A Clinical Review of 40 Cases With Tuberculous Spondylitis in Adults

Abstract

The purpose of this clinical review was to review clinical presentations, laboratory, and radiologic findings and difficulties on management of tuberculous spondylitis from a series of 40 cases. We carried out a retrospective analysis of 40 adult patients (50% male) with tuberculous spondylitis between January 1997 and December 2003. Infection was diagnosed in patients having a presentation compatible with characteristic histologic and/or microbiologic evidence of tuberculous spondylitis and diagnostic radiographic features, or following adequate response to antituberculous therapy with highly suggestive imaging features. Outcome was assessed according to clinical, radiologic, and laboratory criteria. Mean age was 44.7 ± 19 years. Thirty percent of patients had a history of contact with a patient having active pulmonary tuberculosis. The most frequent symptom and sign were back pain (92.5%) and, spinal tenderness (55%). Magnetic resonance imaging was found to be the most helpful technique for diagnosis. Lumbar spine was the most common affected region (82.5%). Thirty (75%) patients had paraspinal abscess and, 4 (10%) had concomitant sacroiliitis. Spinal biopsy had a yield of 76.5%, 52.9%, and 47% granulomas, positive culture, and acid-fast smear, respectively. Resistance to antituberculous drugs was 44.4%. Although medical treatment alone was given in 15% cases, 85% required additional surgical intervention. The mean duration of therapy was 12 ± 12 months. The improvement without sequela was 77.5% of the patients. In developing countries, diagnostic delay in tuberculous spondylitis is still common and disastrous. Bacteriologic confirmation and susceptibility testing should be achievable in all adult cases.

Tuberculosis of the spine. A systematic review of case series

“…7 (50) 1 (7) 3 (21) 2 (14) Rasit et al [11] 50 (94) 28 ( (8) 93 (57) -53 (33) 4 (2) Rodriguez-Gómez et al [42] 33 (89) 11 ( 31 (84) 0 (0) 8 (22) 11 (30) Meddeb et al [43] 29 (100) 24 ( 236 (93) 236 (93) 153 (60) 13 (5) 132 (54) 36 (14) 53 (22) 9 (4) Dharmalingam et al (4) 32 (41) 11 (14) 25 (32) 5 (6) Schlesinger et al [13] 9 (75) 4 (33) 6 (50) ----1 (8) 3 (25) 4 (33) 3 (25) 1 (8) López Cordoba et al [46] 27 ( 69 (51) 0 (0) 45 (46) 0 (0) Tasova et al [48] 37 (93) -2 (5) 18 …”

Espondilitis tuberculosa en adultos: revisión de una serie de casos en un hospital de tercer nivel, Lima-Perú

“…Nuestra mediana de edad (31 años con intervalo de 23 a 53 años); así como la predominancia de sexo masculino, es similar a series nacionales previas, donde la media fue 27 años (8,9) .…”

“…La espondilitis tuberculosa (ET) es una forma de tuberculosis extrapulmonar que constituye el 1,7% de todos los casos de tuberculosis (4)(5)(6) , constituye el 50% de los casos de tuberculosis esquelética y, de estas, constituye la variante con mayor morbilidad debido a la destrucción ósea, deformidad y potencial déficit neurológico (7,8) . El desarrollo de mejores procedimientos diagnósticos no había disminuido el retraso para el diagnóstico especialmente en nuestro país donde 47% de ET eran diagnosticados alrededor de los seis meses (9,10) .…”

Late-onset post-diskectomy tuberculosis at the same operated lumbar level: case report and review of literature

“…MDR-TB is also of great concern because of the increased age of the population and increased number of health-care professionals involved in the treatment [25]. Other possible factors for increased incidence include: increase in diagnosis [29], unemployment and hygiene problems [39].…”

“…The spinal column is affected in 1% of all TB patients [1,12,40]; however, Pott's disease (or spinal column TB) is the most dangerous of all [40]. In spite of the availability of diagnostic modalities, surgical techniques and effective anti-tuberculosis regimens, spinal TB is still a life-threatening disease [40], which can cause bony destruction, deformity and neurological deficits [39].…”