Spinal Tuberculosis

Epidemiology

 

Most common site for skeletal TB

- usually haematogenous spread

- can be direct from lung

 

3 patterns

 

1.  Peridiscal (50%) - originating in metaphyseal region

2.  Central - high incidence of vertebral collapse

3.  Anterior - instability less common with less bony destruction

 

Pathology

 

Affects multiple contiguous vertebrae

- starts anterior 1/3 vert body

- doesn't stay within body

- spreads along fascial planes

- spreads under ALL

 

More likely to produce kyphosis

 

Disc sequestered rather than destroyed

 

Posterior elements frequently involved unlike pyogenic

 

Xray

 

Short kyphotic deformity

- known as Gibbus Deformity

 

DDx

 

May be mistaken for neoplasia

 

Similar Xray appearance 

- brucellosis, hydatid disease

- fungus (aspergillosis / Cryptococcus / candidiasis)

 

Prognosis

 

Age influences risk of paralysis

 

Cervical in patient younger than 10 years

- 17% risk of cord injury

 

Cervical in patient older than 10 years 

- up to 81% risk of paralysis

 

Management

 

Non operative

 

British Medical Research Council

- 77% settled with drug treatment alone

- no patients with neurology / paralysis

- drug treatment for 12/12

- spontaneous fusion can be expected

 

Operative

 

Indications for Surgery

 

1.  Deformity

- kyphosis

- >50% verterbral body destruction

 

2.  Neurology

 

3.  Biopsy

 

4.  Failure nonoperative treatment

 

Technique

 

Hong Kong Procedure

- debridement of infected bone

- decompression of spinal canal

- correction of kyphotic deformity using structure grafting

- instrumentation