruction caused by spinal tuberculosis. However, the abnormal TGF-β1/SMADs signaling pathway in spinal tuberculosis is not fully understood. Herein, we found for the first time that HCG18 was significantly upregulated in spinal tuberculosis nucleus pulposus clinical samples and confirmed that HCG18 negatively regulates the proliferation and migration ability of nucleus pulposus cells (NPCs). In vitro experiments further suggest that overexpression of HCG18 can significantly promote TGF-β1/SMADs pathway activity and inhibit proliferation, migration, and apoptosis of NPCs, an effect which can be reversed by overexpressing hsa-miR-146a-5p. On the contrary, knocking down HCG18 yields the opposite result. In vivo experiments suggest that knocking down HCG18 can significantly alleviate the destruction of the nucleus pulposus in rats with spinal tuberculosis by inhibiting the activity of the TGF-β1/SMADs pathway. In summary, our research suggests that HCG18 can promote the progression of spinal tuberculosis by alleviating the inhibitory effect of hsa-miR-146a-5p on the TGF-β1/SMADs pathway. This study provides new insights into the occurrence and development of spinal tuberculosis, as well as new strategies for the prevention and treatment of spinal tuberculosis.

Background Spinal tuberculosis is a rare condition that can result in significant neurological impairments. It is typically classified into two main types based on the anatomical involvement: parenchymal and meningeal. However, existing studies have not provided systematic reports that clarify the differences in aetiology, pathophysiological mechanisms, and clinical presentations between these two types. Methods This retrospective study includes 107 patients diagnosed with intracranial tuberculosis accompanied by spinal tuberculosis via magnetic resonance imaging (MRI) between May 2019 and May 2024 at our hospital. Patients are categorised into parenchymal and meningeal types based on radiological manifestations. Clinical symptoms, comorbidities, peripheral blood and cerebrospinal fluid laboratory indices, and MRI data are collected for both groups. Statistical analyses are performed using Chi-square tests, independent sample t-tests and non-parametric tests. Results Parenchymal spinal tuberculosis is more frequently associated with haematogenous pulmonary dissemination, exhibits a stronger inflammatory response and is linked to poorer nutritional status. Meningeal spinal tuberculosis often co-occurs with tuberculous meningitis, with common symptoms including sensory and motor deficits and lumbar back pain. Further, MRI findings indicate that parenchymal tuberculosis predominantly features nodular lesions, whereas meningeal tuberculosis is characterised by dural linear or leptomeningeal enhancement. Conclusion Significant differences exist in the clinical and radiological manifestations of parenchymal and meningeal spinal tuberculosis, and MRI enhancement scans play a crucial role in diagnosis, aiding in the optimisation of diagnostic and treatment strategies.

The present study aims to establish a method of constructing a New Zealand rabbit spinal tuberculosis model by direct local infusion of M. tuberculosis H37Rv strain into the intervertebral disc space through the posterior lateral approach. Sixty-six New Zealand rabbits were pretreated with complete Freund's adjuvant and randomly divided into 4 group: the posterolateral approach model group (Group A, 25), ventral transverse process approach model group (Group B, 25), control group (Group C, 10), and blank group (Group D, 6). In Groups A and B, the bone holes were filled with gelatin sponge after drilling, and the local area was directly infused with 0.1 ml of M. tuberculosis H37Rv strain suspension. In Group C, the gelatin sponge was filled through the posterolateral approach and the local area was infused with 0.1 ml of normal saline suspension. In Group D, No specific treatment was performed. The general conditions of the experimental rabbits in each group were compared to those of a control group; the degree of vertebral body exposure, incision length, and complications of the two methods were compared; and the tuberculosis models were evaluated by imaging, histopathology, and bacterial culture. In Group A, the lateral side of the vertebral body was well exposed, the damage was mild, and no peritoneal rupture or gastrointestinal complications were observed. In Group B, the ventral side of the vertebral body and the intervertebral disc were exposed, and abdominal complications were more likely to occur. The survival rates of the experimental rabbits at 8 weeks after surgery were 92.0% in Group A, 88.00% in Group B, 90.0% in Group C, and 100% in Group D. MRI examinations showed that in Group A, the positive rate of radiographic bone findings was 86.9% at 4 weeks after surgery and 100% at 8 weeks after surgery; in Group B, the positive rate of radiographic bone findings was 78.2% at 4 weeks after surgery and 95.4% at 8 weeks after surgery. There was no significant difference between Groups A and B in the radiographic bone findings rate detected by the same imaging method at the same time point ( P  > 0.05). Eight weeks after surgery, bone destruction, paravertebral abscess, and caseous necrosis occurred in the vertebral bodies of surviving rabbits in Groups A and B. The BacT/ALERT 3D rapid culture system was used to culture the pus in the lesion, and the results showed that the positive rate of tuberculosis was 52.17% in Group A and 54.54% in Group B, and the difference was not statistically significant ( P  > 0.05). After pretreatment with complete Freund's adjuvant, direct infusion of the H37Rv strain of M. tuberculosis into the intervertebral disc space of New Zealand rabbits via the posterolateral approach and the ventral transverse process approach can successfully establish rabbit spinal tuberculosis models.

