Spinal tuberculosis: overlooked?

Abstract

Objective. The aim of the present study was to ascertain the degree of occurrence of tuberculous infection in patients presenting with low back pain (LBP). Methods. Forty consecutive patients seeking primary medical attention for the main symptom of LBP and presenting to the Rheumatology Outpatient Clinic of our institution from January 2004 to June 2005, were recruited in this cohort study. All patients were thoroughly interrogated (occupational, trauma, infection, diabetes mellitus and medication history), subjected to a rigorous clinical examination and a battery of investigations Results. Twelve of the 40 patients (33%) proved to have spinal TB as the cause of backache. Eight of these patients were above the age of 65. Five of the 12 patients with spinal TB also had concomitant osteoarthritic changes of the spine and two patients had concomitant disc prolapse. Eleven of the 12 patients with spinal TB had a completely normal chest X-ray and in 10 of these patients the plain X-ray of the lumbosacral region failed to show any significant lesion. In all 12 patients, sputum analysis failed to reveal acid-fast bacilli. Conclusions. The findings of this study indicate that TB is a common cause of LBP that is liable to be overlooked in the differential diagnosis of LBP. Furthermore, evidence of concurrent active intrathoracic TB may be lacking and consequently a high level of suspicion is required. The need for prompt diagnosis and treatment of skeletal TB is of utmost importance to prevent serious bone and joint destruction and severe neurological sequelae. A reliable imaging modality for diagnosing spinal TB seems to be magnetic resonance imaging.

Late-onset post-diskectomy tuberculosis at the same operated lumbar level: case report and review of literature

“…Various clinical presentations of TB spondylodisktis have been described [2]. Depending on the site of involvement, age at diagnosis and the number of vertebrae involved, the disease may appear as a simple back pain or severe deformity of the vertebral column [21].…”

“…Pain is the main symptom in spinal TB [2,24]. Fever and systemic symptoms may not be present until the late stages of musculoskeletal TB [2].…”

“…Fever and systemic symptoms may not be present until the late stages of musculoskeletal TB [2]. Hence, the diagnosis is often difficult and long-standing symptoms may persist before a definite diagnosis [14].…”

“…Although these have facilitated diagnosis to a great extent [6,28], biopsy is the preferred diagnostic modality [28]. MRI is the best imaging method [2,24], and shows typical diskitis, as well as epidural and paraspinal abscesses, better than any other method [24]. Administration of gadolinium increases the resolution and helps to distinguish an infective process from degenerative changes in end plates and intervertebral disks [36].…”

“…The incidence of spinal TB appears to be increasing as well [2,8]. Spinal TB constitutes 60% of bone and joint tuberculosis [1,18].…”