Noncontiguous spinal tuberculosis: incidence and management
- 9 April 2009
- journal article
- Published by Springer Science and Business Media LLC in European Spine Journal
- Vol. 18 (8), 1096-1101
- https://doi.org/10.1007/s00586-009-0966-0
Abstract
Tuberculosis (TB) has a worthy reputation as one of the great mimickers in medicine with a multitude of clinical pictures and variations. Noncontiguous spinal TB is described as atypical and case reports are published as rarities in the mainstream academic journals. The aim of the study was to asses the incidence and review of the management of non-contiguous spinal TB. We identified 16 cases of noncontiguous spinal TB from a single surgeon series of 98 patients, who were managed surgically between 2001 and 2006. These were diagnosed on whole spine MRI. This represents the largest series reported in literature to date and is higher than the expected incidence. Case notes and imaging were retrospectively reviewed in an attempt to ascertain if there were any parameters to differentiate this group from the rest of the TB spine population. Our incidence of noncontiguous spinal TB is 16.3%. There was a higher incidence of neurology in the noncontiguous group (75%) compared to the rest of our group (58.5%). Non-contiguous TB was not found to be a manifestation of HIV, MDR TB or of chronicity in our series. Most noncontiguous lesions were evident on plain radiology. Noncontiguous spinal TB is common in areas of high prevalence such as South Africa. Despite being frequently missed initially, noncontiguous involvement is evident on plain radiography and simply requires a higher index of suspicion. When investigating spine TB patients, simple radiology of the entire spine is mandatory. If available, a full spine sagittal MRI is extremely useful in identifying noncontiguous lesions. Treatment of noncontiguous tuberculosis is as for standard spinal TB cases in our unit with similar outcomes, but care needs to be taken in surgical planning as patients may have multiple areas of neurological compromise.Keywords
This publication has 25 references indexed in Scilit:
- Non-contiguous multifocal spinal tuberculosis involving cervical, thoracic, lumbar and sacral segments: a case reportEuropean Spine Journal, 2006
- Spectrum of Spine Infections in Patients with HIVClinical Orthopaedics and Related Research, 2006
- Vertebral infectionEuropean Radiology Supplements, 2004
- Multifocal Pott’s Disease (Tuberculous Spondylitis) Incidentally Detected on Tc-99m MDP Bone and Ga-67 Citrate Scintigraphy in a Patient with DiabetesClinical Nuclear Medicine, 2003
- Spinal TuberculosisClinical Orthopaedics and Related Research, 2002
- Atypical Spinal TuberculosisClinical Orthopaedics and Related Research, 2002
- Bone scintigraphy in tuberculous spondylodiscitisEuropean Spine Journal, 1999
- Multifocal skeletal tuberculosisNuclear Medicine Communications, 1996
- Imaging of TuberculosisActa Radiologica, 1996
- Anterior spinal fusion a preliminary communication on the radical treatment of pott's disease and pott's paraplegiaBritish Journal of Surgery, 1956