Spinal tuberculosis: a review

Abstract

Spinal tuberculosis is a destructive form of tuberculosis. It accounts for approximately half of all cases of musculoskeletal tuberculosis. Spinal tuberculosis is more common in children and young adults. The incidence of spinal tuberculosis is increasing in developed nations. Genetic susceptibility to spinal tuberculosis has recently been demonstrated. Characteristically, there is destruction of the intervertebral disk space and the adjacent vertebral bodies, collapse of the spinal elements, and anterior wedging leading to kyphosis and gibbus formation. The thoracic region of vertebral column is most frequently affected. Formation of a 'cold' abscess around the lesion is another characteristic feature. The incidence of multi-level noncontiguous vertebral tuberculosis occurs more frequently than previously recognized. Common clinical manifestations include constitutional symptoms, back pain, spinal tenderness, paraplegia, and spinal deformities. For the diagnosis of spinal tuberculosis magnetic resonance imaging is more sensitive imaging technique than x-ray and more specific than computed tomography. Magnetic resonance imaging frequently demonstrates involvement of the vertebral bodies on either side of the disk, disk destruction, cold abscess, vertebral collapse, and presence of vertebral column deformities. Neuroimaging-guided needle biopsy from the affected site in the center of the vertebral body is the gold standard technique for early histopathological diagnosis. Antituberculous treatment remains the cornerstone of treatment. Surgery may be required in selected cases, e.g. large abscess formation, severe kyphosis, an evolving neurological deficit, or lack of response to medical treatment. With early diagnosis and early treatment, prognosis is generally good.

Figure 1

‘Gibbus formation’ in the thoraco-lumbar region of a patient with spinal tuberculosis (left). The magnetic resonance shows spinal tuberculosis at T10–T12. Spinal tuberculosis causes the destruction, collapse of vertebrae, and angulation of vertebral column (right).

Figure 2

T1-weighted image of an MRI scan shows a bilateral paravertebral abscess with destruction of lumbar vertebrae as well as the intervertebral disks.

Figure 3

X-rays of cervical region showing retropharyngeal abscess.

Figure 4

X-ray of sacral region of spine shows destruction of vertebrae which is suggestive of spinal tuberculosis (left). X-ray chest of same patient which shows presence of extensive pulmonary tuberculosis (right).

Figure 5

X-ray of cervical region which shows spinal tuberculosis of cervical six to seven vertebrae and a retropharyngeal abscess (left). T1-weighted image of an MRI of same patient, which shows destruction of C6–C7 vertebrae.