LATIN Neurosurgery Journal


Eduardo Laos-Plasier, Almenara Hospital, Lima, PeruFollow
Pedro Aleixo-Nogueira, State University of Campinas, Brazil
Armando Alpizar-Aguirre, National Autonomous University of Mexico, Mexico
Tania Arancibia-Baspineiro, Center for Neurological Diseases, Bolivia
Julio C. Burgos-Flores, Central Hospital of the Social Security Institute, Paraguay
Andrei Fernandes-Joaquim, University of Campinas, Brazil
Edson Lizarazu-Oroz, Hospital Obrero Nr 5, Potosı City, Bolivia
Carlos A. Llanos-Lucero, Faculty of Health Sciences. Universidad del Valle, Colombia
José L. López-Segales, Caja Nacional de Salud Hospital Obrero # 3, Bolivia
Thiago Magalhães-de Souza, State University of Campinas, Brazil
Juan F. Mier-García, Faculty of Health Sciences. Universidad del Valle, Colombia
Fernando Molina-Pizarro, Caja Nacional de Salud Hospital Obrero # 3, Bolivia
Filadelfo Normabuena, Hospital Puerto Montt, Chile
María E. Núñez-Castillo, Hospital Central de las Fuerzas Armadas (HCFFAA), Dominican Republic
Erika Reyes-Quezada, Centro CardioNeuro Oftalmologico y Transplante (CECANOT), Dominican Republic
Wilson Quispe-Alanoca, National Institute of Rehabilitation LGII of Mexico City, Mexico
Paulo G. Sacramento-da Silva, State University of Campinas, Brazil
Byron Salazar-Maldonado, Military Hospital, Quito, Ecuador
Jorge Salazar-Flores, Metropolitan Hospital, Quito, Ecuador
Juan C. Salcedo-Moreno, School of Medicine. Faculty of Health Sciences. Universidad del Valle, Colombia
Josselin M. Sánchez-Mamani, Hospital Obrero Nr 5, Potosí city, Bolivia
Felipe A. Santos-de Queiroz-Chaves, Neurosurgery Resident, State University of Campinas, Brazil
Reddy A. Simón-Nunes, Central Hospital of the Social Security Institute, Paraguay
Manuel E. Soto-García, Minimally Invasive Spine Surgery, Neurological Center, The American-British Cowdray Medical Center IAP, Mexico
Perla M. Del Valle-Oros, Universidad de Sonora, Mexico
José A. Israel-Romero-Rangel, The American-British Cowdray Medical Center IAP, Campus Santa Fe, CDMX, Mexico
Luis M. Duchén-Rodríguez, Center for Neurological Diseases, Public University of El Alto, Bolivia
José A. Soriano-Sánchez, The American British Cowdray Medical Center IAP, Mexico

Document Type

Original Article


Introduction: Interferon-gamma release assays are indirect immunological tests used mainly for the diagnosis of latent tubercu losis, their use in active tuberculosis being controversial. This study aims to analyze the usefulness of gamma interferon release assays in the diagnosis of spinal tuberculosis and to obtain a consensus for their use.
Methods: A systematized search was carried out in PubMed and Scielo for ar ticles in English, Spanish, or Portuguese from 10/01/2012 to 10/01/2022, eligibility criteria were applied, the papers included were analyzed according to the GRADE methodology and then established the SORT type recommendation.
Results: We obtained 27 articles, of which only five we considered suitable for analysis; 4 were of low quality and one very low quality. The interferon-gamma release assays used were T.SPOT-TB and QuantiferonTB Gold in tube, both of which showed high sensitivity and moderate to high specificity for QuantiferonTB Gold in tube and T.SPOT-TB, respectively.
Discussion/Conclusion: Despite the low quality of the articles, we consider a type B recommendation (SORT) for the use of IGRA (T.SPOT-TB and QuantiferonTB Gold in tube) as a complementary test in the diagnosis of spinal tuberculosis, in the absence of definitive test results with high clinical imaging suspicion.


