Spinal Tuberculosis
Current Management Approach
Keywords:
Anti‑tuberculosis drugs, kyphosis, Pott’s disease, spondylodiscitis, surgery, tuberculosisAbstract
Broad narrative review. To review and summarise the current literature on the management of tuberculosis (TB) spine. A thorough review of literature was performed on the epidemiology, aetiology, pathophysiology, pathology, clinical features and management of TB spine. Spinal TB accounts for half of skeletal TB and remains a common cause of public health concern in the developing world. The thoracic spine segment is the most affected. Patient commonly present with back pain and gibbus. The diagnosis involves demonstrating Mycobacterium tuberculosis on microscopy or culture as well as characteristic histology findings. Magnetic resonance imaging is the gold standard imaging modality. Medical therapy with anti‑TB agents is the mainstay of treatment. Surgery is supplementary and indicated in selected cases. Spinal TB carries a good prognosis when detected and treated early. Delays can be associated with the development of complications including difficult‑to‑manage deformities. Multi‑drug anti TB chemotherapy remains the bedrock of treatment. Surgery is supplementary and when indicated, takes the form of abscess drainage, debridement and fusion with or without instrumentation.
References
1. Mbata GC, Ofondu E, Ajuonumam B, Asodike VC, Chukwumam D. Tuberculosis of the spine (Pott’s disease) presenting as hemiparesis. AfrJ Res Med 2012;8:18-20.
2. Rasouli MR, Mirkoohi M, Vaccaro AR, Yarandi KK,Rahimi‑Movaghar V. Spinal tuberculosis: Diagnosis and management. Asian Spine J 2012;6:294‑308.
3. Iyidobi EC, Nwadinigwe CU, Ekwunife RT. Management ofmusculoskeletal tuberculosis in Enugu Nigeria. Tropical Med Surg2013;1:156.
4. Knechel NA. Tuberculosis: Pathophysiology, clinical features, anddiagnosis. Crit Care Nurse 2009;29:34‑43.
5. Yasaratne BM, Wijesinghe SN, Madegedara MD. Spinal tuberculosis:A study of the disease pattern, diagnosis and outcome of medicalmanagement in Sri Lanka. Indian J Tuberculosis 2013;60:208‑16.
6. Monica C, Masae KL. ATS patient education series: What istuberculosis? Am J Res Critical Care Med 2017;195:7‑8.
7. Agrawal V, Patgaonkar PR, Nagariya SP. Tuberculosis of spine. J Craniovertebr Junction Spine 2010;1:74‑85.
8. Rivas‑Garcia A, Sarria‑Estrada S, Torrents‑Odin C, Casas‑Gomila L,Franquet E. Imaging findings of Pott’s disease. Eur Spine J2013;22 Suppl 4:567‑78.
9. Ahmed EG, Elbadawi NE, Ibrahim EK, Mohammed MM. Clinicalpresentation of pott’s disease of the spine in adult Sudanese patients. J Med Microbiol Diagnosis 2013;2:120.
10. Akinyoola A, Adegbehingbe O, Ashaleye C. Tuberculosis of the spine inNigeria: Has anything changed? Int J Third World Med 2006;4:9.
11. Harvey R, Champe PC, Fischer B, Lippincott’s Illustrated Reviews:Microbiology. 2nd ed. New Jersey: Lippincott and Wilkins; 2007.
12. Smith I. Mycobacterium tuberculosis pathogenesis and moleculardeterminants of virulence. Clin Microbiol Rev 2003;16:463‑96.
13. Rajasekaran S, Soundararajan DC, Shetty AP, Kanna RM. SpinalTuberculosis: Current Concepts. Global Spine J 2018;8:96S‑108S.
14. Robert L, Wani S. Tuberculosis: Pathophysiology and microbiology ofpulmonary tuberculosis. South Sudan Med J 2013;6:10‑2.
15. Agrawal A, Shanthi V, Mohan KM, Reddy GV. Lumbosacral spinaltuberculosis: A case report and review of literatures. Egypt Orthop J2015;50:73-5.
16. Dunn R. The medical management of spinal Tuberculosis. South AfrOrthop J 2009;9:37‑41.
17. Jain AK. Tuberculosis of the spine: A fresh look at an old disease. J Bone Joint Surg Br 2010;92:905‑13.
18. Oguz E, Sehirlioglu A, Altinmakas M, Ozturk C, Komurcu M,Solakoglu C, et al. A new classification and guide for surgical treatment of spinal tuberculosis. Int Orthop 2008;32:127‑33.
19. World Health Organization. Tuberculosis guidelines for treatment ofDrug-susceptible tuberculosis and patient care. WHO; 2017. Availablefrom: http://www.who.int/tb/publication/2017/d207_guidance_2017/en/. ISBN978-92-4-155000-0 WHO/HYM/2017.05. [Last accessed on2019 Dec 25].
20. Myung‑Sang M. Development in the management of tuberculosis of thespine. Curr Orthop 2006;20:132‑40.
21. Cao G, Rao J, Cai Y, Wang C, Liao W, Chen T, et al. Analysis oftreatment and prognosis of 863 patients with spinal tuberculosisin Guizhou province. Biomed Res Int 2018;2018;10:1-8.DOI:10.1155/2018/3265735.
Downloads
Published
Issue
Section
License
Copyright (c) 2019 John E. Onuminya, Eghosa Morgan, Mutaleeb Ayodele Shobode (Author)
This work is licensed under a Creative Commons Attribution 4.0 International License.
Authors publishing in the Nigerian Journal of Orthopaedics and Trauma retain the copyright to their work.
All articles are published under the Creative Commons Attribution 4.0 International (CC BY 4.0) licence, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
