Abstract
We report 36 cases of spinal tuberculosis who were evaluated at the Internal Medicine Department of Istanbul University between January 1990 and March 2016. Twelve cases were accompanied by active pulmonary tuberculosis while ten patients had a previous history of tuberculosis. Eight patients had diabetes mellitus; six patients were on chronic steroid treatment with a mean dose of 24 mg/day while two patients used azathioprine and methotrexate. The dominant symptom was back pain that was present in 64% of the subjects followed by low grade fever (42%), and malaise (38%). Lytic and destructive lesions were noted in various vertebrae in all of the cases while four patients had spinal compression, and two patients had iliopsoas abscess. The preliminary diagnosis was myeloproliferative disease with vertebral metastasis in eight patients. Tuberculin test was over 15 mm in 20 patients (58.8%) while ERS and Creactive protein were highly elevated in 78%, and 84% of the patients. Diagnosis of tuberculosis was confirmed by culture of aspirated material from intervertebral disc space, collection under CT guidance, sputum or bronchial lavage, and by retrospective anti-tuberculous treatment response. MRI revealed compatible findings with spinal tuberculosis in 30 (80%) patients. In endemic countries, tuberculous spondilitis should be considered in immunosuppressed patients with back pain. Current or past tuberculosis infection is not a reliable indicator for Pott’s disease in these patients. Laboratory findings were not usually useful to support the diagnosis. The low sensitivity of the tuberculin test may lead to an erronous diagnosis. Sensitivity of vertebral radiography and CT was low. MRI was the most useful radiologic investigation for the diagnosis of spinal tuberculosis. Tuberculosis of the spine is a diagnostic impasse notably in immunodeficient patients for the clinician.
Highlights
Pott’s disease, known as tuberculous spondylitis, is one of the oldest demonstrated diseases of humankind
We report 36 cases of spinal tuberculosis who were evaluated at the Internal Medicine Department of Istanbul University between January 1990 and March 2016
Spinal tuberculosis can present with atypical features resembling neoplastic or infectious lesions that necessitate the exclusion of such etiologies
Summary
Pott’s disease, known as tuberculous spondylitis, is one of the oldest demonstrated diseases of humankind. Bone and soft-tissue tuberculosis accounts for approximately 10% - 15% of the extrapulmonary tuberculosis cases and between 1% and 2% of the total cases. Tuberculous spondylitis is the most common form of musculoskeletal tuberculosis, comprising 40% - 50% of all patients [1] [2] [3] [4]. Spinal tuberculosis may be a diagnostic and a therapeutic challenge for the clinician. Neural involvement occurs in approximately half of the patients causing irreversible damage if not promptly and adequately treated [2] [5]. Immunosuppression may be a significant risk factor for tuberculosis. The role of immunosuppression for the development and outcome of spinal tuberculosis has not been determined
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