TUBERCULOSIS OF THE SPINE

Tuberculous spondylitis (Pott’s disease) is the most common form of skeletal TB; it usually affects the lower thoracic and upper lumbar region. Infection begins with inflammation of the intervertebral joints and can spread to involve the adjacent vertebral body. Once two adjacent vertebrae are involved, infection can involve the adjoining intervertebral disc space, leading to vertebral collapse. Subsequent kyphosis can lead to cord compression and paraplegia.

Causes

  • A chronic infection caused by Mycobacteria

Clinical features

  • Most common in young adults
  • Local pain, which increases in severity over weeks to months, sometimes in association with muscle spasm and
    rigidity
  • Constitutional symptoms such as fever and weight loss are present in < 40% of cases
  • With the progression and spreading of the disease, anterior collapse of affected vertebrae leads to visible deformity (angular kyphosis or gibbus), and risk of cord compression:
  • Weakness of legs (Pott’s paraplegia)
    • Visceral dysfunction

Differential diagnosis

  • Staphylococcal spondylitis
  • Brucellosis
  • Metastatic lesion

Investigations

  • Adequate history and careful examination
  • X-ray spine: disc space narrowing, paravertebral shadow, single/multiple vertebral involvement, destruction lesions of 2 or more vertebrae without new bone formation, destruction of vertebral end-plates
  • Blood: raised ESR, WBC (within normal limits)

Management

  • Rest the spine
  • Fit a spinal corset or plaster jacket for pain relief
  • TB treatment as per guidelines (see section 5.3 for more details)
  • Surgical intervention is warranted for patients in the following circumstances:
    • Patients with spinal disease and advanced neurological deficits
    • Patients with spinal disease and worsening neurological deficits, progressing while on
      appropriate therapy
    • Patients with spinal disease and kyphosis >40 degrees at the time of presentation
    • Patients with chest wall cold abscess