Spinal tuberculosis (Pott’s disease): its clinical presentation, surgical management, and outcome. A survey study on 694 patients

Abstract

Tuberculosis (TB) of the spine (Pott's disease) is both the most common and most dangerous form of TB infection. Delay in establishing diagnosis and management cause spinal cord compression and spinal deformity. This study investigated the data on all cases of Pott's disease reported in Turkey from 1985 to 1996. A total of 694 cases were included. Out of the patients evaluated, 19% were reported in the first half of the period (1985-1990) and 81% in the second half (1991-1996). Tuberculosis affecting the spine was commonly localized in the thoracic region and involved the vertebral body. The presenting symptoms were leg weakness (69%), gibbus (46%), pain (21%), and palpable mass (10%). Decompressive surgery plus anti-TB chemotherapy remains the best mode of therapy for Pott's disease. Follow-up information was available in 414 of the 694 patients and there were ten deaths (2%), one occurring intraoperatively and the other nine postoperatively. This meta-analysis demonstrates that in Turkey Pott's disease remains a serious problem, causing paraplegia. It should be considered when patients present with neurological findings suggesting spinal cord compression and spinal deformity. In the present study, it was concluded that the neurological involvement due to Pott's disease is relatively benign if urgent decompression is performed at the onset of the disease.

A 6500-year-old Middle Neolithic child from Pollera Cave (Liguria, Italy) with probable multifocal osteoarticular tuberculosis

“…No other evidence has been published to date from the Neolithic of Italy (Rubini et al, 2014), and sites such as Çatalhöyük, with hundreds of burials, have not reported clear evidence of TB (Knüsel, personal communication 2016). Considering the potential for differential preservation of children's skeletons (Roberts and Buikstra, 2003: 50;Bello et al, 2006), the low percentage of untreated individuals with TB that show skeletal involvement today (1%, Turgut: 2001;3-5%: Vigorita, 1999), and in particular of disseminated TB (4-5% of individuals with skeletal involvement, McTammany et al, 1963), one could speculate that TB must have had a high prevalence during the Neolithic in Liguria. Future research will aim to test this hypothesis, and will attempt to identify the possible risk factors for this population.…”

Non-contiguous multifocal spinal tuberculosis involving cervical, thoracic, lumbar and sacral segments: a case report

“…In the last case, it was not clear if the patient was operated or not [8]. However, in the papers including those cases with multilevel involvement, 34-86% of the patients (totally 64%) required an operation [2,5,8,9]. The higher operation percentage of the multilevel spinal tuberculosis is possibly due to ''fulminant'' behaviour of the disease in those patients.…”

“…Non-contiguous multifocal tuberculous spondylitis is rare. Turgut [9] reported only one patient with non-contiguous thoracic and lumbar involvement in 694 patients. Rezai et al [8] reported one patient with thoracic and thoracolumbar involvement in 20 patients.…”

“…Its incidence is also increasing in developed countries because of immigration from underdeveloped and developing countries, and increased incidence of human immune deficiency virus (HIV) [4]. Tuberculous spondylitis occurs in 1% of the patients with pulmonary tuberculosis [9]. In the vast majority of the cases, lesions are at the thoracic and lumbar spine, and that at the cervical spine is present at about 5% of all tuberculous spondylitis cases [1].…”

“…Non-contiguous multiple tuberculous spondylitis is rare, and most of the reported cases have lesions only in two levels [2,3,5,8,9]. There is only one case with extensive spinal involvement in literature [10].…”