[1] S Rajasekaran, Dilip Chand Raja Soundararajan, Ajoy Prasad Shetty, and Rishi Mugesh Kanna. Spinal tuberculosis: current concepts. Global Spine Journal, 8(4 suppl):96S–108S, 2018.
[2] C. H. Chen, Y. M. Chen, C. W. Lee, Y. J. Chang, C. Y. Cheng, and J. K. Hung. Early diagnosis of spinal tuber culosis. J Formos Med Assoc Taiwan Yi Zhi, 115(10):825–836, 2016.
[3] Ajoy Shetty, Rishi Mugesh Kanna, and S Rajasekaran. Tb spine—current as pects on clinical presentation, diagno sis, and management options. In Semi nars in Spine Surgery, volume 28, pages 150–162. Elsevier, 2016.
[4] A. Pandita, N. Madhuripan, S. Pandita, and R. M.Hurtado. Challenges and con troversies in the treatment of spinal tu berculosis. J Clin Tuberc Mycobact Dis, 19:100151, 2020.
[5] A. Batirel, H. Erdem, G. Sengoz, F. Pehlivanoglu, E. S. G¨ uls¨un, and et al. Ramosaco, The course of spinal tuberculosis (pott disease): Results of the multinational, multicentre backbone-2 study. Clin Microbiol Infect Off Publ Eur Soc Clin Microbiol Infect Dis, 21(11):1008.e9–1008.e18, 2015.
[6] M. R. Rasouli, M. Mirkoohi, A. R. Vac caro, K. K. Yarandi, and V. Rahimi Movaghar. Spinal tuberculosis: Diag nosis and management. Asian Spine J., 6(4):294–308, 2012.
[7] Krishn Khanna and Sanjeev Sabharwal. Spinal tuberculosis: a comprehensive review for the modern spine surgeon. The Spine Journal, 19(11):1858–1870, 2019.
[8] Vivek Pandey, Kiran Chawla, Kiran Acharya, Sripathi Rao, and Sugandhi Rao. The role of polymerase chain re action in the management of osteoar ticular tuberculosis. International or thopaedics, 33:801–805, 2009.
[9] Anil M Solanki, Saumyajit Basu, Ami tava Biswas, Subhendu Roy, and Aditya Banta. Sensitivity and specificity of gene xpert in the diagnosis of spinal tuberculosis: a prospective controlled clinical study. Global Spine Journal, 10(5):553–558, 2020.
[10] AK Jain. Tuberculosis of the spine: a fresh look at an old disease. The Journal of Bone &Joint Surgery British Volume, 92(7):905–913, 2010.
[11] Kai Yuan, Xueqiong Wu, Qiang Zhang, Zhaoming Zhong, and Jianting Chen. Enzyme-linked immunospot assay re sponse to recombinant cfp-10/esat-6 fu sion protein among patients with spinal tuberculosis: implications for diagno sis and monitoring of surgical therapy. International Journal of Infectious Dis eases, 17(9):e733–e738, 2013.
[12] Xiaojiang Hu, Hongqi Zhang, Yanbin Li, Guang Zhang, Bo Tang, Dongcheng Xu, Mingxing Tang, Chaofeng Guo, Shaohua Liu, and Qile Gao. Anal ysis of the diagnostic efficacy of the quantiferon-tb gold in-tube assay for preoperative differential diagnosis of spinal tuberculosis. Frontiers in cellular and infection microbiology, 12:983579, 2022.
[13] Kai Yuan, Zhao-ming Zhong, Qiang Zhang, Shu-chai Xu, and Jian-ting Chen. Evaluation of an enzyme-linked immunospot assay for the immunodi agnosis of atypical spinal tuberculosis (atypical clinical presentation/atypical radiographic presentation) in china. The Brazilian Journal of Infectious Dis eases, 17(5):529–537, 2013.
[14] SungimChoi, KyungHwaJung,Hyo-Ju Son, Seung Hyun Lee, Jung Min Hong, Min Chul Kim, Min Jae Kim, Yong Pil Chong, Heungsup Sung, Sang-Oh Lee, et al. Diagnostic usefulness of the quantiferon-tb gold in-tube test (qft-git) for tuberculous vertebral osteomyeli tis. Infectious Diseases, 50(5):346–351, 2018.
[15] M. J. Page, J. E. McKenzie, P. M. Bossuyt, I. Boutron, T. C. Hoffmann, C. D. Mulrow, and et al. The prisma 2020 statement: An updated guideline for reporting systematic reviews. BMJ, 372:n71, 2021.
