AKA
- Tuberculous spondylitis,
- Pott’s disease.
Location
- Lower thoracic and upper lumbar levels.
- Has a predilection for the vertebral body, sparing the posterior elements.
- Psoas abscess is common (the psoas major muscle attaches to the bodies and intervertebral discs from T12–5).
Investigation
- Radiology
- Sclerosis of the involved vertebral body may occur.
- Definitive diagnosis
- Identification of acid-fast bacilli on culture or Gram stain of biopsy material (may be done percutaneously).
Clinical features
- Typically symptomatic for many months.
- Usually affects more than one level.
- Neurologic deficit
- In 10–47% of patients,
- Due to
- Medullary and radicular artery inflammation in most cases.
- Neuronal Compression from
- Epidural granulation tissue or fibrosis
- Kyphotic bony deformity
- The infection itself rarely extends into the spinal canal;
Management
- Antibiotics
- Surgery
- The role of surgical debridement and fusion with TB is controversial, and good results may be obtained with either medical treatment or surgery.
- Surgery may be more appropriate when definite cord compression is documented or for complications such as abscess or sinus formation or spinal instability.
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