Tuberculosis Of The Spine

Jagdish Kathwate
MD Pediatrics. Assistant Professor, Government Medical College, Aurangabad, India.
First Created: 02/20/2001  Last Updated: 08/01/2015

Patient Education

What is Tuberculosis of the spine?

Tuberculosis of the spine also known as Koch's spine and Tuberculous Vertebral Osteomyelitis is the commonest form of skeletal tuberculosis and accounts for 88% of chronic vertebral infections.

What is the Incidence of Koch's spine?

There are 30 million cases of tuberculosis in the world. 6 million cases of sputum positive tuberculosis are in India. 1-3% of cases have skeletal tuberculosis.

How does it occur?

Vertebral affection occurs due to hematogenous dissemination from a primary infected organ (usually pulmonary or lymph node). The primary focus may be active or quiescent, apparent or latent.

What are types of Tuberculosis of the spine?

Pathologically, tuberculosis occurs in two forms:
Granulomatous inflammation is characterized by granulation tissue and tubercles.

Caseous types are associated with abscess and sinus formation.

What are symptoms of Tuberculosis of the spine?

Constitutional symptoms in the form of fever, malaise, loss of weight, loss of appetite may be present. Neurological complications occur in 10 - 30% of cases. They are of two types:
Early Onset: This occurs within 2 years of the disease. Inflammation, edema, abscess, caseous tissue, or sequestrum from vertebral bodies producing neural compression. The prognosis of early-onset paresis is good following appropriate management.

Late-onset paresis: which occurs after 2 years of onset of disease and result from stretching of the cord over an internal gibbus causing myelomalacia and gliosis of the cord, or may result from mechanical pressure on the cord or recrudescence of disease. The prognosis is poor, as permanent degenerative changes may have occurred in the cord.

What investigations are required for diagnosis Tuberculosis of the spine?

X rays of the spine: show a reduced disc space and loss of definition of the paradisical margins.

MRI or CT scans are used to define the cause of the neurological deficit and the status of the cord.

Blood investigations: CBC, ESR help in diagnosis.

Other investigations: X-ray Chest may also aid in the diagnosis. As skeletal

Tuberculosis .cultures are usually negative. The confirmation of the diagnosis is on histopathology.

What is treatment for Tuberculosis of the spine?

Anti-tuberculous chemotherapy and bed rest and later protective bracing and mobilization form the mainstay of treatment.Operative intervention is required when:

  • There is a progressive neurological deficit
  • No response to conservative management
  • Persistent neurological deficit
  • Decompression of large abscesses

The various surgeries are:

  • Draining of an abscess.
  • Decompression and scraping of the infected lesion.
  • Decompression with bone grafting.
  • In presence of a deformity correction of the deformity and stabilization by internal fixation and fusion.

1. Tuli SM. Tuberculosis of the skeletal system. Jaypee Brothers, 1st Edn.,1991.
2. Hodginson AR. Stock FE. Anterior spinal fusion for the treatment of tuberculosis of the spine. J. Bone Joint Surg. 1960, 42 - A:295.
3. Hodgson AR, Skinses OK, Leong CY. Pathogenesis of Potts paraplegia. J. Bone Joint Surg. 1967, 49-A:1147.
4. Hallock H. Jones B. Tuberculosis of the Spine. J Bone Joint Surg. 1954, 36-A:219.
5. Griffiths DL. Short course chemotherapy in the treatment of surgical tuberculosis : A report from the Medical Research Council's Working Party. J Bone Joint Surg. 1986, 68-A:158.
6. Evarts MC. Surgery of the musculo-skeletal system. Churchill Livingstone, 2nd Edition, 1990.
7. Cauthen JC. Lumbar spine surgery. Williams and Wilkins, 1st Edition 1983.

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