Abstract: Aim: was to demonstrate possibilities of timely radiological diagnosis and treatment of spinal tuberculosis in a patient with a single lung after pleuropneumonectomy for fibrocavernous pulmonary tuberculosis. Materials and methods: patient, 26 y.o. female, country inhabitant, grocery store clerk. She was hospitalized to the National Medical Research Center for Phthisiopulmonology and Infectious Diseases of the Ministry of Health of the Russian Federation with a diagnosis: “Tuberculosis spondylitis Th12-L2, focal tuberculosis S2 of the single right lung in the infiltration phase. M.Tb(-). Pleuropneumonectomy for fibrocavernous tuberculosis of left lung (December 18, 2018)”. To clarify etiology and lesion volume and to determine surgical treatment tactics, multispiral computed tomography (MSCT) of lungs and thoracolumbar spine and subsequent percutaneous trephine biopsy of the L1 vertebra were performed. Results: according to MSCT data, destruction of Th12-L1-2 vertebral bodies was revealed; in single right lung, medium-intensity focal lesion with a diameter of 5 mm in C1, a small calcinate in C2, and a subpleural focal lesion in C4 were visualized. Small-focal dissemination was observed throughout the entire length of single lung. Bacteriological study of biological material taken during trephine biopsy revealed the growth of Mycobacterium tuberculosis, confirmed by diagnostics of polymerase chain reaction (PCR). Taking into account the pulmonary pathology, operation was performed in the volume of resection of Th12-L1-2 bodies and antero-lateral spinal fusion with a Mesh body replacement implant with bone autoplasty from left-side access, transpedicular fixation (TPF) of Th11-L3 with a four-screw structure under intraoperative radiation control. As a result of treatment, patient was discharged in a satisfactory condition. Conclusions: presented case report demonstrates the importance of timely radiological diagnosis in patients with combined infectious lesions of lungs and spine for obtaining of complete information about the state of respiratory and bone systems, using MSCT and interventional radiology methods and for determination of pathological process etiology. It made it possible to perform timely diagnosis and complex surgical intervention with the most sparing and light surgical access to affected vertebrae in tuberculosis spondylitis from the side of previous pleuropneumonectomy. References 1. Giller DB, Martel’ II, Imagozhev YG, et al. An experience of single lung resection and pneumonectomy after contralateral lung resection in treatment of tuberculosis. Khirurgiya (Mosk). 2021; (1): 15-21 [In Russ]. https://doi.org/10.17116/hirurgia2015935-42 2. Giller DB, Giller GV, Imagozhev YG. Surgical collapse in the treatment of single lung tuberculosis. Khirurgiia. 2021; (1): 15-21 [In Russ]. https://doi.org/10.17116/hirurgia202101115 3. Mushkin AYu, Vishnevskiy AA, Peretsmanas EO, et al. Infectious Lesions of the Spine: Draft National Clinical Guidelines. Khirurgiya pozvonochnika. 2019; 16(4): 63-76 [In Russ]. https://doi.org/10.14531/ss2019.4.63-76 4. Sovetova NA, Vasileva GYu, Soloveva NS. Tuberculous spondylitis in adults (clinical and radiographic manifestation). Tuberkulez I bolezni legkikh. 2014; (10): 33-37 [In Russ]. 5. Dunn RN, Ben Husien M. Spinal tuberculosis: review of current management. Bone Joint J. 2018; 1(100-B(4)): 425-431.
Abstract: A standard X-ray is still the most affordable method of evaluation of patients, including those with spinal diseases since 1895 when X-rays were found and were introduced into general practice. In the standard X-ray examination of the spine and all the anatomical structures located at different depths and different distances, projected onto x-ray film or a screen in the form of planar image. In order to neutralize these drawbacks and to improve visualization, various tomographic techniques have been developed. The most modern and promising diagnostic method is a multisection linear imaging (tomosynthesis), in which a single pass X-ray tube is a series of slices. Digital X-ray tomography with multislice linear are used as a rule, in the world, for examination of breast and lungs. The article presents data on the different types of X-ray tomography in evaluation of patients with tuberculous spondylitis.
Abstract: The main part of the research is given to radiodiagnostics of tubercolisis lesion of backbone (traditional x-ray, ultrasound diagnostics, computed tomography, magnetic resonance imaging). We have exmined 452 patients: 40 patients (8,8%) had cervical spine lesions, 185 patients (41%) - thoracic spine lesions, thoracic-lumbar spine - 75 patients (16,8%), lumbar spine - 141 patients (31,1%), lumbar-sacral spine - 11 patients (2,5%). It is especially marked that combination of lungs tuberculosis and spondylitis is higher not only in patients with antibiotic resistant infection but n patients with tuberculosis combined with AIDS. References 1. Митусова Г.М. Лучевая диагностика туберкулезного спондилита у взрослых, осложненного неврологическими расстройствами. Дис. на соиск. к.м.н. С.-Пб. 2002. 2. Советова Н.А., Савин И.Б., Мальченко О.В. и др. Лучевая диагностика внелегочного туберкулеза. Проблемы туберкулеза. 2006; 11: 7-9. 3. Руководство по легочному и внелегочному туберкулезу. Под ред. Ю.Н. Левашева и Ю.М. Репина. ЭЛБИ-С.-Пб. 2008; 273-283. 4. Васильев А.В. Современные проблемы туберкулеза в регионе Северо-Запада России. Проблемы туберкулеза. 1999; 3: 5-7. 5. Лавров В.Н. Диагностика и лечение больных туберкулезным спондилитом. Проблемы туберкулеза. 2001; 4: 30-32. 6. Гусева Н.И., Иванов В.М., Потапенко Е.И. и др. Иммунный статус больных активным туберкулезным спондилитом. Проблемы туберкулеза и болезней легких. 2003; 6: 25-28. 7. Селюкова Н.В. Зонография в диагностике туберкулеза позвоночника на поликлиническом этапе. Проблемы туберкулеза и болезней легких. 2008; 11, 21-23. 8. Мердина Е.В., Митусова Г.М., Советова Н.А. Ультразвуковая диагностика забрюшинных абсцессов при туберкулезе позвоночника. Проблемы туберкулеза. 2001; 4: 19-21. 9. Лукьяненок П.И. Магнитно-резонансная томография в диагностике туберкулезного спондилита. Руководство для врачей. 2008. 10. Щ Советова Н.А., Джанкаева О.Б., Кравцова О.С. и др. Туберкулезный спондилит взрослых в условиях генерализации инфекции и лекарственной резистентности возбудителя. Невский радиологический форум 2-5 апреля 2011 г. С.-Пб.: Научные материалы. 2011; 223-224. 11. Шилова М.В. Туберкулез в России в 2009 г. М. 2009; 159-161.
