Spinal Tuberculosis

Abstract

Spinal tuberculosis is severe and can lead to spinal deformities, segmental instabilities, or neurologic deficits. The spine is usually infected through hematogenous dissemination from a pulmonary focus. Spinal tuberculosis includes spondylodiscitis and spinal epidural, subdural, and cord lesions. Spondylodiscitis (Pott’s disease) is the most frequent form. Spinal tuberculosis progresses slowly and insidiously. Common clinical manifestations include spinal pain and tenderness, paraplegia, and spinal deformities. MRI is more sensitive than plain radiography and more specific than CT scans. Routine laboratory investigations are not specific. Etiological confirmation is made either by demonstration of Mycobacterium tuberculosis on pathological specimen or histological evidence of epithelioid-giant cell granulomas with caseating necrosis on the biopsy material. DNA amplification techniques and the QuantiFERON^®-TB Gold In-Tube assay are helpful for early and rapid diagnosis. The primary treatment of spinal tuberculosis is chemotherapy. Surgery is indicated mainly for failure of conservative treatment, progressive neurologic deficit, and the prevention or correction of spinal deformity. When diagnosed early and treated adequately, the prognosis of tuberculous spondylodiscitis is usually favorable, particularly in patients without neurologic deficit and deformity. Patients with intradural lesions have a much poorer neurologic prognosis than those with spondylodiscitis.