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.
A18.01 – Tuberculosis of spine
35984006 – Tuberculosis of vertebral column
Differential Diagnosis & Pitfalls