Spinal Tuberculosis in Adults: A Study of 103 Cases in a Developed Country, 1980-1994

Abstract

Spinal tuberculosis (TB) accounts for about 2% of all cases of TB. New methods of diagnosis such as magnetic resonance imaging (MRI) or percutaneous needle biopsy have emerged. Two distinct patterns of spinal TB can be identified, the classic form, called spondylodiscitis (SPD) in this article, and an increasingly common atypical form characterized by spondylitis without disk involvement (SPwD). We conducted a retrospective study of patients with spinal TB managed in the area of Paris, France, between 1980 and 1994 with the goal of defining the characteristics of spinal TB and comparing SPD to SPwD. The 103 consecutive patients included in our study had TB confirmed by bacteriologic and/or histologic studies of specimens from spinal or paraspinal lesions (93 patients) or from extraspinal skeletal lesions (10 patients). Sixty-eight percent of patients were foreign-born subjects from developing countries. None of our patients was HIV-positive. SPD accounted for 48% of cases and SPwD for 52%. Patients with SPwD were younger and more likely to be foreign-born and to have multiple skeletal TB lesions. Neurologic manifestations were observed in 50% of patients, with no differences between the SPD and SPwD groups. Of the 44 patients investigated by MRI, 6 had normal plain radiographs; MRI was consistently positive and demonstrated epidural involvement in 77% of cases. Bacteriologic and histologic yields were similar for surgical biopsy (n = 16) and for percutaneous needle aspiration and/or biopsy (n = 77). Cultures for Mycobacterium tuberculosis were positive in 83% of patients, and no strains were resistant to rifampin. Median duration of antituberculous chemotherapy was 14 months. Surgical treatment was performed in 24% of patients. There were 2 TB-related deaths. Our data suggest that SPwD may now be the most common pattern of spinal TB in foreign-born subjects in industrialized countries. The reasons for this remain to be elucidated.

Noncontiguous spinal tuberculosis: incidence and management

“…3 demonstrating atlanto-axial and sub-axial involvement intervening disc space, often accompanied by a paravertebral soft tissue shadow. Atypical radiographic features are described by Pande et al: centrosomic (single isolated body), which may progress to vertebrae plana and be confused with malignancy; ''ivory vertebrae''; isolated neural arch involvement; circumferential or pan-vertebral involvement, which causes significant instability; and multiple vertebral disease, which may be in continuity or noncontiguous [16,18]. In a study of 103 cases by Pertuiset et al [18], pathology consistent with spinal TB was evident on plain films in 94% of patients.…”

Spinal tuberculosis occurring after a closed bursting fracture of the vertebrae

“…A retrospective case-control study including 705 patients with TB in the United States from 1996 to 2000 showed women, non-Hispanic blacks, and HIV-positive persons had a significantly higher risk for extrapulmonary TB than men, non-Hispanic whites, and HIV-negative persons [7]. In another retrospective review conducted in France from 1980 to 1994, risk factors for ST included foreign birth site, diabetes mellitus, and prior exposure to TB [8]. Whereas none of the above mentioned risk factors had existed in our patient except for the identity of Asian resident.…”

A large tuberculosis abscess causing spinal cord compression of the cervico-thoracic region in a young child

“…Spinal TB has no specific diagnostic characteristics or features on radiologic imaging and usually manifests in two distinct entities: (1) spondylodiscitis (classic), and (2) spondylitis without disc involvement (atypical); involvement of contiguous vertebrae is common [16]. Vertebral compression fractures should also raise suspicion for spinal TB in patients with appropriate risk factors [16].…”

“…Several reports on tuberculosis of the cervical spine in children have stated principles of management [16,18,19,22,[30][31][32] as follows: (1) obtaining a definitive diagnosis through an appropriate biopsy and culture of the specimen, whenever feasible; (2) institution of appropriate medical management with or without surgical treatment; (3) preservation or restoration of normal neurological function and (4) maintenance of the growing spine stability to prevent subsequent secondary osseous and neurological dysfunction. The combination of raised inflammatory markers, plain X-rays, CT and MRI scans, usually support or is helpful for diagnosis in many cases.…”