[Misdiagnosis and mismanagement of pathological fractures in spinal tuberculosis:causes and management strategies].

OBJECTIVE: To explore the perioperative management of pathological fractures in spinal tuberculosis patients undergoing vertebral augmentation,and to provide clinical data for the differential diagnosis of spinal tuberculosis.

METHODS: A retrospective analysis was conducted on the clinical data of 30 spinal tuberculosis patients who underwent vertebral augmentation from April 2017 to May 2022. According to the treatment methods,the patients were divided into three groups:Group A (posterior spinal approach with bone cement mass removal,decompression,and bone graft fusion),Group B(posterior spinal decompression and bone graft fusion),and Group C (conservative treatment). Group A included 10 patients(6 males and 4 females) with an average age of (68.50±6.81) years. Group B included 12 patients (8 males and 4 females) with an average age of (67.92±5.86) years. Group C included 8 patients (4 males and 4 females) with an average age of (65.00±7.09) years. All patients received anti-tuberculosis drug treatment for 18 to 24 months. The erythrocyte sedimentation rate (ESR),C-reactive protein (CRP),tuberculosis infection T-cell spot test (T-SPOT.TB),visual analogue scale (VAS) for pain,American Spinal Injury Association(ASIA) neurological function classification,and modified Barthel index(MBI) for assessing activities of daily living were observed and compared among the three groups.

RESULTS: All 30 patients were followed up at 3 and 12 months postoperatively. Among them,27 patients showed elevated ESR and CRP during the preoperative period,and tested positive for T-SPOT.TB;The remaining 3 patients had normal ESR and CRP levels and negative T-SPOT.TB results. In Group A,the VAS decreased from 7.05±1.09 before treatment to 1.85±0.81 at 12 months postoperatively,with a statistically significant difference (P<0.05). In Group B,the preoperative VAS was 7.67±1.26,which decreased to 2.13±0.74 at 12 months postoperatively,showing a statistically significant difference(P<0.05). In Group C,the VAS score decreased from 8.56±1.21 before treatment to 3.06±1.23 at 12 months after treatment,with a statistically significant difference(P<0.05). The ESR and CRP levels of the three groups all returned to the normal range at 3 and 12 months postoperatively,which were significantly different from those before the operation (P<0.05). At 12 months postoperatively,26 patients achieved complete recovery of ASIA neurological function,and 4 patients achieved partial recovery. The MBI scores of the three groups at 12 months after treatment were significantly improved compared with those before treatment(P<0.05). Additionally,at 3 and 12 months after treatment,the MBI scores of Group A and Group B were superior to those of Group C,with statistically significant differences (P<0.05).

CONCLUSION: Vertebral wedge deformation is not an exclusive indicator of primary osteoporotic fractures. Clinical details should be thoroughly analyzed,and attention should be paid to the imaging changes of the soft tissues around the vertebral body and inflammatory changes. Before vertebral augmentation,routine ESR,CRP tests,and enzyme-linked immunospot assays (T-SPOT.TB) are recommended. For spinal tuberculosis cases that have already undergone vertebral augmentation,individualized surgical treatment plans should be adopted.