Spinal tuberculosis: a comprehensive review for the modern spine surgeon

• Published in: The spine journal Vol. 19; no. 11; pp. 1858 - 1870
• Main Authors: Khanna, Krishn, Sabharwal, Sanjeev
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-11-2019
• Subjects: Antitubercular Agents - therapeutic use; Debridement; Gibbus; Humans; Kyphosis; Kyphosis - etiology; Kyphosis - surgery; Medical management of tuberculosis; Pott's disease; Spinal Fusion; Spinal tuberculosis; Spine - surgery; Surgical management of spinal tuberculosis; Tuberculosis; Tuberculosis, Spinal - complications; Tuberculosis, Spinal - diagnosis; Tuberculosis, Spinal - epidemiology; Tuberculosis, Spinal - surgery; Spinal tuberculosis; Kyphosis; Tuberculosis; Pott's disease; Medical management of tuberculosis; Gibbus; Surgical management of spinal tuberculosis
• ISSN: 1529-9430; 1878-1632
• DOI: 10.1016/j.spinee.2019.05.002

Nearly one-third of the human population is infected with tuberculosis. Of those with active disease, approximately 10% are impacted by skeletal tuberculosis. Though, traditionally a disease of the developing world and susceptible populations, with the rise of immigration, patients may present in developed countries. The microbe responsible is the mycobacterium tuberculosis complex bacillus. The infection begins in the anterior vertebral bodies. The natural history and presentation are notable for cold abscesses causing mass effect, early or late neurological deficit, and kyphotic deformity of the spine caused by anterior vertebral body destruction. The disease can be diagnosed with laboratory studies and characteristic imaging findings, but tissue diagnosis with cultures, histology, and polymerase chain reaction is the gold standard. The cornerstone of medical management is multidrug chemotherapy to minimize relapse and drug resistance, and can be curative for spinal tuberculosis with minimal residual kyphosis. Surgical management is reserved for patients presenting with neurological deficits or severe kyphosis. The mainstays of surgical management are debridement, correction of spinal deformity and stable fusion. With appropriate and timely management, clinical outcomes of the treatment of spinal tuberculosis are overall excellent.