Spinal Tuberculosis: A Major Public Health Hazard in Isfahan

Abstract

Background: Tuberculosis remains a major public health hazard, especially in developing countries. Vertebral tuberculosis is the most common form of the skeletal tuberculosis. The purpose of our essay is to review spinal tuberculosis in three hospitals in Isfahan, Iran. Methods: We carried out a cross sectional study of 630 patients with tuberculosis and identified 100 patients with spinal involvement in the three hospitals Medical School in Isfahan. Tuberculosis was diagnosed on the basis of one of a compatible clinical picture. A radiographic study of the spine with suspicious signs and skin tested were performed for each patient. Demographic data, sign, symptoms and site of spinal involvement were recorded. In all patients we took a chest x ray and sputum smear and culture for ruling out of pulmonary tuberculosis. The data obtained were analyzed by SPSS. Results: Out of the 100 patients with spinal tuberculosis, 58% were male and 42% were female. Main symptoms were spinal deformity, local tenderness and neurologic deficits. Fever and constitutional symptoms were in 80% of cases. Only 68% had a positive tuberculin skin test. 3% involvement were the upper thoracic spine, 23% the lower thoracic spine, 69% also the lower thoracic, T12 and upper lumbar spines, (thoracolumbar) and 5% the cervical spine. 20% developed Para spinal abscesses. Only 18% of patients had pulmonary involvement. 40 cases underwent bone biopsy that 25% had a positive smear, whereas 62.5% had a positive culture. Histologic findings suggestive of tuberculosis involvement of the bone were found in 37 of the 40 biopsies. The most commonest age for spinal involvement were 20–40 years (p < 0.05). There were no differences between age and sex with site of spinal involvments. In 50% cases adjunctive surgical therapy were used. Conclusion: Spinal tuberculosis may be missed in patients with no evidence of pulmonary. No pathognomonic imaging signs allow tuberculosis to be readily distinguished from other conditions. A history of chronicity and slow progression is suggestive of tuberculosis. Only biopsy can achieve a provide diagnosis.