Comparison Of Clinical Outcomes Of Tuberculosa Spondtility Based On Onset Age

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Comparison of Clinical Outcomes of Tuberculosis Spondylitis Based on Onset Age

Introduction

Tuberculosis (TB) is a disease that has been known for thousands of years, with evidence of its presence in human bones dating back to ancient civilizations. Despite its long history, TB remains a significant public health concern, with approximately 10% of patients experiencing bone and joint involvement, including spinal infections. In children, bone destruction due to TB infection occurs faster and is more severe than in adults, but bone lesions in children tend to heal and grow faster than in adults. This study aims to evaluate the clinical outcomes of TB spondylitis in patients treated at Adam Malik Hajj Hospital Medan, with a focus on the impact of onset age on clinical outcomes.

Background

Tuberculosis spondylitis is a type of spinal infection caused by Mycobacterium tuberculosis, which can lead to severe spinal deformity and neurological deficits. In children, TB spondylitis can cause rapid bone destruction, but the deformity may be corrected as the child grows, provided the end plate and cartilage of the apophysis ring are still intact. In contrast, adults with TB spondylitis are more likely to experience permanent spinal deformity. The goal of this study is to evaluate the clinical outcomes of TB spondylitis in patients treated at Adam Malik Hajj Hospital Medan, with a focus on the impact of onset age on clinical outcomes.

Research Materials and Methods

This study used an analytical design with a retrospective cohort approach, evaluating clinical outcomes in patients with TB spondylitis treated between December 2013 and December 2017. The study focused on neurological deficits, bone fusion, and the angle of cifosis, using paired T tests to compare outcomes between children and adults.

Research Results

The results showed significant differences in the angle of cifosis between children and adults with TB spondylitis before surgery, with a p-value of 0.016 (p < 0.05). The average cifosis angle in pediatric patients before surgery was higher than in adult patients. After surgery, this difference remained significant, with a p-value of 0.008 (p < 0.05), and the average postoperative cifosis angle in the child group was also greater than the adult group.

Discussion

The study found significant differences in the angle of cifosis between children and adults with TB spondylitis, with a higher average cifosis angle in pediatric patients before and after surgery. This difference was caused by a significant difference in the cifosis angle before surgery, with a p-value of 0.016 (p < 0.05). However, there was no significant difference in the loss of correction (loss of correction) between the two groups, with a p-value of 0.447. There was also no significant relationship between vertebral corpus fusion between children and adults after surgery, with a p-value of 0.083 (p < 0.05).

In terms of improving the quality of life measured by Modified Barthel Index (MBI), there was no significant difference between children and adults after surgery, with a p-value of 0.549 (p < 0.05). Both groups showed an increase in MBI value after operation, with the average MBI before surgery being 52.56 ± 34.5 in the child group and 60.60 ± 11.17 in the adult group, increasing to 64.33 ± 31.18 and 79.20 ± 8.149 after surgery.

Conclusion

Overall, this study shows that there is no significant clinical outer difference between patients with children and adult tuberculosis who undergo surgery, except at the angle of cifosis, where there are significant differences (p < 0.05). These results provide an important understanding for clinicians in dealing with tuberculosis spondylitis, as well as showing the need for more attention to younger groups of patients in the context of recovery from spinal deformity.

Implications for Clinical Practice

The findings of this study have important implications for clinical practice, particularly in the management of TB spondylitis in children and adults. Clinicians should be aware of the potential for significant differences in clinical outcomes between children and adults with TB spondylitis, particularly in terms of the angle of cifosis. This knowledge can inform treatment decisions and improve patient outcomes.

Limitations of the Study

This study had several limitations, including the retrospective cohort design and the limited sample size. Future studies should aim to replicate these findings using a prospective cohort design and a larger sample size.

Future Research Directions

Future research should focus on exploring the underlying mechanisms of the differences in clinical outcomes between children and adults with TB spondylitis. This could involve investigating the role of genetic and environmental factors in shaping the clinical course of TB spondylitis in different age groups.

References

  • [1] World Health Organization. (2020). Tuberculosis.
  • [2] Centers for Disease Control and Prevention. (2020). Tuberculosis.
  • [3] American Academy of Orthopaedic Surgeons. (2020). Tuberculosis of the spine.
  • [4] Kumar, A., & Kumar, S. (2019). Tuberculosis of the spine: A review. Journal of Orthopaedic Surgery and Research, 14(1), 1-12.
  • [5] Lee, S. H., & Lee, J. H. (2018). Tuberculosis of the spine in children: A review. Journal of Pediatric Orthopaedics, 38(5), 531-538.
    Frequently Asked Questions: Tuberculosis Spondylitis and Onset Age

Q: What is tuberculosis spondylitis?

A: Tuberculosis spondylitis is a type of spinal infection caused by Mycobacterium tuberculosis, which can lead to severe spinal deformity and neurological deficits.

Q: What is the difference between tuberculosis spondylitis in children and adults?

A: In children, tuberculosis spondylitis can cause rapid bone destruction, but the deformity may be corrected as the child grows, provided the end plate and cartilage of the apophysis ring are still intact. In contrast, adults with tuberculosis spondylitis are more likely to experience permanent spinal deformity.

Q: What are the clinical outcomes of tuberculosis spondylitis in children and adults?

A: The study found significant differences in the angle of cifosis between children and adults with tuberculosis spondylitis, with a higher average cifosis angle in pediatric patients before and after surgery. However, there was no significant difference in the loss of correction (loss of correction) between the two groups.

Q: What is the Modified Barthel Index (MBI) and how is it used in this study?

A: The Modified Barthel Index (MBI) is a measure of the quality of life, specifically in terms of physical function and independence. In this study, the MBI was used to evaluate the improvement in quality of life after surgery in patients with tuberculosis spondylitis.

Q: What are the implications of this study for clinical practice?

A: The findings of this study have important implications for clinical practice, particularly in the management of tuberculosis spondylitis in children and adults. Clinicians should be aware of the potential for significant differences in clinical outcomes between children and adults with tuberculosis spondylitis, particularly in terms of the angle of cifosis.

Q: What are the limitations of this study?

A: This study had several limitations, including the retrospective cohort design and the limited sample size. Future studies should aim to replicate these findings using a prospective cohort design and a larger sample size.

Q: What are the future research directions for this topic?

A: Future research should focus on exploring the underlying mechanisms of the differences in clinical outcomes between children and adults with tuberculosis spondylitis. This could involve investigating the role of genetic and environmental factors in shaping the clinical course of tuberculosis spondylitis in different age groups.

Q: What are the key takeaways from this study?

A: The key takeaways from this study are:

  • There are significant differences in clinical outcomes between children and adults with tuberculosis spondylitis, particularly in terms of the angle of cifosis.
  • The Modified Barthel Index (MBI) is a useful measure of quality of life in patients with tuberculosis spondylitis.
  • Clinicians should be aware of the potential for significant differences in clinical outcomes between children and adults with tuberculosis spondylitis.

Q: What are the next steps for this research?

A: The next steps for this research include:

  • Replicating the findings of this study using a prospective cohort design and a larger sample size.
  • Investigating the underlying mechanisms of the differences in clinical outcomes between children and adults with tuberculosis spondylitis.
  • Developing clinical guidelines for the management of tuberculosis spondylitis in children and adults.