Objectives To investigate the pathological diagnostic value of spinal tuberculosis (STB) lesions with different submitting methods and tissue types, provide a reference for accurate submission of STB tissue specimens, and improve the accuracy of pathological diagnosis. Methods The clinical data and intraoperative lesion specimens of 68 STB patients surgically treated in the Department of Orthopedics of General Hospital of Ningxia Medical University from June 2019 to October 2022 were collected and divided into two groups according to the different ways of submitting lesion tissues for examination. In group A, the lesion tissues were submitted for examination separately, including granulation tissues, vertebral lesion bone tissues, and intervertebral discs for pathological examination; in group B, all lesion specimens were mixed and submitted for pathological examination. Group A included 34 cases, 19 males and 15 females, while Group B included 34 cases, 17 males and 17 females. The tissue specimens were routinely decalcified, dehydrated, embedded, sectioned, and stained with hematoxylin-eosin (HE), and the typical and atypical pathological changes of STB were observed under a high-power microscope. Observe the accuracy rate of pathological diagnosis of different lesion tissues in Group A, and carry out comparative analysis within the group; meanwhile, compare and analyze the difference in pathological diagnosis between Group A and B. Ten cases of clinically suspected STB were selected to undergo lesion tissue puncture biopsy, of which 6 cases were male and 4 cases were female, to obtain suspected granulation tissue, vertebral lesion bone tissue, and intervertebral discs for pathological examination, and to compare and analyze the difference between pathological diagnosis of the preoperative puncture specimens and the final diagnosis after operation. Results In Group A, 27 granulation tissues, 34 vertebral lesion bone tissues, and 30 intervertebral discs were sent for examination respectively, and the accuracy of pathologic diagnosis was 59.3%, 44.1%, and 26.7%. Of the 34 STB patients in Group A, 28 were pathologically diagnosed as STB by comprehensive analysis of granulation tissue, vertebral lesion bone tissue, and intervertebral disc, and the overall pathological diagnostic accuracy rate in Group A was 82.4%. The difference between the overall pathological diagnostic accuracy of group A compared with the independent pathological detection rates of granulation tissue, vertebral lesion bone tissue, and intervertebral disc tissue was statistically significant ( P  < 0.05); The difference in the accuracy of pathological diagnosis between granulation tissue, intervertebral disc tissue and vertebral lesion bone tissue was not statistically significant in group A ( P  > 0.05); the difference in the rate of pathological diagnosis between granulation tissue and intervertebral disc tissue was statistically significant ( P  < 0.05). Thirty-four samples were submitted for examination in Group B, and the accuracy rate of pathological diagnosis was 58.8%. The difference between the overall pathological detection rate of Group A and that of Group B was statistically significant ( P  < 0.05). Ten cases of clinically suspicious STB were selected for lesion tissue puncture biopsy; suspicious granulation tissue, vertebral lesion bone tissue, and intervertebral disc tissue were sent for examination in 9, 10, and 9 pieces, respectively, and the accuracy rates of pathological diagnosis were 44.4%, 60.0%, and 33.3%, respectively; the comprehensive analysis of mixed lesion tissue supported the diagnosis of STB in 8 out of 10 cases. However, due to the small sample size, these findings should be considered exploratory and warrant validation in larger cohorts. Conclusions The accuracy of pathological diagnosis of STB lesion tissues submitted separately was higher than that of mixed submission, in which the pathological diagnosis rate of granulation tissue and vertebral bone tissue was higher. It will help to improve the accuracy of pathological diagnosis of STB by submitting STB tissue specimens separately and submitting vertebral lesion bone or granulation tissue by preoperative puncture.

The purpose of this study was to describe and compare the clinical data, laboratory examination and imaging examination of tuberculous spondylitis (TS) and pyogenic spondylitis (PS), and to provide ideas for diagnosis and treatment intervention. The patients with TS or PS diagnosed by pathology who first occurred in our hospital from September 2018 to November 2021 were studied retrospectively. The clinical data, laboratory results and imaging findings of the two groups were analyzed and compared. The diagnostic model was constructed by binary logistic regression. In addition, an external validation group was used to verify the effectiveness of the diagnostic model. A total of 112 patients were included, including 65 cases of TS with an average age of 49 ± 15 years, 47 cases of PS with an average of 56 ± 10 years. The PS group had a significantly older age than the TS group (P = 0.005). In laboratory examination, there were significant differences in WBC, neutrophil (N), lymphocyte (L), ESR, CRP, fibrinogen (FIB), serum albumin (A) and sodium (Na). The difference was also statistically significant in the comparison of imaging examinations at epidural abscesses, paravertebral abscesses, spinal cord compression, involvement of cervical, lumbar and thoracic vertebrae. This study constructed a diagnostic model, which was Y (value of TS > 0.5, value of PS < 0.5) = 1.251 * X1 (thoracic vertebrae involved = 1, thoracic vertebrae uninvolved = 0) + 2.021 * X2 (paravertebral abscesses = 1, no paravertebral abscess = 0) + 2.432 * X3 (spinal cord compression = 1, no spinal cord compression = 0) + 0.18 * X4 (value of serum A)−4.209 * X5 (cervical vertebrae involved = 1, cervical vertebrae uninvolved = 0)−0.02 * X6 (value of ESR)−0.806 * X7 (value of FIB)−3.36. Furthermore, the diagnostic model was validated using an external validation group, indicating a certain value in diagnosing TS and PS. This study puts forward a diagnostic model for the diagnosis of TS and PS in spinal infection for the first time, which has potential guiding value in the diagnosis of them and provides a certain reference for clinical work.

