Tuberculosis of the spine
Vertebral tuberculosis is the commonest form of skeletal tuberculosis and it constitutes about 50% of all the cases.
Spinal tuberculosis is always the result of hematogenous dissemination from a primary focus.
The thoracolumbar junction and lower thoracic vertebra are the most common area of tuberculous infection; however cervical spine tuberculosis is more common in children.
There are four types of spinal tuberculosis – paradiscal, central, anterior, and appendicular type.
Spinal tuberculosis is most common during the first three decades of life and is equally distributed among both the gender.
The usual symptoms are malaise, loss of weight, loss of appetite, night sweats and evening rise of temperature.
During sleep, the muscle relaxes permitting movement between the inflamed surface results in typical night cries.
On examination, the spine is stiff and painful on movement with the localized kyphotic deformity which is tender on percussion and paraspinal muscle spasm is present.
The most dreaded and crippling complication is neuro-deficit and it is due to inflammatory edema, extradural mass, bony disorder, meningeal changes, infarction of spinal cord, or extradural granuloma and tuberculoma of the spinal cord.
Blood investigation like complete blood count, erythrocyte sedimentation rate (ESR), CRP is the basic investigations.
Other investigations are the Mantoux test, synovial fluid analysis, and serological investigation.
The basic radiologic investigation includes an anteroposterior and lateral view of the spine followed by higher investigations like ultrasonography, computed tomography, and magnetic resonance imaging.
Magnetic resonance imaging is an important diagnostic tool in the assessment and management of spinal tuberculosis.
Biopsy demonstrating the caseation necrosis with tubercle is the diagnostic of tuberculosis of the spine.
All patients during the active stage of the disease are treated with multi-drug therapy and rest
The supportive measures include multivitamins, hematinic, and high protein diet.
Any palpable cold abscess or neuro-deficits need surgical intervention.
The favourable response is seen in the early stage of disease with appropriate medical and surgical intervention.
In advanced cases, cases treated inappropriately or neglected cases result in unfavourable outcome with deformity and neuro-deficits.