Spinal tuberculosis: A review

Abstract

Spinal tuberculosis is a destructive form of tuberculosis. It accounts for approximately half of all cases of musculoskeletal tuberculosis. Spinal tuberculosis is more common in children and young adults. The incidence of spinal tuberculosis is increasing in developed nations. Genetic susceptibility to spinal tuberculosis has recently been demonstrated. Characteristically, there is destruction of the intervertebral disk space and the adjacent vertebral bodies, collapse of the spinal elements, and anterior wedging leading to kyphosis and gibbus formation. The thoracic region of vertebral column is most frequently affected. Formation of a 'cold' abscess around the lesion is another characteristic feature. The incidence of multi-level noncontiguous vertebral tuberculosis occurs more frequently than previously recognized. Common clinical manifestations include constitutional symptoms, back pain, spinal tenderness, paraplegia, and spinal deformities. For the diagnosis of spinal tuberculosis magnetic resonance imaging is more sensitive imaging technique than x-ray and more specific than computed tomography. Magnetic resonance imaging frequently demonstrates involvement of the vertebral bodies on either side of the disk, disk destruction, cold abscess, vertebral collapse, and presence of vertebral column deformities. Neuroimaging-guided needle biopsy from the affected site in the center of the vertebral body is the gold standard technique for early histopathological diagnosis. Antituberculous treatment remains the cornerstone of treatment. Surgery may be required in selected cases, e.g. large abscess formation, severe kyphosis, an evolving neurological deficit, or lack of response to medical treatment. With early diagnosis and early treatment, prognosis is generally good.

Anaplastic large cell lymphoma of the vertebra masquerading as tuberculous spondylitis: potential pitfalls of conventional imaging

“…From there, the infection tracks in a typical subligamentous fashion beneath the anterior and posterior longitudinal ligaments to the neighboring vertebrae, resulting in contiguous vertebral involvement. Progressive vertebral destruction leads to multiple consecutive vertebral collapses, eventually resulting in kyphosis and gibbus formation [2,3]. This typical imaging appearance of TB spondylitis was present in this patient.…”

“…TB is a prevalent granulomatous infection. Bony involvement accounts for approximately 5 % of extrapulmonary TB, of which vertebral involvement accounts for approximately 50 % of them [2,3]. Both TB and ALCL can involve different organs and are known to be mimickers of disease with a few reports of the two entities masquerading as the other, particularly in the form of vertebral involvement [4,5].…”

“…The classic appearance of TB spondylitis on conventional imaging is involvement of two or more contiguous vertebrae with associated paravertebral mass or collection. There is usually a relative sparing of the intervertebral disks until the disease is advanced [2,3]. This classic imaging appearance is due to hematogenous spread of Mycobacterium tuberculosis to the vertebral column with formation of TB abscesses.…”

Sacroiliitis preceding disseminated pelvic and peritoneal tuberculosis

“…Poncet's arthritis, [4] TB arthritis, [5] peripheral septic arthritis, [6] TB spondylodiscitis and SI are some forms of presentation of extrapulmonary tuberculosis. [7][8][9][10] Even without any pathognomonic radiologic sign of TB SI, nuclear resonance showing subchondral bone marrow edema and irregularity of articular surface on an asymmetric distribution confirms unilateral SI. [11,12] Asymmetric SI without any other findings suggestive of spondiloarthropathy should be promptly investigated for infectious disease.…”

Outcome assessment in conservatively managed patients with cervical spine tuberculosis

“…Most patients with spinal tuberculosis respond to medical treatment. 3 Antituberculosis treatment protocols used for treatment of spinal tuberculosis vary from 6 to 18 months. British Medical Research Council studies have indicated that thoracolumbar spinal tuberculosis needs be treated with a combination antituberculosis treatment regimen for 6-9 months.…”