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Tuberculous spondylitis
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Tuberculous spondylitis

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Contributors: Neil Mendoza MD, Paritosh Prasad MD
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Synopsis

Tuberculous spondylitis, also known as skeletal tuberculosis or Pott disease, refers to infection of the spine due to Mycobacterium tuberculosis.

Infection of the spine may result from lymphatic spread in patients with pleural disease. Alternately, infection may be due to contiguous spread or hematogenous seeding.

Magnetic resonance imaging will reveal extensive destruction of vertebral bodies. Typically, destruction begins at the anterior aspect of the vertebral body, resulting in the classic imaging appearance of anterior "wedging" of adjacent vertebral bodies. Imaging may also reveal a paraspinal abscess, which occurs commonly.

In developing countries, most patients are children or young adults. In the United States, most patients with this infection are older adults.

For most of the course of infection, patients have minimal symptoms and may complain only of back pain. As the infection progresses and destruction of the vertebral bodies advances, patients may present with weakness of the lower extremities. Paraspinal abscesses are common, and a draining sinus may be identified on physical exam. In a recent review of cases from a hospital in India, typical symptoms were described as back pain with a localized deformity in the back. There was associated malaise, loss of weight, loss of appetite, night sweats, and fever. About 19% had evidence of pulmonary tuberculosis.

Treatment is with a combination of anti-tuberculosis antibiotics. Patients with more advanced disease with neurologic compromise may require surgery.

Codes

ICD10CM:
A18.01 – Tuberculosis of spine

SNOMEDCT:
35984006 – Tuberculosis of vertebral column

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Diagnostic Pearls

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Differential Diagnosis & Pitfalls

  • Other infectious causes of vertebral osteomyelitis – blood cultures, serology, or culture of the spinal lesion can usually be used to identify the pathogen
  • Malignancy – bone should be sent for pathology
  • Vertebral body compression fracture – may present as acute back pain

Best Tests

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Management Pearls

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Therapy

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References

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Last Updated: 10/26/2016
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Tuberculous spondylitis
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Tuberculous spondylitis : Fever, Low back pain, Muscle spasm, Weight loss
Copyright © 2019 VisualDx®. All rights reserved.