Spinal tuberculosis: proposed spinal infection multidisciplinary management project (SIMP) flow chart revision

Area of Science:

• Infectious Diseases
• Orthopedic Surgery
• Radiology

Background:

• Spinal tuberculosis (TB) is a significant cause of osteoarticular TB, often presenting with delayed diagnosis.
• Standardized management protocols are crucial for optimizing patient care and outcomes.

Purpose of the Study:

• To propose and evaluate a revised flowchart for the Spinal Infection Multidisciplinary Management Project (SIMP).
• To standardize the diagnostic process and management of spinal TB.
• To assess the effectiveness of a multidisciplinary approach in managing spinal TB.

Main Methods:

• Retrospective review of osteoarticular TB cases treated between 2013-2017 at a tertiary teaching hospital.
• Cross-linking notified TB cases with the SIMP database for data analysis.
• Analysis of clinical, diagnostic (imaging, laboratory tests), and treatment data of spinal TB patients managed by SIMP.

Main Results:

• Spinal TB accounted for 52% of osteoarticular TB cases (21/40).
• Back pain was the primary symptom in 67% of patients, with a median delay of 4.5 months to hospital admission.
• Interferon gamma release assay was positive in 75%, MRI showed spondylodiscitis in 90%, and 18F-FDG-PET/CT indicated high uptake in 89.5%.
• Bacteriological confirmation was achieved in 86% of cases.
• 95% of patients successfully completed anti-TB treatment after multidisciplinary management, with one-third undergoing surgery.

Conclusions:

• A multidisciplinary approach, guided by a standardized flowchart, facilitates early and accurate diagnosis of spinal TB.
• This integrated management strategy improves both medical and surgical outcomes for patients with spinal TB.