Spinal tuberculosis (STB) is a common form of extrapulmonary tuberculosis (ETB). However, the molecular mechanism of pathological injury in STB remains unclear. The purpose of this study was to explore the pathogenic mechanism of STB, and compare it with (E.coli) bone infections and lumbar degenerative disease (LDD) patients. In this study, the infected lumbar spine bone tissue of STB patients was collected for the infection group. LDD patients and E.coli lumbar spine infection (SEcoli) patients were collected for the non-M.TB infection group. Proteins from the bone tissue were extracted for 4D-Label Free Proteomics (4D-LFQ) analysis to compare the pathogenesis and immune mechanisms of STB and SEcoli. The osteoclast growth inhibitory factors tumor necrosis factor receptor superfamily member 11B (TNFRSF11B) and semaphorin-3A (Sema3A) were significantly down-regulated in STB, while the protein Wnt-5a (WNT5A) secreted by osteoblasts was significantly up-regulated. These changes in STB bone metabolism may lead to an increase in the number of osteoclasts and bone injury. In addition, the significantly up-regulated expression of thymocyte selection-related family member 2 (THEMIS2) suggests that THEMIS2 may be a potential therapeutic target for STB that could control the Toll-like receptor response of macrophages. Meanwhile, the PI3K-Atk anti-apoptotic pathway and the ECM-receptor interaction pathway were inhibited during both infections. This study explored the pathogenic mechanism of STB based on proteomics and compared its differences with E.coli bone infection, providing new insight into the treatment of STB.

In this retrospective study, charts of inpatients with spinal tuberculosis (STB) treated in large-scale general hospitals in Changsha, Hunan, China, between 2007 and 2016 were reviewed to investigate their clinical characteristics. Demographic, epidemiological and clinical features, imaging findings, treatment methods, and prognosis were summarized and analyzed. There were 1378 patients, 805 males and 573 females, with a mean age of 43.7 years. The mean interval between symptom onset and diagnosis was 16.0 months (range 15 days–240 months). The incidence of back pain, radicular pain and symptoms of systemic toxicity was 92.5%, 40.1%, and 32.1%, respectively. The rate of neurological impairment was 49.9 %. STB was present in two or more vertebrae in 91.1% of patients, with two adjacent vertebrae being involved in 67.9% of them. The lumbar segment (38.2%) was the most frequently affected, followed by the thoracic spine (35.7%). The sacrococcygeal area was the least frequently involved (0.8%). Abscesses were detected in 65.5% of patients. One thousand patients (72.6%) were managed with surgery and 378 (27.4%) with anti-TB drugs only. Cure was achieved in 1215 patients (88.2%), whereas 49 (3.5 %) had relapses. Concomitant pulmonary TB (PTB) was diagnosed in 366 patients (26.6%) and 63 (4.6%) had concomitant diabetes. Compared with the previous five years, the number of older patients, urban patients, and medical staff with STB had increased by 6.1%, 5.2%, and 1.3%, respectively in the five years studied. STB remains a severe public health problem that cannot be ignored. Most of the patients ignored early symptoms and therefore received untimely treatment. Thus, surveillance for and treatment of STB in South-central China requires strengthening. In addition to the current China-wide database of patients with PTB, a China-wide database of patients with STB should also be set up.

The aim of this retrospective review was to assess the overall burden and trend in spinal tuberculosis (TB) at tertiary hospitals in the Western Cape Province of South Africa. All spinal TB cases seen at the province's three tertiary hospitals between 2012 and 2015 were identified and clinical records of each case assessed. Cases were subsequently classified as bacteriologically confirmed or clinically diagnosed and reported with accompanying clinical and demographic information. Odds ratios (OR) for severe spinal disease and corrective surgery in child vs. adult cases were calculated. A total of 393 cases were identified (319 adults, 74 children), of which 283 (72%) were bacteriologically confirmed. Adult cases decreased year-on-year ( P = 0.04), however there was no clear trend in child cases. Kyphosis was present in 60/74 (81%) children and 243/315 (77%) adults with available imaging. Corrective spinal surgery was performed in 35/74 (47%) children and 80/319 (25%) adults (OR 2.7, 95% confidence interval 1.6–4.5, P = 0.0003). These findings suggest that Western Cape tertiary hospitals have experienced a substantial burden of spinal TB cases in recent years with a high proportion of severe presentation, particularly among children. Spinal TB remains a public health concern with increased vigilance required for earlier diagnosis, especially of child cases.