Spinal tuberculosis: Diagnosis and management

Asian Spine Journal

Volumn 6, Issue 4, 2012, Pages 294-308

  Rasouli, Mohammad R ^a,b   Mirkoohi, Maryam ^a   Vaccaro, Alexander R ^b   Yarandi, Kourosh Karimi ^a   Rahimi Movaghar, Vafa ^a,c  

^a TEHRAN UNIVERSITY OF MEDICAL SCIENCES   (Iran)

^b THOMAS JEFFERSON UNIVERSITY   (United States)

^c UNIVERSITY OF TEHRAN   (Iran)

Author keywords

Diagnosis; Drug therapy; Spinal tuberculosis; Therapeutics

Indexed keywords

EID: 84873028002     PISSN: 19761902     EISSN: 19767846     Source Type: Journal    
DOI: 10.4184/asj.2012.6.4.294     Document Type: Review

References (115)

1. Sai Kiran NA, Vaishya S, Kale SS, Sharma BS, Mahapatra AK. Surgical results in patients with tuberculosis of the spine and severe lower-extremity motor deficits: a retrospective study of 48 patients. J Neurosurg Spine 2007;6:320-6.
2. Rezai AR, Lee M, Cooper PR, Errico TJ, Koslow M. Modern management of spinal tuberculosis. Neurosurgery 1995;36:87-97.
3. Turgut M. Spinal tuberculosis (Pott's disease): its clinical presentation, surgical management, and outcome. A survey study on 694 patients. Neurosurg Rev 2001;24:8-13.
4. Barnes PF, Bloch AB, Davidson PT, Snider DE Jr. Tuberculosis in patients with human immunodeficiency virus infection. N Engl J Med 1991;324:1644-50.
5. Moorthy S, Prabhu NK. Spectrum of MR imaging findings in spinal tuberculosis. AJR Am J Roentgenol 2002;179:979-83.
6. Pertuiset E, Beaudreuil J, Liote F, et al. Spinal tuberculosis in adults. A study of 103 cases in a developed country, 1980-1994. Medicine (Baltimore) 1999;78:309-20.
7. Hidalgo JA, Alangaden G, Cunha BA, et al. Pott disease: tuberculous spondylitis [Internet]. New York: WebMD LLC; 2008 [cited 2010, Oct. 15]; Available from: http://emedicine.medscape.com/article/226141-overview.
8. Nussbaum ES, Rockswold GL, Bergman TA, Erickson DL, Seljeskog EL. Spinal tuberculosis: a diagnostic and management challenge. J Neurosurg 1995;83:243-7.
9. Jain AK. Tuberculosis of the spine: a fresh look at an old disease. J Bone Joint Surg Br 2010;92:905-13.
10. Brisson-Noel A, Aznar C, Chureau C, et al. Diagnosis of tuberculosis by DNA amplification in clinical practice evaluation. Lancet 1991;338:364-6.
11. Al Arabi KM, Al Sebai MW, Al Chakaki M. Evaluation of radiological investigations in spinal tuberculosis. Int Orthop 1992;16:165-7.
12. Andronikou S, Jadwat S, Douis H. Patterns of disease on MRI in 53 children with tuberculous spondylitis and the role of gadolinium. Pediatr Radiol 2002;32:798-805.
13. Babhulkar SS, Tayade WB, Babhulkar SK. Atypical spinal tuberculosis. J Bone Joint Surg Br 1984;66:239-42.
14. Pande KC, Babhulkar SS. Atypical spinal tuberculosis. Clin Orthop Relat Res 2002; (398): 67-74.
15. Rahimi-Movaghar V. A case report of Pott's disease with unusual involvement of two separate levels of spine and delayed progressive Kyphosis. Acta Med Iran 2001;39:54-7.
16. Desai SS. Early diagnosis of spinal tuberculosis by MRI. J Bone Joint Surg Br 1994;76:863-9.
17. Narlawar RS, Shah JR, Pimple MK, Patkar DP, Patankar T, Castillo M. Isolated tuberculosis of posterior elements of spine: magnetic resonance imaging findings in 33 patients. Spine (Phila Pa 1976) 2002;27:275-81.
