The five stages of natural history of tuberculosis of spine have been developed from the clinician's point of view. Management of tuberculosis of spine, in general, it is no different than management of soft tissue tuberculosis, in HIV negative or positive patients. Role of surgery is very limited. Management of tubercular paraplegia, based upon the grading of paraplegia is simple, logical, efficient and easy to understand and remember by any orthopedic surgeon.

Tuberculous involvement of the posterior elements of the spine is uncommon. Review of the literature reveals little information and there is scant mention of this subject in standard textbooks of orthopaedics. A study of 27 cases of such lesions seen over 6 years is presented, drawn from two separate centres, 21 from Central India and 6 from South Eastern Iran. The clinical presentation, investigations and treatment are analysed. A new four point classification is described based upon the site of the lesion, the stage of the lesion, associated lesions and neurological deficit.

Multifocal osteoarticular tuberculosis is uncommonly reported despite its incidence of 7 to 10% in the Indian population. We describe the clinical features and management of 48 patients seen in the last nine years.

Axial traction to correct spinal deformity is a very old concept. The oldest reference available is in ancient Hindu mythological epics (written between 3500 BC and 1800 BC) where it is mentioned how Lord Krishna corrected the hunchback of one of his devotees. Later, Hippocrates (460 BC to 377 BC) described certain devices. Galen (131 AD to 201 AD), a follower of Hippocrates, used axial traction with direct pressure. Ibn Sena (980 AD to 1037 AD) in the Middle East also used similar methods. Osteopaths of Turkey also used axial traction to correct spinal deformities. But gradually mechanical methods for the correction of the spinal deformity went into disrepute due to the invariable production of paraplegia. In the past few decades, interest in the correction of spinal deformity has been rejuvenated due to better understanding of anatomy, physiology, and pathomechanics of spinal deformity. Controlled axial traction has been the keystone of several modern procedures such as Cotrel traction, Halo traction, and Harrington Outrigger instrumentation, etc. It appears that the primitive ways of application of axial traction by crude methods did not totally vanish but have been modified. In Indian tribal areas, bone setters still practice it in modified form.

Tuberculosis (TB) is mainly a disease of the lungs, but Mycobacterium tuberculosis (Mtb) can establish infection in virtually any organ in the body. Rising rates of extrapulmonary (EP) TB have been largely associated with the HIV epidemic, as patients co-infected with HIV show a four-fold higher risk of EPTB. Spinal TB (Pott's Disease), one of the most debilitating extrapulmonary forms of disease, is difficult to diagnose and can cause deformity and/or neurological deficits. This study examined the histopathology and distribution of immune cells within spinal TB lesions and the impact of HIV on pathogenesis. The overall structure of the spinal granulomas resembled that seen in lung lesions from patients with pulmonary TB. Evidence of efficient macrophage activation and differentiation were detectable within organized structures in the spinal tissue, irrespective of HIV status. Interestingly, the granulomatous architecture and macroscopic features were similar in all samples examined, despite a reversal in the ratio of infiltrating CD4 to CD8 T cells in the lesions from HIV-infected patients. This study provides a foundation to understand the mechanism of tissue destruction and disease progression in Spinal TB, enabling the future development of novel therapeutic strategies and diagnostic approaches for this devastating disease.

One-hundred-twenty-three patients with neurological deficit due to spinal tuberculosis underwent anterior spinal decompression and anterior column reconstruction with fresh-frozen femoral allograft. Fifty-two patients with a follow-up of more than 5 years were evaluated to assess the incorporation and the efficacy of allograft in maintaining correction. The allograft was incorporated in 49 patients at a mean follow-up of 6.5 (5.3-8.2) years. Complete neurological recovery occurred in 39 patients. The mean pre-operative kyphosis of 37 degrees (15 degrees -67 degrees ) was corrected to 18 degrees (5 degrees -45 degrees ). Fresh-frozen allografts are a suitable alternative to autologous rib and iliac crest grafts in the treatment of spinal tuberculosis.

total of 39 HIV-infected adults with spinal tuberculosis underwent anterior spinal decompression for neurological deficit. Fresh-frozen allografts were used in 38 patients. Antituberculous drugs were prescribed for 18 months, but antiretroviral therapy was not used. Six patients died within two years of surgery. Neurological recovery and allograft incorporation were observed at follow-up at a mean of 38 months, although the CD4/CD8 ratios were reversed in all patients. Adequate preoperative nutritional support and compliance with antituberculous treatment are essential in ensuring a satisfactory outcome.

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