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Tuberculous Spondylitis
- See:
- Myobacterium tuberculosis
- Vertebral Osteomyelitis
- Discussion:
- 4000 cases of extrapulmonary involvment each year in the US;
- most common extra pulmonary location of TB is the spine;
- spine is the extrapulmonary site in over 50% of the cases of bone
and joint involvement;
- about 2/3 of patients will have abnormal chest x-rays;
- severe kyphosis, sinus formation, & (Pott's) paraplegia are all late
sequelae;
- sites of involvement:
- thoracolumbar spine is most common site of involvement (50% of patients);
- cervical spine and lumber spine are each involved in 25% of patients;
- pelvis, femur, and tibia may each be involved in 10% of patients;
- clinical features:
- neurologic deficit is uncommon in children;
- spinal cord injury may occur secondary to direct pressure from abscess, bony
sequestra (good prognosis);
- most common presenting symptom is back pain, but systemic signs, such as
fever, night sweats, anorexia, and weight loss, are common;
- associated injuries:
- probably more significant is the fact that any patient with spinal TB has 50%
chance of having associated pulmonary, renal, or other viceral TB in their past medical
history;
- Diagnostic Studies:
- sed rate:
- sed rate of < 50 mm / hour may indicate uncomplicated TB osteomyelitis
rather than pyogenic form;
- skin testing:
- in the U.S. about 10-15% of the population will have positive test;
- w/ infection, skin tests are usually, but not always, positive;
- false negative tests will occur in malnourished patients and AIDS patients;
- skin testing in a patient w/ an active infection may result in skin slough;
- histology:
- from CT guided needle biopsy, look for granulomatous pattern w/ caseating
necrosis & giant cell formation;
- acid fast bacilli on staining may or may not be seen, and cultures are
frequently negative;
- note, due to the high occurance of false negative results w/ aspiration, attempt
to obtain a tissue sample to assist w/ the dx (may not always be possible);
- radiographs:
- contiguous vertebral involvment w/ diffuse osteopenia, erorsions, kyphosis,
and ultimately bony or fibrous briding;
- it usually involves body of vertebra, sparing the posterior elements;
- typically appearance involves anterior destruction of two adjacent vertebrae
and destruction of the intervening intervertebral disc (in some cases eroded vertebrae
will be at different levels);
- disc involvement will help shift the diagnosis away from malignancy and
toward infection;
- note that myeloma and lymphoma may cause disc erosion;
- bone scan:
- unreliable for diagnosis of acitve TB (cold scans in upto 35-40%);
- CT scan:
- helps define the extent of soft tissue involvement inaddition to osseous
destruction;
- soft tissue calcification will help distinguish spinal TB from other conditions;
References
Progressive kyphosis following solid anterior spine fusion in children with tuberculosis of the
spine. A long-term study.
Surgical management of spinal tuberculosis in adults. Hong Kong operation compared with
debridement surgery for short and long term outcome of deformity.
The effect of age on the change in deformity after radical resection and anterior arthrodesis for
tuberculosis of the spine.
17-year prospective study of surgical management of spinal tuberculosis in children. Hong Kong
operation compared with debridement surgery for short- and long-term outcome of deformity.
Last updated by Data Trace Staff on Tuesday, February 26, 2013 4:34 pm