OBJECTIVES Tuberculous spondylitis (TS), also known as Pott's disease (PD), is a form of tuberculosis in which the vertebral column is affected. Since the first description by Katz et al. in 1992, it became clear that Bacillus Calmette-Guérin (BCG) instillations in the treatment of superficial transitional cell carcinoma (TCC) form a plausible way in which PD is introduced. Nowadays, BCG forms the most effective treatment modality for superficial TCC. The incidence of other than minor complications have been estimated under five per cent. Here we report a case of TS after BCG-instillation in the treatment of TCC. Furthermore, all available literature concerning this topic was gathered into a systematic review. The primary objective was to create an overview of all available literature concerning TS after intravesical BCG-instillations, with an emphasis on the neurosurgical approach of these patients, forming a scaffold at which future case reports can be compared. As a secondary objective, we tried to raise the awareness concerning this very rare complication of intravesical BCG-instillation as a possible cause of low back pain (LBP). PATIENTS AND METHODS We performed a systematic review, in which patients who developed TS after intravesical BCG-therapy in the treatment of TCC, were examined. A total of twenty-three articles (twenty-four cases) obtained from MEDLINE were included. Search terms included: "tuberculous spondylitis", "Pott's disease", "vertebral osteomyelitis", "intravesical", "Bacillus Calmette-Guérin" and "transitional cell carcinoma". Additional studies were identified by checking reference lists. Furthermore, we present a case concerning one of our own patients who consulted our Neurosurgical department with a similar clinical presentation. This systematic review is in conformity with the PRISMA-guidelines. The case report is in accordance with the CARE statement guidelines. RESULTS Results are based on twenty-five cases (twenty-four cases extracted from previous literature and our case report). All included articles are case reports written in English. Publication year and recruitment time varies from 1992 to 2018. Mean age at clinical presentation varies from 35 to 94 years old (mean 74). All patients were male. Surgery was performed in 17 out of 25 cases (68%). A posterior approach was performed in seven cases (41%), zero anterior approaches (0%), a combined approach in five cases (29%) and not specified in five cases (29%). All patients received intravesical BCG-instillation in the treatment of TCC, ranging from one month to twelve years before clinical presentation (mean 26). Radiographic abnormalities were seen in thoracic vertebral segments in thirteen cases (52%), eleven cases in lumbar segments (44%), one at the thoracolumbar transition level (4%) and not in cervical vertebral segments. CONCLUSION Although very rare, TS should be part of the differential diagnosis in patients with LBP, even years after BCG-instillation for TCC. It mostly affects elderly men and involves the thoracolumbar spine through hematogenous spread via Batson's plexus. Antitubercular therapy remains the mainstay in the treatment of TS. A posterior surgical approach, with debridement and stabilization, should be preferred when surgical intervention seems necessary. To our knowledge, this systematic review forms one of the first comprehensive reviews evaluating neurosurgical intervention for PD following intravesical BCG-therapy in the treatment of TCC.

中文翻译：

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膀胱内卡介素滴注治疗移行细胞癌后结核性脊柱炎：病例报告和系统评价

目的 结核性脊柱炎 (TS)，也称为 Pott 病 (PD)，是一种影响脊柱的结核病。自 Katz 等人首次描述以来。1992 年，很明显卡介苗 (BCG) 滴注治疗浅表移行细胞癌 (TCC) 形成了引入 PD 的合理方式。如今，BCG 是浅表性 TCC 最有效的治疗方式。非轻微并发症的发生率估计低于 5%。在这里，我们报告了一例在 TCC 治疗中 BCG 滴注后 TS 的病例。此外，有关该主题的所有可用文献都被收集到系统评价中。主要目标是创建有关膀胱内 BCG 滴注后 TS 的所有可用文献的概述，强调这些患者的神经外科方法，形成一个可以比较未来病例报告的支架。作为次要目标，我们试图提高人们对这种非常罕见的膀胱内 BCG 灌注并发症的认识，它可能是导致腰痛 (LBP) 的原因。患者和方法 我们进行了一项系统评价，其中对在 TCC 治疗中膀胱内注射 BCG 治疗后发生 TS 的患者进行了检查。共纳入从 MEDLINE 获得的 23 篇文章（24 例）。搜索词包括：“结核性脊柱炎”、“波特氏病”、“椎骨骨髓炎”、“膀胱内”、“卡介苗”和“移行细胞癌”。通过检查参考列表确定了其他研究。此外，我们还介绍了一个案例，该案例涉及我们自己的一位患者，该患者在我们的神经外科就诊时具有类似的临床表现。该系统评价符合 PRISMA 指南。病例报告符合 CARE 声明指南。结果 结果基于 25 个案例（从以前的文献和我们的案例报告中提取的 24 个案例）。所有纳入的文章都是用英文撰写的病例报告。发表年份和招募时间从 1992 年到 2018 年不等。临床表现的平均年龄从 35 岁到 94 岁不等（平均 74 岁）。所有患者均为男性。25 例中的 17 例（68%）进行了手术。7 例（41%）采用后路入路，0 例前路入路（0%），5 例（29%）联合入路，5 例（29%）未指定。所有患者在 TCC 治疗中均接受膀胱内卡介苗灌注，时间范围为临床表现前 1 个月至 12 年（平均 26 年）。胸椎节段 X 线异常 13 例（52%），腰椎节段 11 例（44%），胸腰椎过渡节段 1 例（4%），颈椎节段无异常。结论 尽管非常罕见，但 TS 应该是 LBP 患者鉴别诊断的一部分，即使是在 TCC 滴注 BCG 后数年。它主要影响老年男性，并通过经 Batson 神经丛的血行播散累及胸腰椎。抗结核治疗仍然是治疗 TS 的主要方法。当似乎需要手术干预时，应首选后路手术入路，清创和稳定。据我们所知，