18. Chang MC, Wu HT, Lee CH, Liu CL, Chen TH. Tuberculous spondylitis and pyogenic spondylitis: comparative magnetic resonance imaging features. Spine (Phila Pa 1976) 2006;31:782-8.
19. Gupta RK, Agarwal P, Rastogi H, Kumar S, Phadke RV, Krishnani N. Problems in distinguishing spinal tuberculosis from neoplasia on MRI. Neuroradiology 1996;38 Suppl 1:S97-104.
20. Kang M, Gupta S, Khandelwal N, Shankar S, Gulati M, Suri S. CT-guided fine-needle aspiration biopsy of spinal lesions. Acta Radiol 1999;40:474-8.
21. Mondal A, Misra DK. CT-guided needle aspiration cytology (FNAC) of 112 vertebral lesions. Indian J Pathol Microbiol 1994;37:255-61.
22. Kumar K. A clinical study and classification of posterior spinal tuberculosis. Int Orthop 1985;9:147-52.
23. Mehta JS, Bhojraj SY. Tuberculosis of the thoracic spine. A classification based on the selection of surgical strategies. J Bone Joint Surg Br 2001;83:859-63.
24. Oguz E, Sehirlioglu A, Altinmakas M, et al. A new classification and guide for surgical treatment of spinal tuberculosis. Int Orthop 2008;32:127-33.
25. Samuel S. Comment on Oguz et al.: a new classification and guide for surgical treatment of spinal tuberculosis. Int Orthop 2010;34:613.
26. Ito H, Suchiya J, Asami G. A new radical operation for Pott's disease: report of ten cases. J Bone Joint Surg Am 1934;16:499-515.
27. Tuli SM. Tuberculosis of the spine: a historical review. Clin Orthop Relat Res 2007;460:29-38.
28. Kirkaldy-Willis WH, Thomas TG. Anterior approaches in the diagnosis and treatment of infections of the vertebral bodies. J Bone Joint Surg Am 1965;47:87-110.
29. Arct W. Operative treatment of tuberculosis of the spine in old people. J Bone Joint Surg Am 1968;50:255-67.
30. Wilkinson MC. Tuberculosis of the spine treated by chemotherapy and operative debridement: a long-term follow-up study. J Bone Joint Surg Am 1969;51:1331-42.
31. Rajasekaran S, Shanmugasundaram TK, Prabhakar R, Dheenadhayalan J, Sherry AP, Shetty DK. Tuberculous lesions of the lumbosacral region: a 15-year follow-up of patients treated by ambulant chemotherapy. Spine (Phila Pa 1976) 1998;23:1163-7.
32. Hodgson AR, Stock FE. Anterior spinal fusion for the treatment of tuberculosis of the spine. J Bone Joint Surg Am 1960;42:1147-56.
33. Kohli SB. Radical surgical approach to spinal tuberculosis. J Bone Joint Surg Br 1967;49:668-73.
34. Albee FH. Transplantation of a portion of the tibia into the spine for Pott's disease: a preliminary report. JAMA 1911;57:885-6.
35. Hibbs RA. An operation for Pott's disease of the spine. JAMA 1912;59:433-6.
36. Fu Y, Huo H, Xiao Y, Yang X, Xing W, Zhao Y. Combination of intensified anti-tuberculosis with operation for treatment of thoracolumbar tuberculosis. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi 2009;23:1427-30.
37. Jain AK. Treatment of tuberculosis of the spine with neurologic complications. Clin Orthop Relat Res 2002; (398): 75-84.
38. Bakhsh A. Medical management of spinal tuberculosis: an experience from Pakistan. Spine (Phila Pa 1976) 2010;35:E787-91.
39. Kirkman MA, Sridhar K. Posterior listhesis of a lumbar vertebra in spinal tuberculosis. Eur Spine J 2011;20:1-5.
40. Gupta SK, Mohindra S, Sharma BS, et al. Tuberculosis of the craniovertebral junction: is surgery necessary? Neurosurgery 2006;58:1144-50.
