Latin NeuroSurg.

Alpizar A

Vertebral Destruction Syndrome and Spinal

Tuberculosis

Sı́ndrome de destrucción vertebral y tuberculosis

espinal

Sı́ndrome de Destruição Vertebral e Tuberculose

Espinhal

Armando Alpizar
National Autonomous University of Mexico
Mexico

6 Vol. 1, Num. 1, 2024

Latin NeuroSurg.
When the Editorial Committee and its
Founder Managing Editor, Jose Alberto Israel
Romero-Rangel, invited me to present this
First Volume of Latin Neurosurgery, an event
of unimaginable importance for Latin Ameri-
can Neurosurgery, I began to think about what
I could write as a preamble to this remarkable
and renowned group of Experts from Latin
America on Spinal Tuberculosis, and imme-
diately one of the topics to which I have dedi-
cated myself for at least two decades of my
life came to mind: To describe, study and
spread the ”Vertebral Destruction Syndrome”
[1], a pathology that we discovered and we
integrate the Medical terminology as a prod-
uct of years of work and research and that has
begun to bear fruit within the Medical com-
munity mainly in Mexico, Latin America and
now in the rest of the World.
At the end of the 90’s in the National In-
stitute of Rehabilitation of Mexico City in
the Spine Surgery Service, we were receiv-
ing a large number of patients referred from
other public and private hospitals for Spine
ailments. all of them characterized by Verte-
bral Destruction, with similar symptoms and
signs, however caused by different diseases,
having within their clinical history a long evo-
lution picture that went from several weeks,
months and even some of them years, with the
expected neurological sequelae in a serious
structural alteration of the spine, this by los-
ing two of its basic functions: axial load and
protection of intraspinal neurological struc-
tures, leaving some patients with permanent
neurological sequelae despite being caused in
most cases for curable diseases.
They were patients in whom a diagnos-
tic approach had been carried out under the
diagnostic presumption of any of the pos-
sible causes of vertebral destruction, which
we grouped into three large groups, those of
tumoral, infectious and metabolic origin, in
which cases despite having a different eti-
ology, the predominant clinical picture was
caused by biomechanical alterations in the
spine and most of them did not have a con-
firmed diagnosis, without specific treatment.
All this powerfully caught our attention,
we were facing a series of pathologies that
represented a challenge to obtain their diag-
nosis, with a common clinical picture: spon-
taneous axial pain that increased on local pal-
pation depending on the site of the affected
spine, in some cases increased volume, ac-
companied by alterations in sensitivity and
strength in the pelvic extremities, a picture
7 Vol. 1, Num. 1, 2024
Alpizar A
that correlated with the structural alteration
of the spine. Having a characteristic in com-
mon, said picture secondary to a complex
pathology of the spine that delayed diagno-
sis and therefore timely treatment. When an-
alyzing the form of diagnostic approach to
which these patients were subjected, we noted
that the diagnostic suspicion was based on
the background, clinical picture and imaging
findings. And since, in the process to reach
the diagnosis, the role of the biopsy is funda-
mental, the fact that it has a diagnostic pre-
cision in our environment of only 57%, the
remaining 43% remained without diagnosis,
in most of the cases this delayed the diagno-
sis with the consequent neurological deterio-
ration.
In order to try to speed up the diagnos-
tic process in these patients, we use the con-
cept of ”Syndrome” which in medicine rep-
resents a diagnostic strategy for dealing with
complex diseases that are difficult to diag-
nose and treat and have similar clinical mani-
festations with a common pathophysiological
background, which in this case it was the al-
teration in the structure and ultrastructure of
the spine caused by different nosological en-
tities.
Under this new concept of ”Vertebral De-
struction Syndrome” (VDS) [1], we began
the study of a group of 105 patients with the
aim of speeding up their diagnostic process
and establishing timely treatment in order to
limit the neurological sequelae already de-
scribed when the diagnosis is late. The use
of this diagnostic strategy allowed us to sys-
tematize the study of these patients in an ob-
jective manner without diagnostic presump-
tions that would delay the diagnostic objec-
tive and therefore the treatment. With this
concept, based on its sensitivity, specificity,
positive predictive value, and negative pre-
dictive value, we selected a number of lab-
oratory and cabinet studies that provided di-
agnostic evidence of ”Vertebral Destruction
Syndrome” and that considered all possible
etiologies.
The most important finding was the de-
crease in time to reach the diagnosis and the
optimization of studies.
Since then, the term ”Vertebra destruction
syndrome” has been used in hospitals in Mex-
ico and Latin America as part of a diagnos-
tic strategy that has streamlined the diagnosis
and therefore the treatment of these patients
[2].
At present, the incidence in the presenta-
Latin NeuroSurg.
tion of Vertebral Destruction Syndrome con-
tinues to be an important public health prob-
lem throughout the world [3]. In this con-
text, the use of the Vertebral Destruction Syn-
