Tuberculosis of the Spine

➢ Diagnosis of spinal tuberculosis (TB) in the early (inflammatory) stage is essential to prevent the development of spinal deformity and neurological deficit. ➢ As spinal TB is a paucibacillary disease, diagnosis is established through a combination of clinical evaluation, imaging features, acid-fast bacilli smear, mycobacterial culture, histologic and/or cytologic evaluation, and molecular methods of diagnosis. No single modality can ascertain a diagnosis in all cases. ➢ Spinal TB is a medical disease to be treated by antitubercular therapy (ATT) until healing is attained. The consensus for the definition of a healed status in bone and joint TB, and consequent length of ATT intake, remains unresolved. Children with spinal TB need to be followed until skeletal maturity as kyphotic deformity may increase with growth. ➢ The indications for surgery and type of surgery performed (decompression, instrumented stabilization, or deformity correction) are case-specific decisions. Surgical correction of spinal deformity is easier to perform in active disease than in healed disease. ➢ Drug-resistant strains present an emerging challenge. Demonstration of drug resistance is often difficult in patients with spinal TB because of the lack of bacterial growth on culture. Molecular methods of diagnosis are often useful in such patients. Establishment of treatment protocols requires further long-term and large-scale clinical trials.