41. Topuz K, Kutlay AM, Simsek H, Colak A, Kaya S, Demircan MN. Effect of hyperbaric oxygen therapy on the duration of treatment of spinal tuberculosis. J Clin Neurosci 2009;16:1572-7.
42. Moon MS, Moon YW, Moon JL, Kim SS, Sun DH. Conservative treatment of tuberculosis of the lumbar and lumbosacral spine. Clin Orthop Relat Res 2002; (398): 40-9.
43. Bhojraj S, Nene A. Lumbar and lumbosacral tuberculous spondylodiscitis in adults. Redefining the indications for surgery. J Bone Joint Surg Br 2002;84:530-4.
44. Alothman A, Memish ZA, Awada A, et al. Tuberculous spondylitis: analysis of 69 cases from Saudi Arabia. Spine (Phila Pa 1976) 2001;26:E565-70.
45. Chadha M, Agarwal A, Singh AP. Craniovertebral tuberculosis: a retrospective review of 13 cases managed conservatively. Spine (Phila Pa 1976) 2007;32:1629-34.
46. Nene A, Bhojraj S. Results of nonsurgical treatment of thoracic spinal tuberculosis in adults. Spine J 2005;5:79-84.
47. Kotil K, Alan MS, Bilge T. Medical management of Pott disease in the thoracic and lumbar spine: a prospective clinical study. J Neurosurg Spine 2007;6:222-8.
48. Tuli SM. Results of treatment of spinal tuberculosis by "middle-path" regime. J Bone Joint Surg Br 1975;57:13-23.
49. Parthasarathy R, Sriram K, Santha T, Prabhakar R, Somasundaram PR, Sivasubramanian S. Short-course chemotherapy for tuberculosis of the spine. A comparison between ambulant treatment and radical surgery: ten-year report. J Bone Joint Surg Br 1999;81:464-71.
50. Communicable diseases module: 14. diagnosis and treatment of tuberculosis [Internet]. Milton Keynes (UK): The Open University; c2012 [Cited 2012 Nov. 27]. Available from: http://labspace.open.ac.uk/mod/oucontent/view.php?id= 452597§ion=1.5.
51. Upadhyay SS, Saji MJ, Yau AC. Duration of antituberculosis chemotherapy in conjunction with radical surgery in the management of spinal tuberculosis. Spine (Phila Pa 1976) 1996;21:1898-903.
52. Wang Z, Ge Z, Jin W, et al. Treatment of spinal tuberculosis with ultrashort-course chemotherapy in conjunction with partial excision of pathologic vertebrae. Spine J 2007;7:671-81.
53. Guo LX, Ma YZ, Chen X, Bao D, Luo XB. Clinical study of short-course chemotherapy combined with radical operation in retreating spinal tuberculosis. Zhongguo Gu Shang 2010;23:491-4.
54. Guo LX, Ma YZ, Li HW, Xue HB, Peng W, Luo XB. Variety of ESR and C-reactive protein levels during perioperative period in spinal tuberculosis. Zhongguo Gu Shang 2010;23:200-2.
55. Okada Y, Miyamoto H, Uno K, Sumi M. Clinical and radiological outcome of surgery for pyogenic and tuberculous spondylitis: comparisons of surgical techniques and disease types. J Neurosurg Spine 2009;11:620-7.
56. Krishnan A, Patkar D, Patankar T, et al. Craniovertebral junction tuberculosis: a review of 29 cases. J Comput Assist Tomogr 2001;25:171-6.
57. Murugappan K, Khandwal P, Upendra B, Jayaswal A. Comment on the new classification of surgical treatment of spinal tuberculosis. Int Orthop 2009;33:291-2.
58. Liu ZX, Zhu H, Qi QL, Liu J. Analysis of the curative effect of 162 cases of thoracic and lumbar tuberculosis. Zhongguo Gu Shang 2010;23:497-9.
59. Jain AK, Dhammi IK, Jain S, Mishra P. Kyphosis in spinal tuberculosis: prevention and correction. Indian J Orthop 2010;44:127-36.
