Spinal Tuberculosis

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Tuberculosis is a deadly disease affecting many people in the world. The prevalence of spinal tuberculosis is likely to increase as the number of those infected with human immunodeficiency virus (HIV) rises. This presentation summarizes the current knowledge of spinal tuberculosis and its management. It describes and updates the material the author has previously published on this subject.

The scientific basis for the clinical management of spinal tuberculosis has been well established by the British Medical Research Council group and a group of University of Hong Kong surgeons. The Hong Kong group, while working at Duchess of Kent Children's Hospital at Sandy Bay in the 1960s, pioneered a breakthrough anterior approach that became known across the world as the “Hong Kong Operation”.

It is believed, however, that well-controlled basic and clinical studies are required if the incidence of the three unwanted complications of spinal tuberculosis is to be reduced further. Antituberculosis agents are the mainstay of management, with chemotherapy for 12 months preferred to shorter courses. The standard is a combination of isoniazid, rifampin, and pyrazinamide, with or without ethambutol.

Anterior surgery consisting of radical focal debridement without fusion does not prevent vertebral collapse. The major advantage of anterior arthrodesis is the reduced tendency for the deformity's progression. Patients whose deformity show up late in their lives are candidates for anterior debridement and stabilization with corrective instrumentation.

Posterior stabilization with instrumentation has been found to help arrest the disease and to bring about early fusion. Posterior instrumented stabilization to prevent kyphosis in early spinal tuberculosis is indicated, however, only when anterior and posterior elements of the spine are involved, particularly in children. With early detection, the use of chemotherapy and improved surgical techniques, patients with kyphosis are rarely seen today, particularly in urban centers that have an effective medical system.

For the same reasons, patients with spinal tuberculosis who have paraplegia and no deformity usually respond well to treatment. It is concluded that spinal tuberculosis without unsightly kyphosis and neurologic symptoms is a medical, rather than a surgical, condition. Surgery should be reserved for those patients who have advanced tuberculosis with unacceptable complications such as paraplegia and/or deformity. Citing: Moon-Kim's Institute of Orthopaedic Research, Seoul, Korea.