TB spine—Current aspects on clinical presentation, diagnosis, and management options

Abstract

The increased incidence of co-infection with HIV, multi-drug resistance, and global migration has lead to the resurgence of tuberculosis in both the developing and developed world. Spinal tuberculosis accounts for 50% of musculoskeletal tuberculosis and commonly affects the lower thoracic and thoracolumbar region. The disease classically leads to destruction of the intervertebral disc and the adjacent vertebral bodies, leading to progressive collapse, kyphosis, and neurological deficit. Patients typically present with constitutional symptoms, back pain, deformity, and possible neurologic deficits. Although clinical presentation, MRI findings, and laboratory reports are suggestive of tuberculosis, a tissue diagnosis is often necessary for a firm diagnosis. Uncomplicated spinal tuberculosis is now a medical disease and can be effectively treated by multi-drug ambulatory chemotherapy and surgery is reserved for patients with instability, neurological deficit, and prevention or correction of deformity. Children are prone for progressive deformity even after the cure of the disease during the entire period of growth and hence should be followed up till growth cessation. “Spine at-risk” radiographic signs identify children prone for severe deformity in whom early surgical stabilization is indicated. Anterior surgical approaches were traditionally preferred for the ability to thoroughly debride all infected tissues, but recently the trend is toward an “all posterior” global reconstruction, especially in the thoracic and lumbar spine. The outcome following appropriate chemotherapy is generally good, with about 85–95% of patients showing improved outcome even when patients present with deformity and neurologic deficits. Increasing co-infection with HIV and multi-drug resistance are now the major challenges for the effective treatment and control of tuberculosis.