60. Jain AK, Dhammi IK, Prashad B, Sinha S, Mishra P. Simultaneous anterior decompression and posterior instrumentation of the tuberculous spine using an anterolateral extrapleural approach. J Bone Joint Surg Br 2008;90:1477-81.
61. Rajasekaran S, Soundarapandian S. Progression of kyphosis in tuberculosis of the spine treated by anterior arthrodesis. J Bone Joint Surg Am 1989;71:1314-23.
62. Jain AK, Maheshwari AV, Jena S. Kyphus correction in spinal tuberculosis. Clin Orthop Relat Res 2007;460:117-23.
63. Teegala R, Kumar P, Kale SS, Sharma BS. Craniovertebral junction tuberculosis: a new comprehensive therapeutic strategy. Neurosurgery 2008;63:946-55.
64. Kotil K, Dalbayrak S, Alan S. Craniovertebral junction Pott's disease. Br J Neurosurg 2004;18:49-55.
65. Sinha S, Singh AK, Gupta V, Singh D, Takayasu M, Yoshida J. Surgical management and outcome of tuberculous atlantoaxial dislocation: a 15-year experience. Neurosurgery 2003;52:331-8.
66. Chacko AG, Moorthy RK, Chandy MJ. The transpedicular approach in the management of thoracic spine tuberculosis: a short-term follow up study. Spine (Phila Pa 1976) 2004;29:E363-7.
67. Benli IT, Kaya A, Acaroglu E. Anterior instrumentation in tuberculous spondylitis: is it effective and safe? Clin Orthop Relat Res 2007;460:108-16.
68. Khoo LT, Mikawa K, Fessler RG. A surgical revisitation of Pott distemper of the spine. Spine J 2003;3:130-45.
69. Oga M, Arizono T, Takasita M, Sugioka Y. Evaluation of the risk of instrumentation as a foreign body in spinal tuberculosis: clinical and biologic study. Spine (Phila Pa 1976) 1993;18:1890-4.
70. Dai LY, Jiang LS, Wang W, Cui YM. Single-stage anterior autogenous bone grafting and instrumentation in the surgical management of spinal tuberculosis. Spine (Phila Pa 1976) 2005;30:2342-9.
71. Sundararaj GD, Amritanand R, Venkatesh K, Arockiaraj J. The use of titanium mesh cages in the reconstruction of anterior column defects in active spinal infections: can we rest the crest? Asian Spine J 2011;5:155-61.
72. Govender S. The outcome of allografts and anterior instrumentation in spinal tuberculosis. Clin Orthop Relat Res 2002; (398): 60-6.
73. Yilmaz C, Selek HY, Gurkan I, Erdemli B, Korkusuz Z. Anterior instrumentation for the treatment of spinal tuberculosis. J Bone Joint Surg Am 1999;81:1261-7.
74. Jin D, Qu D, Chen J, Zhang H. One-stage anterior interbody autografting and instrumentation in primary surgical management of thoracolumbar spinal tuberculosis. Eur Spine J 2004;13:114-21.
75. Moon MS, Woo YK, Lee KS, Ha KY, Kim SS, Sun DH. Posterior instrumentation and anterior interbody fusion for tuberculous kyphosis of dorsal and lumbar spines. Spine (Phila Pa 1976) 1995;20:1910-6.
76. Bailey HL, Gabriel M, Hodgson AR, Shin JS. Tuberculosis of the spine in children. Operative findings and results in one hundred consecutive patients treated by removal of the lesion and anterior grafting. J Bone Joint Surg Am 1972;54:1633-57.
77. Chen WJ, Wu CC, Jung CH, Chen LH, Niu CC, Lai PL. Combined anterior and posterior surgeries in the treatment of spinal tuberculous spondylitis. Clin Orthop Relat Res 2002; (398): 50-9.
78. Chen WJ, Chen CH, Shih CH. Surgical treatment of tuberculous spondylitis: 50 patients followed for 2-8 years. Acta Orthop Scand 1995;66:137-42.
