Spinal Tuberculosis

Abstract

Tuberculous spondylitis is a spine infection associated with tuberculosis that is characterized by bone destruction, fracture, and collapse of the vertebrae, resulting in kyphotic deformity. The spinal canal can be narrowed by abscesses, granulation tissue, or direct dural invasion, leading to spinal cord compression and neurologic deficits. Spinal tuberculosis may be caused by hematogenous spread from well-established, extra-spinal foci, or from visceral lesions by direct extension. The goals of treatment are to eradicate the infection and prevent or treat neurologic deficits and spinal deformity. Mortality from tuberculous spondylitis has decreased dramatically with the introduction of effective chemotherapeutic agents, which play an integral role in the management of spinal tuberculosis. Currently used first-line drugs include isoniazid, rifampin, pyrazinamide, streptomycin, and ethambutol. Second-line agents that are used in special circumstances include ethionamide, cycloserine, kanamycin, capreomycin, prothionamide, and aminosalicylic acid. Surgery may be performed to drain abscesses, to débride sequestered bone and disk, to decompress the spinal cord, or to stabilize the spine for the prevention or correction of deformity.

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