[16] J. L. Bro˙ zek, E. A. Akl, E. Compalati, J. Kreis, L. Terracciano, A. Fiocchi, and et al. Grading quality of evidence and strength of recommendations in clinical practice guidelines part 3 of 3. the grade approach to developing recommenda tions. Allergy, 66(5):588–595, 2011.
[17] J. L. Brozek, E. A. Akl, P. Alonso Coello, D. Lang, R. Jaeschke, J. W. Williams, and et al. Grading quality of evidence and strength of recommenda tions in clinical practice guidelines. part 1 of 3. an overview of the grade ap proach and grading quality of evidence about interventions. Allergy, 64(5):669 677, 2011.
[18] J. L. Brozek, E. A. Akl, R. Jaeschke, D. M.Lang, P.Bossuyt, P. Glasziou, and et al. Grading quality of evidence and strength of recommendations in clini cal practice guidelines: Part 2 of 3. the grade approach to grading quality of ev idence about diagnostic tests and strate gies. Allergy, 64(8):1109–1116, 2009.
[19] Mark H Ebell, Jay Siwek, Barry D Weiss, Steven H Woolf, Jeffrey Sus man, Bernard Ewigman, and Marjorie Bowman. Strength of recommendation taxonomy (sort): a patient-centered ap proach to grading evidence in the medi cal literature. The Journal of the Ameri can BoardofFamilyPractice, 17(1):59 67, 2004.
[20] E Vanino, M Tadolini, G Evange listi, E Zamparini, L Attard, K Scolz, S Terzi, G Barbanti Brodano, M Giro lami, V Pipola, et al. Spinal tubercu losis: proposed spinal infection multi disciplinary management project (simp) f low chart revision. European Review for Medical and Pharmacological Sci ences, 24(3):1428–1434, 2020.
[21] A. Shafeque, J. Bigio, C. A. Hogan, M. Pai, and N. Banaei. Fourth generation quantiferon-tb gold plus: What is the evidence? J Clin Microbiol, 58(9):e01950–19, 2020.
[22] Madhukar Pai, Claudia M Denkinger, Sandra V Kik, Molebogeng X Ran gaka, Alice Zwerling, Olivia Oxlade, John Z Metcalfe, Adithya Cattamanchi, David W Dowdy, Keertan Dheda, et al. Gammainterferon release assays for de tection of mycobacterium tuberculosis infection. Clinical microbiology re views, 27(1):3–20, 2014.
[23] Jun-Chi Xu, Ze-Yi Li, Xin-Nian Chen, Cui-Lin Shi, Mei-Ying Wu, Hui Chen, Xiao-Yan Zhu, Hua-Feng Song, Min Juan Wu, and Ping Xu. More signifi cance of tb-igra except for the diagnosis of tuberculosis. Journal of clinical lab oratory analysis, 32(1):e22183, 2018.
[24] Linchuan Wang, Xu-dong Tian, Yan Yu, and Wei Chen. Evaluation of the per formance of two tuberculosis interferon gamma release assays (igra-elisa and t spot. tb) for diagnosing mycobacterium tuberculosis infection. Clinica chimica acta, 479:74–78, 2018.
[25] Wan-Li Kang, Gui-Rong Wang, Mei Ying Wu, Kun-Yun Yang, Shu-Cai Wu, Shu-Jun Geng, Zhi-Hui Li, Ming Wu Li, Liang Li, and Shen-Jie Tang. Interferon-gamma release assay is not appropriate for the diagnosis of active tuberculosis in high-burden tuberculosis settings: a retrospective multicenter in vestigation. Chinese Medical Journal, 131(03):268–275, 2018.
[26] Quantiferon-tb gold in-tube test in ac tive tuberculosis patients and healthy adults. Rev Inst Med Trop Sao Paulo, 60:e56, 2018.
[27] Yuanyuan Yu, Yidian Liu, Lan Yao, Yanheng Shen, Qin Sun, and Wei Sha. Factors influencing false-negative re sults of quantiferon-tb gold in-tube (qft git) in active tuberculosis and the de sirability of resetting cutoffs for differ ent populations: A retrospective study. Tropical Medicine and Infectious Disease, 7(10):278, 2022.