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The spectrum of tuberculosis of the spine in pediatric age group: a review



Pediatric spinal tuberculosis is characterized by rapid bone destruction and carries the risk of rapid onset neurological deficits and severe deformity of the spine. Behavior of spinal deformity over time is affected by growth of spine. Owing to this dynamic behavior of pediatric spinal tuberculosis both in active phase and in healed phase, it presents with challenges which are quite different from adults with caries spine. A clinician must have high index of suspicion for accurate and early diagnosis of spinal tuberculosis in the pediatric population and should also have a thorough knowledge of differences in natural history between adult and pediatric spinal tuberculosis.


This is based on the senior author’s experience of dealing with tuberculosis of the spine in children over the last two decades. Recent advances in field of rapid diagnosis of tuberculosis based on nuclear material-related diagnostic tests have further improved the management of tuberculosis. At the same time, the basic treatment principles remain the same. However, the threshold for surgical vs conservative treatment have subtle differences when compared to adult population. The importance of long-term follow-up after treatment must be appreciated.


Tuberculosis in the spine in children needs early attention. Prompting to diagnostic and medical therapy measures can avoid neurological sequellae and delayed deformity.

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  1. World Health Organization. Global tuberculosis report 2016

  2. Maltezou HC, Spyridis P, Kafetzis DA (2000) Extra-pulmonary tuberculosis in children. Arch Dis Child 83(4):342–346

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  3. Moon MS, Kim SS, Lee BJ, Moon JL (2012) Spinal tuberculosis in children: retrospective analysis of 124 patients. Indian J Orthop 46:150–158

    Article  PubMed  PubMed Central  Google Scholar 

  4. (1973) A controlled trial of ambulant out-patient treatment and in-patient rest in bed in the management of tuberculosis of the spine in young Korean patients on standard chemotherapy a study in Masan. Korea. First report of the Medical Research Council Working Party on Tuberculosis of the Spine. J Bone Joint Surg Br 55:678–697

  5. (1974) A controlled trial of anterior spinal fusion and debridement in the surgical management of tuberculosis of the spine in patients on standard chemotherapy: a study in Hong Kong. Br J Surg 61:853–866

  6. (1982) A 10-year assessment of a controlled trial comparing debridement and anterior spinal fusion in the management of tuberculosis of the spine in patients on standard chemotherapy in Hong Kong. Eighth Report of the Medical Research Council Working Party on Tuberculosis of the Spine. J Bone Joint Surg Br 64:393–398

  7. Basu S (2012) Spinal injuries in children. Front Neurol 3:96

    Article  PubMed  PubMed Central  Google Scholar 

  8. Jain AK, Sreenivasan R, Mukunth R, Dhammi IK (2014) Tubercular spondylitis in children. Indian J Orthop 48(2):136–144

    Article  PubMed  PubMed Central  Google Scholar 

  9. Dimeglio A, Canavese F (2012) The growing spine: how spinal deformities influence normal spine and thoracic cage growth. Eur Spine J 21(1):64–70

    Article  PubMed  Google Scholar 

  10. Teo HE, Peh WC (2004) Skeletal tuberculosis in children. Pediatr Radiol 34(11):853–860

    Article  PubMed  Google Scholar 

  11. Tyagi R (2016) Spinal infections in children: a review. J Orthop 13(4):254–258

    Article  PubMed  PubMed Central  Google Scholar 

  12. De Vuyst D, Vanhoenacker F, Gielen J et al (2003) Imaging features of musculoskeletal tuberculosis. Eur Radiol 13:1809–1819

    Article  PubMed  Google Scholar 

  13. Tuli SM (2016) Tuberculosis of the skeletal system. JP Medical Ltd

  14. Hoffman EB, Crosier JH, Cremin BJ (1993) Imaging in children with spinal tuberculosis—a comparison of radiography, computed tomography and magnetic resonance imaging. JBJS 75B:233–239

    Google Scholar 

  15. Jain AK, Agarwal AN, Mehrotra G (1999) Correlation of canal encroachment with neurological deficit in tuberculosis of spine. Int Orthop 23(2):85–86

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  16. Jain AK, Kumar J (2013) Tuberculosis of spine: neurological deficit. Eur Spine J 22(4):624–633

    Article  PubMed  Google Scholar 

  17. Jain AK, Sinha S (2005) Evaluation of paraplegia grading systems in tuberculosis of the spine. Spinal Cord 43(6):375–380

    Article  PubMed  CAS  Google Scholar 

  18. Govender S, Ramnarain A, Danaviah S (2007) Cervical spine tuberculosis in children. Clin Orthop Relat Res 460:78–85

    Article  PubMed  CAS  Google Scholar 

  19. Jain AK, Dhammi IK, Jain S, Mishra P (2010 Apr) Kyphosis in spinal tuberculosis–prevention and correction. Indian J Orthop 44(2):127–136

    Article  PubMed  PubMed Central  Google Scholar 

  20. Rajasekaran S (2001) The natural history of post-tubercular kyphosis in children: radiological signs which predict late increase in deformity. Bone Joint J 83(7):954–962

    Article  CAS  Google Scholar 

  21. Cohn DL, O'Brien RJ, Geiter LJ, Rockville MD, Gordin FM, Hershfield E, Horsburgh CR Jr, Jereb JA, Jordan TJ, Kaplan JE, Nolan CM (2000) Targeted tuberculin testing and treatment of latent tuberculosis infection. Am J Respir Crit Care Med 161(4):221–247