drome diagnostic strategy, which emerged in
Latin America due to the presentation of a
significant number of cases of Vertebral De-
struction of various etiologies, represents a
valuable tool to facilitate early diagnosis and
avoid advanced disease symptoms. through
timely treatment. Making use of this concept
represents an effective strategy to speed up
the diagnosis of a disease as complex as Ver-
tebral Destruction of different etiologies, one
of them caused by spinal tuberculosis, which
still represents one of the main public health
problems in Latin America. daily disability
and death among the population.
Speaking of spinal tuberculosis, timely
and accurate diagnosis continues to be a chal-
lenge for the clinician, due to the variety of
clinical manifestations and, above all, due to
the complex isolation of the microbiological
agent, Mycobacterium Tuberculosis. In this
pathology, the delay in diagnosis also implies
the possibility of permanent neurological se-
quelae in patients, so it is essential to have
the necessary tools to make an early diagno-
sis and an effective and timely treatment [4].
Tuberculosis is a worldwide epidemic that
has terrible social, economic and health con-
sequences. Since Dr. Robert Koch in 1822
discovered the bacteria that causes it, [5] the
possibility of accurately diagnosing it has in-
creased, and therefore treatment is It has been
established in a more timely and effective
manner, however, despite these efforts, 4,000
people die every day as a result of it and ap-
proximately 30,000 people contract the dis-
ease. The World Health Organization re-
ported a total of 1,500,000 people killed by
this disease in 2020 and 1,600,000 people in
2021, making it one of the deadliest infec-
tious diseases in the world, a situation that
increased for the first time in more than 10
years. from the year 2020 as a result of the ap-
pearance of the COVID-19 pandemic [6, 7].
Spinal tuberculosis represents 50% of
cases of extrapulmonary tuberculosis, repre-
senting 5% of all cases, in which when the di-
agnosis is delayed and therefore timely treat-
ment is not started, the neurological seque-
lae can be catastrophic and permanent, de-
spite being a curable disease. In addition,
the appearance of other types of diseases such
as HIV and drug addiction have increased
the appearance of this in first world coun-
8 Vol. 1, Num. 1, 2024
Alpizar A
tries [7]. In the effective and timely treat-
ment of spinal tuberculosis in Latin American
countries, several factors are involved, among
which is a public health system sometimes
without sufficient resources, and also the lack
of effective and efficient diagnostic strategies
to reach a diagnosis. accurate.
This is how the diagnostic strategy for
Vertebral Destruction Syndrome represents a
useful tool in its diagnostic approach, not only
in Latin America, but also in the rest of the
world.
The volume presented here represents a
valuable effort by Latin American Physicians
aimed at making available to the reader an
updated scientific review of all the aspects
necessary to carry out an effective diagnos-
tic and therapeutic approach to Spinal Tuber-
culosis. It brings together the experience of
many years in the treatment of Spinal Tuber-
culosis, of Infectologists, Neurosurgeons and
Spine Surgeons from Countries hit by this
World Epidemic that affects poor countries
with a higher incidence.
The aforementioned makes this volume
special, providing a current systematic biblio-
graphic review of all relevant aspects of spinal
tuberculosis, from its history, epidemiology,
pathophysiology, clinical manifestations, lab-
oratory, and cabinet studies with the great-
est utility in its diagnostic confirmation, the
usefulness of percutaneous biopsy, aspects of
the most useful classifications, current medi-
cal and surgical treatment, and its neurologi-
cal and clinical sequelae in general.
In conclusion, I hope that the reader en-
joys it and finds it useful regardless of where
in the world it is read.
References
[1] Armando Alpı́zar-Aguirre, Alejandro
Elı́as-Escobedo, Luis M Rosales-
Olivares, Vı́ctor Miramontes-Martı́nez,
and Alejandro Reyes-Sánchez. Vertebral
destruction syndrome. evaluation sys-
tems in diagnosis. Cirugı́a y Cirujanos,
76(3):205–211, 2008.
[2] Jose Maria Jimenez-Avila, Mario Al-
berto Cahueque-Lemus, Andres Enrique
Cobar-Bustamante, and Maria Cristina
Bregni-Duraés. Vertebral destruction
syndrome: From knowledge to practice.
J Spine, 4(4), 2015.
Latin NeuroSurg. Alpizar A

[3] MA Cahueque-Lemus, AE Cobar-

Bustamante, MC Bregni-Duraés, and
JM Jiménez-Ávila. Syndrome of ver-
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practice. Acta ortopédica mexicana,
32(3):182–187, 2018.
[4] Eli Kamara, Sahil Mehta, James CM
Brust, and Anil K Jain. Effect of delayed
diagnosis on severity of pott’s disease.
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[5] A Thomas Pezzella. History of pul-
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[6] Jeremiah Chakaya, Mishal Khan,

Francine Ntoumi, Eleni Aklillu, Razia
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tuberculosis report 2020–reflections
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[7] World Health Organization. Global Tu-
berculosis Report 2022. Geneva, 2022.
Licence CC BY-NC-SA 3.0 IGO.

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