Spinal tuberculosis (TB) can cause compression of peripheral nerves leading to loss of sensation and motor functions. There are two types of this affliction:

1. Spondylodiscitis;
2. Atypical form or spondylitis without disc involvement.

Lesions of tuberculosis affecting the vertebrae are characterized with spreading to adjacent spinal structures, provocating osteomyelitis, and arthritis in numerous vertebrae [1]. TB can cause the destruction of the bone tissue that leads to the development of kyphotic or kyphoscoliotic disfigurement and possible compression of root nerves with the collapse of the vertebrae [2]. Spinal canal can narrow due to the protrusion of granulations, lesions like cold abscesses developed in the course of the TB infection or direct infiltration. Cold abscesses are known to spread in subligamentous fashion, considering the bacteria cannot exert a lytic effect in these tissues [1] [2].

Patients with spinal TB present with local symptoms such as pain in the affected area, reduced amplitude of movement due to compression, and loss of function. Non-specific complaints are fever, night sweats, signs of wasting like reduction of weight, loss of appetite, and fatigue [3] [4] [5].

Neurological assessment can be made using the American Spinal Injury Association (ASIA) impairment scale which classifies neurologic deficit into grades. Although alternative methods are available, ASIA classification is used more frequently due to the correlation with findings from the magnetic resonance imaging scans [2].

Spasticity, progressive loss of sensory and either partial or complete motor function is expected if the tuberculosis lesions are not treated [6].

• Fever

  Spinal tuberculosis commonly presents with back pain, fever and night sweats. In this report, we present a case of spinal tuberculosis complicated by bilateral large psoas abscesses. [ncbi.nlm.nih.gov]

  J Postgrad Med 2003;49:346-7 A 2-year-old girl presented with fever, anorexia and progressive spinal deformity for the past two months, and cough and breathlessness for the past two weeks. [jpgmonline.com]

  Persistent back pain present even during rest, fever and loss of appetite should alert one. [timesofindia.indiatimes.com]

• Gangrene

  2016 2017 2018 2019 Billable/Specific Code tuberculous A18.01 Lordosis M40.50 ICD-10-CM Diagnosis Code M40.50 Lordosis, unspecified, site unspecified 2016 2017 2018 2019 Billable/Specific Code tuberculous A18.01 Necrosis, necrotic (ischemic) - see also Gangrene [icd10data.com]

• Prolonged Immobilization

  Biomechanically, the environment was less stable and frequently patients required prolonged immobilization or additional posterior instrumentation. [ghrnet.org]

• Night Sweats

  Spinal tuberculosis commonly presents with back pain, fever and night sweats. In this report, we present a case of spinal tuberculosis complicated by bilateral large psoas abscesses. [ncbi.nlm.nih.gov]

• Back Pain

  The patient presented with bilateral flank pain and swellings rather than the classic presentation of back pain. [ncbi.nlm.nih.gov]

  Patients with tubercular spondylitis experience acute back pain, which can cause tingling, numbness or weakness in the legs. Pain in the spine leads to weakened muscles and causes the sufferer to sit and walk in a rigid and upright manner. [onlymyhealth.com]

  Increasing back pain should suggest plain radiography of the spine, and perhaps followed by MRI. Our patients present with persistent back pain. Spinal radiographic findings were misinterpreted as compression fractures. [nature.com]

• Low Back Pain

  After 3 month history of low back pain and 2 weeks radiated pain of right lower extremity, an operation was performed and the total intra-spinal mass was resected. Histological examination revealed a granulomatous necrosis with caseum. [ncbi.nlm.nih.gov]

  Disc prolapse has been implicated as one of the important causes of low back pain radiating to limbs. Apart from conservative therapy all other forms of treatment aim at decompressing the nerve roots. [indiamart.com]

  This is one reason why it is important to keep the diagnosis of TB in mind for any patient with back pain or low-back pain, and to do a laboratory work-up for TB. [ispub.com]

• Paravertebral Muscle Spasm

  Physical examination of the spine reveals localised tenderness and paravertebral muscle spasm. A kyphotic deformity due to prominence of spinous process may be evident due to collapse and anterior wedging of vertebral bodies. [rxpgonline.com]

  Relaxation of muscles during sleep permits movements which are very painful. As the infection progresses, pain increases and paraspinal muscle spasm occurs. [najms.org]