79. Talu U, Gogus A, Ozturk C, Hamzaoglu A, Domanic U. The role of posterior instrumentation and fusion after anterior radical debridement and fusion in the surgical treatment of spinal tuberculosis: experience of 127 cases. J Spinal Disord Tech 2006;19:554-9.
80. Hirakawa A, Miyamoto K, Masuda T, et al. Surgical outcome of 2-stage (posterior and anterior) surgical treatment using spinal instrumentation for tuberculous spondylitis. J Spinal Disord Tech 2010;23:133-8.
81. Fukuta S, Miyamoto K, Masuda T, et al. Two-stage (posterior and anterior) surgical treatment using posterior spinal instrumentation for pyogenic and tuberculotic spondylitis. Spine (Phila Pa 1976) 2003;28:E302-8.
82. Huang QS, Zheng C, Hu Y, et al. One-stage surgical management for children with spinal tuberculosis by anterior decompression and posterior instrumentation. Int Orthop 2009;33:1385-90.
83. Kim MC, Chung HT, Kim DJ, Kim SH, Jeon SH. The clinical and radiological outcomes of minimally invasive transforaminal lumbar interbody single level fusion. Asian Spine J 2011;5:111-6.
84. Jayaswal A, Upendra B, Ahmed A, Chowdhury B, Kumar A. Video-assisted thoracoscopic anterior surgery for tuberculous spondylitis. Clin Orthop Relat Res 2007;460:100-7.
85. Kapoor SK, Agarwal PN, Jain BK Jr, Kumar R. Videoassisted thoracoscopic decompression of tubercular spondylitis: clinical evaluation. Spine (Phila Pa 1976) 2005;30:E605-10.
86. Huang TJ, Hsu RW, Chen SH, Liu HP. Video-assisted thoracoscopic surgery in managing tuberculous spondylitis. Clin Orthop Relat Res 2000; (379): 143-53.
87. Ito M, Sudo H, Abumi K, et al. Minimally invasive surgical treatment for tuberculous spondylodiscitis. Minim Invasive Neurosurg 2009;52:250-3.
88. Benli IT, Kiş M, Akalin S, Citak M, Kanevetçi S, Duman E. The results of anterior radical debridement and anterior instrumentation in Pott's disease and comparison with other surgical techniques. Kobe J Med Sci 2000;46:39-68.
89. Rajasekaran S. The problem of deformity in spinal tuberculosis. Clin Orthop Relat Res 2002; (398): 85-92.
90. Rajasekaran S, Prasad Shetty A, Dheenadhayalan J, Shashidhar Reddy J, Naresh-Babu J, Kishen T. Morphological changes during growth in healed childhood spinal tuberculosis: a 15-year prospective study of 61 children treated with ambulatory chemotherapy. J Pediatr Orthop 2006;26:716-24.
91. Rajasekaran S. The natural history of post-tubercular kyphosis in children. Radiological signs which predict late increase in deformity. J Bone Joint Surg Br 2001;83:954-62.
92. Smith-Petersen MN, Larson CB, Aufranc OE. Osteotomy of the spine for correction of flexion deformity in rheumatoid arthritis. Clin Orthop Relat Res 1969;66:6-9.
93. Thomasen E. Vertebral osteotomy for correction of kyphosis in ankylosing spondylitis. Clin Orthop Relat Res 1985; (194): 142-52.
94. Wang Y, Zhang Y, Zhang X, et al. Posterior-only multilevel modified vertebral column resection for extremely severe Pott's kyphotic deformity. Eur Spine J 2009;18:1436-41.
95. Bridwell KH. Decision making regarding Smith-Petersen vs. pedicle subtraction osteotomy vs. vertebral column resection for spinal deformity. Spine (Phila Pa 1976) 2006;31:S171-8.
96. Kalra KP, Dhar SB, Shetty G, Dhariwal Q. Pedicle subtraction osteotomy for rigid post-tuberculous kyphosis. J Bone Joint Surg Br 2006;88:925-7.
