TUBERCULOSIS OF THE SPINE AND ITS SEQUELAE
Journal Title: Journal of Turkish Spinal Surgery - Year 2003, Vol 14, Issue 3
Abstract
Tuberculosis of the spine may be broadly discussed under 3 categories: (a) typical presentation (b) presentation as a difficult clinical problem, and (c) atypical presentation. TYPICAL PRESENTATION: This group of patients may have one or more of the following: spinal pain, abscess, gibbus, paraplegia. In disease of the cervical spine, paraplegia is common, especially in patients older than 10 years of age. When the disease affects the cervicodorsal or upper dorsal region, the patient may present with “asthma milare”. Radiographs often show narrowing of disc space with paradiscal erosion, a paravertebral shadow, and a kyphosis. In children, spreading in the thoracic spine is rapid, and x-ray may show an aneurysmal syndrome. DIFFICULT CLINICAL PROBLEM: This group may be further sub-divided into (1) As a rigid severe angular kyphosis with or without paraplegia. This usually occurs when the disease is already quiescent or healed. If paraplegia is present or impending, decompression is required. (2) Extensive disease with deformity in old age: in this group of patients bone quality is very poor, and the patients cannot tolerate prolonged recumbency. ATYPICAL PRESENTATIONS: include (1) disease of the neural arch, which is difficult to diagnose on plane x-ray, (2) as an epidural abscess of extensive arachnoiditis (pachymeningitis), when plain x-ray shows no abnormalitiy and (3) disease of the sacro-iliac joint. Disease of neural arch can be diagnosed if there is awareness of its existence, and CT scan is very helpful. Epidural abscess and arachoiditis present with a very spastic type of paraplegia. Arachnoiditis is suspected if a myelographic column shows streaking and an irregular block. Anti-tuberculosis therapy is the mainstay of treatment for tuberculosis of treatment for tuberculosis of the spine. The present trend is to use short-course chemotherapy of nine months to one year, with 2 drugs (INAH and Rifampicin) unless there is concern about antibiotics resistance in that locality ofr there has been inadequate antituberculosis treatment prescribed previously.
Authors and Affiliations
John CY LEONG
Keywords
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