    Google Scholar 

  22. Horsburgh CR Jr (2004) Priorities for the treatment of latent tuberculosis infection in the United States. N Engl J Med 350(20):2060–2067

    Article  PubMed  CAS  Google Scholar 

  23. Hoskyns W (2003) Paediatric tuberculosis. Postgrad Med J 79(931):272–278

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  24. Walls T, Shingadia D (2004) Global epidemiology of paediatric tuberculosis. J Infect 48(1):13–22

    Article  PubMed  Google Scholar 

  25. International Union Against Tuberculosis Committee on Prophylaxis (1982) Efficacy of various durations of isoniazid preventive therapy for tuberculosis: five years of follow-up in the IUAT trial. Bull World Health Organ 60(4):555

    PubMed Central  Google Scholar 

  26. Lewinsohn DM, Leonard MK, LoBue PA, Cohn DL, Daley CL, Desmond E, Keane J, Lewinsohn DA, Loeffler AM, Mazurek GH, O’Brien RJ (2017) Official American Thoracic Society/Infectious Diseases Society of America/Centers for Disease Control and Prevention clinical practice guidelines: diagnosis of tuberculosis in adults and children. Clin Infect Dis 64(2):e1–e33 5

    Article  PubMed  Google Scholar 

  27. Malakmadze N, González IM, Oemig T, Isiadinso I, Rembert D, McCauley MM, Wand P, Diem L, Cowan L, Palumbo GJ, Fraser M (2005) Unsuspected recent transmission of tuberculosis among high-risk groups: implications of universal tuberculosis genotyping in its detection. Clin Infect Dis 40(3):366–373

    Article  PubMed  Google Scholar 

  28. Kimerling ME, Benjamin WH, Lok KH, Curtis G, Dunlap NE (1998) Restriction fragment length polymorphism screening of Mycobacterium tuberculosis isolates: population surveillance for targeting disease transmission in a community. Int J Tuberc Lung Dis 2(8):655–662

    PubMed  CAS  Google Scholar 

  29. Behr MA, Small PM (1997) Molecular fingerprinting of Mycobacterium tuberculosis: how can it help the clinician? Clin Infect Dis 25(4):806–810

    Article  PubMed  CAS  Google Scholar 

  30. Moore SL, Rafi M (2001) Imaging of musculoskeletal and spinal tuberculosis. Radiol Clin N Am 39:329–342

    Article  PubMed  CAS  Google Scholar 

  31. Gard RK, Somvanshi DS (2011) Spinal tuberculosis: a review. J Spinal Cord Med 34:440–454

    Article  Google Scholar 

  32. Guo LX, Ma YZ, Chen X, Bao D, Luo XB (2010) Clinical study of short course chemotherapy in spinal tuberculosis. Zhogguo Gu Shang 23:491–494

    Google Scholar 

  33. Kotil K, Alan MS (2007) Medical management of Pott disease in thoracic and lumbar spine: a prospective clinical study. J Neurosurg Spine 6:222–228

    Article  PubMed  Google Scholar 

  34. Parthasarthy R, Sriram K, Santha T (1999) Short course chemotherapy for tuberculosis of spine—a comparison between treatment and radical surgery. J Bone Joint Surg Br 81:464–471

    Article  Google Scholar 

  35. Mak KC, Cheung KM (2013) Surgical treatment of acute TB spondylitis: indications and outcomes. Eur Spine J 22(4):603–611

    Article  PubMed  Google Scholar 

  36. Tuli SM (1975) Results of treatment of spinal tuberculosis by “middle-path” regime. J Boone Joint Surg (Br) 57B:13–23

    Article  Google Scholar 

  37. Kumar R, Srivastava AK, Tiwari RK (2011) Surgical management of Pott’s disease of the spine in pediatric patients: a single surgeon’s experience of 8 years in a tertiary care center. J PediatrNeurosci 6(Suppl 1):S101–S108

    CAS  Google Scholar 

  38. Chatterjee S, Basu S (2003) Trans sternal decompression of postlaminectomy caries of the upper dorsal spine. Br J Neurosurg 17(3):270–271

    Article  PubMed  CAS  Google Scholar 

  39. Jain AK, Maheshwari AV, Jena S (2007) Kyphus correction in spinal tuberculosis. Clin Orthop Relat Res 460:117–123

    Article  PubMed  Google Scholar 

  40. Laheri VJ, Badhe NP, Dewnany GT (2001) Single stage decompression, anterior interbody fusion and posterior instrumentation for tuberculous kyphosis of the dorso-lumbar spine. Spinal Cord 39:429–436

    Article  PubMed  CAS  Google Scholar 

  41. Bezer M, Kucukdurmaz F, Guven O (2007) Transpedicular decancellation osteotomy in the treatment of posttuberculous kyphosis. J Spinal Disord Tech 20:209–215

    Article  PubMed  Google Scholar 

  42. Moon MS, Woo YK, Lee KS, Ha KY, Kim SS, Sun DH (1995) Posterior instrumentation and anterior interbody fusion for tuberculous kyphosis of dorsal and lumbar spines. Spine 20:1910–1916

    Article  PubMed  CAS  Google Scholar 

  43. Moon MS (1999) Tuberculosis of the spine-controversies and a new challenge. Spine 22:1791–1797

    Article  Google Scholar 

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Correspondence to Sandip Chatterjee.

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Chatterjee, S., Banta, A. The spectrum of tuberculosis of the spine in pediatric age group: a review. Childs Nerv Syst 34, 1937–1945 (2018).

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  • Pediatric spinal tuberculosis
  • Caries spine
  • Skeletal system