97. Deng Y, Lv G, An HS. En bloc spondylectomy for the treatment of spinal tuberculosis with fixed and sharply angulated kyphotic deformity. Spine (Phila Pa 1976) 2009;34:2140-6.
98. Rajasekaran S, Rishi Mugesh Kanna P, Shetty AP. Closing-opening wedge osteotomy for severe, rigid, thoracolumbar post-tubercular kyphosis. Eur Spine J 2011;20:343-8.
99. Kawahara N, Tomita K, Baba H, Kobayashi T, Fujita T, Murakami H. Closing-opening wedge osteotomy to correct angular kyphotic deformity by a single posterior approach. Spine (Phila Pa 1976) 2001;26:391-402.
100. Rajasekaran S, Vijay K, Shetty AP. Single-stage closing-opening wedge osteotomy of spine to correct severe post-tubercular kyphotic deformities of the spine: a 3-year follow-up of 17 patients. Eur Spine J 2010;19:583-92.
101. Chunguang Z, Limin L, Rigao C, et al. Surgical treatment of kyphosis in children in healed stages of spinal tuberculosis. J Pediatr Orthop 2010;30:271-6.
102. Pawar UM, Kundnani V, Agashe V, Nene A. Multidrug-resistant tuberculosis of the spine-is it the beginning of the end? A study of twenty-five culture proven multidrug-resistant tuberculosis spine patients. Spine (Phila Pa 1976) 2009;34:E806-10.
103. Nairnur R. Atypical forms of spinal tuberculosis. J Bone Joint Surg Br 1980;62:162-5.
104. Yalniz E, Pekindil G, Aktas S. Atypical tuberculosis of the spine. Yonsei Med J 2000;41:657-61.
105. Sankaran-Kutty M. Atypical tuberculous spondylitis. Int Orthop 1992;16:69-74.
106. Pandit HG, Sonsale PD, Shikare SS, Bhojraj SY. Bone scintigraphy in tuberculous spondylodiscitis. Eur Spine J 1999;8:205-9.
107. Polley P, Dunn R. Noncontiguous spinal tuberculosis: incidence and management. Eur Spine J 2009;18:1096-101.
108. Emel E, Guzey FK, Guzey D, Bas NS, Sel B, Alatas I. Non-contiguous multifocal spinal tuberculosis involving cervical, thoracic, lumbar and sacral segments: a case report. Eur Spine J 2006;15:1019-24.
109. Turgut M. Multifocal extensive spinal tuberculosis (Pott's disease) involving cervical, thoracic and lumbar vertebrae. Br J Neurosurg 2001;15:142-6.
110. Kulali A, Cobanoǧlu S, Ozyilmaz F. Spinal tuberculosis with circumferential involvement of two noncontiguous isolated vertebral levels: case report. Neurosurgery 1994;35:1154-8.
111. Rahimi-Movaghar V. Unusual pott's disease with involvement of two separate levels of spine and delayed progressive kyphosis: a case report. Acta Med Iran 2001;39:54-7.
112. Cavuşoǧlu H, Kaya RA, Türkmenoǧlu ON, Tuncer C, Colak I, Aydin Y. A long-term follow-up study of anterior tibial allografting and instrumentation in the management of thoracolumbar tuberculous spondylitis. J Neurosurg Spine 2008;8:30-8.
113. Ozdemir HM, Us AK, Oǧiin T. The role of anterior spinal instrumentation and allograft fibula for the treatment of pott disease. Spine (Phila Pa 1976) 2003;28:474-9.
114. Zhang HQ, Guo CF, Xiao XG, Long WR, Deng ZS, Chen J. One-stage surgical management for multilevel tuberculous spondylitis of the upper thoracic region by anterior decompression, strut autografting, posterior instrumentation, and fusion. J Spinal Disord Tech 2007;20:263-7.
115. Park DW, Sohn JW, Kim EH, et al. Outcome and management of spinal tuberculosis according to the severity of disease: a retrospective study of 137 adult patients at Korean teaching hospitals. Spine (Phila Pa 1976) 2007;32:E130-5.