Tuberculosis of The Spine

Ashok Johari
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Tuberculosis of The Spine - Presentation
Majority of the patients present late with a long duration of symptoms. The presenting feature may be a deformity or neurological deficit.

Pain or deformity may be the presenting complaint. Pain is insidious in onset, continuous and associated with spasm of paraspinal muscles. The deformity is in the form of a localized kyphosis, which is tender on percussion. The patient may have a cold abscess, which can present itself far away from the vertebral column along fascial planes or along course of neurovascular bundles. The common sites are:
- Along the paraspinal region in the neck-posterior triangle of the neck, anterior triangle and as a retropharyngeal abscess.
- In the dorsal spine in the posterior mediastinum or along the course of intercostal nerve, as an abscess in the mid axillary line or parasternally.
- In the lumbar region as a psoas abscess or an abscess in the Petit's triangle. The abscess may track along nerves sometimes up to the knee.

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: which occurs within 2 years of 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.


References
Tuberculosis of The Spine Tuberculosis of The Spine 02/20/2001
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