The course of spinal tuberculosis (Pott disease): results of the multinational, multicentre Backbone-2 study

Abstract

We aimed to describe clinical, laboratory, diagnostic and therapeutic features of spinal tuberculosis (ST), also known as Pott disease. A total of 314 patients with ST from 35 centres in Turkey, Egypt, Albania and Greece were included. Median duration from initial symptoms to the time of diagnosis was 78 days. The most common complications presented before diagnosis were abscesses (69%), neurologic deficits (40%), spinal instability (21%) and spinal deformity (16%). Lumbar (56%), thoracic (49%) and thoracolumbar (13%) vertebrae were the most commonly involved sites of infection. Although 51% of the patients had multiple levels of vertebral involvement, 8% had noncontiguous involvement of multiple vertebral bodies. The causative agent was identified in 41% of cases. Histopathologic examination was performed in 200 patients (64%), and 74% were consistent with tuberculosis. Medical treatment alone was implemented in 103 patients (33%), while 211 patients (67%) underwent diagnostic and/or therapeutic surgical intervention. Ten percent of the patients required more than one surgical intervention. Mortality occurred in 7 patients (2%), and 77 (25%) developed sequelae. The distribution of the posttreatment sequelae were as follows: 11% kyphosis, 6% Gibbus deformity, 5% scoliosis, 5% paraparesis, 5% paraplegia and 4% loss of sensation. Older age, presence of neurologic deficit and spinal deformity were predictors of unfavourable outcome. ST results in significant morbidity as a result of its insidious course and delayed diagnosis because of diagnostic and therapeutic challenges. ST should be considered in the differential diagnosis of patients with vertebral osteomyelitis, especially in tuberculosis-endemic regions. Early establishment of definitive aetiologic diagnosis and appropriate treatment are of paramount importance to prevent development of sequelae.

Early Surgical Intervention for Active Thoracic Spinal Tuberculosis with Paraplegia

“…Until now, the timing of surgical intervention suitable for paraplegia of spinal TB has been disputed [14]. Batirel et al [15] believed that paraplegia caused by spinal TB is a slowly developing process, and a short delay in surgical decompression may not change the nal level of recovery of neurological function. Wang et al [16] and Chandra et al [17] considered a period of 2-4 weeks of normal quadruple anti-TB drug treatment before operation is advocated, but stated that emergency operation is needed as neurological impairment progresses.…”

Back pain following instillations of BCG for superficial bladder cancer is not a reactive complication: review of 30 Mycobacterium bovis BCG vertebral osteomyelitis cases

“…Compared to vertebral osteomyelitis due to M. tuberculosis [41], M. bovis BCG vertebral osteomyelitis seems to involved an older population with a male predominance, probably due to the bladder cancer population. However, we noticed that all cases in this review were men, while 74.1% of non-muscle-invasive bladder carcinoma in the United States are male [42].…”

Loss to follow-up among patients diagnosed with spinal tuberculosis at a tertiary hospital in Western Cape Province, South Africa: A retrospective cohort study

“…[1,2] The condition involves gradual destruction of one or more spinal vertebrae following haematogenous spread of Mycobacterium tuberculosis from a primary focus and typically manifests as gradually worsening back pain, with or without constitutional symptoms. [3][4][5][6] Progression of the disease is associated with significant morbidity, with previous reports suggesting spinal deformity in 16 -77% of cases and neurological deficits due to compression of the spinal cord in 33 -73%. [4][5][6][7] Early diagnosis and adequate TB treatment are key factors in optimising outcomes.…”