• Spine Pain

  In the second patient, aged 35 years, during intravesical BCG immunotherapy for carcinoma of the bladder, girdle thoracic spine pain was observed. The MRI and CT of the spine showed visible lesions characteristic of tuberculosis. [ncbi.nlm.nih.gov]

• Bilateral Flank Pain

  The patient presented with bilateral flank pain and swellings rather than the classic presentation of back pain. [ncbi.nlm.nih.gov]

• Hyperreflexia

  This is in contrast to the hyperreflexia seen with spinal cord compression along with bladder involvement (cauda-equina syndrome). Formation of a cold abscess around the vertebral lesion is another characteristic feature of spinal tuberculosis. [ncbi.nlm.nih.gov]

• Spastic Paraplegia

  Tuberculosis of the spine is a preventable and treatable cause of spastic paraplegia. Early diagnosis and comprehensive treatment are needed to control this pubic health problem. [rxpgonline.com]

• Cervical Cord Compression

  The destructive lesion of the sacrum with a rectally palpable presacral mass was thought to be a chordoma or chondrosarcoma until the patient developed upper cervical cord compression with an extradural myelographic block. [ncbi.nlm.nih.gov]

It is important to differentiate spinal TB from other causative agents that can establish lesions in the spine like fungal or pyogenic infections. Metastatic or primary tumors are also subjected to differentiation [1].

A positive skin test is an indicator of M. tuberculosis involvement, despite that, additional studies have to be performed to confirm the disease. This is particularly important in endemic regions where TB is widespread [7].

Biopsy and subsequent procedures associated with polymerase chain reaction amplification methods give rise to an accurate and fast diagnosis of the infection and the causative agent. This is due to difficulties obtaining M. tuberculosis cultures that can take a long time to cultivate and the results may be unreliable, even false negative [1].

Imaging studies are performed to determine the exact location of the tuberculosis lesions and estimate the grade of infiltration. Computed tomography (CT) scan or plain radiography are effective in visualizing the pathologies in the bone structures like the collapse of a vertebral body or bone tissue destruction. Narrowing or even absence of intervertebral space is noted as well [3]. Conversely, a phenomenon of ivory vertebra is possible. It is described as increased opacification of the vertebral body with no changes in size or contours. This renders the image to appear heterogeneous [2].

Magnetic resonance imaging (MRI) is a more accurate radiologic study that can exhibit characteristics of soft tissues and presence of abscesses [7]. Sagittal and axial planes are used. Spinal cord edema and signs of compression in addition to end-plate disruption may be seen [2]. Atypical findings of the spinal TB include lesions not associated with vertebral discs or only small-scale disc involvement, as well as no evidence of soft tissue abscesses [8].

• Treponema Pallidum

  pallidum Treatment Nonoperative pharmacologic treatment +/- spinal orthosis indications no neurological deficit drugs are the mainstay of treatment in most cases pharmacologic agents isoniazid (H), rifampin (R), ethambutol (E) and pyrazanamide (Z) therapy [orthobullets.com]

• Granulomatous Tissue

  However, epidural granulomatous tissue or tuberculoma of the spinal cord may not be detected by these tools [ 8 ]. [ncbi.nlm.nih.gov]

• Foam Cell

  cells, giant cells and epithelioid cells. [ghrnet.org]

To help clarify the treatment over spinal TB patients without absolute surgical indications, we characterized a subtype spinal TB and then analyzed the treatment outcomes of standard chemotherapy alone. [ncbi.nlm.nih.gov]

Original Article N Motsitsi, M Chipeta Keywords frankel grading, medical treatment, prognosis, spinal tuberculosis Citation N Motsitsi, M Chipeta. Prognosis Of Spinal Tuberculosis. The Internet Journal of Orthopedic Surgery. 2006 Volume 4 Number 2. [ispub.com]

In most cases, M. tuberculosis, once recognized and appropriately treated, should result in an excellent prognosis. [ncbi.nlm.nih.gov]

Prognosis The progress is slow and lasts for months or even years. Prognosis is better if caught early and modern regimes of chemotherapy are more effective. A study from London showed that diagnosis can be difficult and is often late [ 4 ]. [patient.info]

On thorough evaluation, they had bilateral psoas abscess and on detailed investigations, tuberculosis was found to be the etiological factor. They were treated conservatively with good follow-up results. [ncbi.nlm.nih.gov]

Pott; disease (manifestation), disease (or disorder); spine or vertebra, tuberculous (etiology), disease (or disorder); spine or vertebra, tuberculous (manifestation), spine or vertebra; disorder, tuberculous (etiology), spine or vertebra; disorder [fpnotebook.com]

[…] patients with CD4+ count of 50 to 200) Anatomic location 15% of patients with TB will have extrapulmonary involvement the spine, and specifically, the thoracic spine is the most common extrapulmonary site 5% of all TB patients have spine involvement Etiology [orthobullets.com]

We performed a retrospective observational study (1993-2014), including all cases of spinal TB diagnosed at a Barcelona hospital to assess the epidemiological changes. [ncbi.nlm.nih.gov]

Aim: To review the epidemiology + clinical management of Spinal TB at Queen Elizabeth Hospital, London. Methods: A retrospective study was performed on spinal TB patients from 2008-2012. Results: 34 patients, mean age 43 years, 22(65%) male. [erj.ersjournals.com]

Pathophysiology and Treatment of Spinal Tuberculosis. J Bone Joint Surg Am. 2014; 2(9). [ Links ] 15. Jia C-G, Gao J-G, Liu F-S, Li Z, Dong Z-L, Yao L-M, et al. [scielo.org.pe]

Pathophysiology and Treatment of Spinal Tuberculosis. J Bone Joint Surg Am. 2014; 2(9). Jia C-G, Gao J-G, Liu F-S, Li Z, Dong Z-L, Yao L-M, et al. [horizontemedico.usmp.edu.pe]

Medical treatment or combined medical and surgical strategies can control the disease in most patients. [4, 5] Pathophysiology Pott disease is usually secondary to an extraspinal source of infection. [emedicine.medscape.com]

Setting: Ohio, USA Methods: A review of the literature on the pathogenesis, pathophysiology, clinical presentation, diagnostic methods, treatment and prognosis of spinal TB was conducted. [nature.com]

Prevention See also Tuberculosis Prevention and Screening. As for all tuberculosis, BCG vaccination. Improvement of socio-economic conditions. Prevention of HIV and AIDS. [patient.info]

The aim of this report is to draw the attention of physicians to this uncommon presentation of spinal tuberculosis, as an early recognition of such condition may expedite diagnosis and treatment, thereby preventing future complications of the disease. [ncbi.nlm.nih.gov]

Advantages of surgery - prevention of progression of abscess relieve pressure on neural tissue graft under compression - fusion almost sure- thus late kyphosis prevented Complications Neurological deficit - paraplegia/quadriplegia Deformity [orthopaedicsone.com]

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2. Gupta AK, Kumar C, Kumar P, Verma AK, Nath R, Kulkarni CD. Correlation between neurological recovery and magnetic resonance imaging in Pott’s paraplegia. Indian J Orthop. 2014;48(4):366-373.
3. Cheng Z, Wang J, Zheng Q, Wu Y, Guo X. Anterolateral Radical Debridement and Interbody Bone Grafting Combined With Transpedicle Fixation in the Treatment of Thoracolumbar Spinal Tuberculosis. Chang. J, ed. Medicine (Baltimore). 2015;94(14):e721.
4. Jiang T, Zhao J, He M, Wang K, Fowdur M, Wu Y. Outcomes and Treatment of Lumbosacral Spinal Tuberculosis: A Retrospective Study of 53 Patients. Cardona P-J, ed. PLoS ONE. 2015;10(6):e0130185.
5. World Health Organization. Global Tuberculosis Report. WHO Library Cataloguing-in-Publication Data; Geneva 27, Switzerland: World Health Organization; 2012:107–1.
6. Jain AK, Dhammi IK, Jain S, Kumar J. Simultaneously anterior decompression and posterior instrumentation by extra pleural retroperitoneal approach in thoracolumbar lesions. Indian J Orthop. 2010;44:409–16.
7. Jain AK. Tuberculosis of the spine: a fresh look at an old disease. J Bone Joint Surg Br. 2010;92:905–913.
8. Sharma A, Chhabra HS, Mahajan R, Chabra T, Batra S. Magnetic Resonance Imaging and GeneXpert: A Rapid and Accurate Diagnostic Tool for the Management of Tuberculosis of the Spine. Asian Spine J. 2016;10(5):850-856.