Tuberculosis is a deadly disease affecting many people in the world. The prevalence of
spinal tuberculosis is likely to rise as the numbers of those infected with human immunodeficiency virus rises. This presentation summarizes present knowledge of
spinal tuberculosis and its management. It describes and updates 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 Hong Kong surgeons. 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 decreased tendency for progression of the
deformity. Patients who present late with
deformity 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, institution of
chemotherapy, and improved surgical techniques, patients with
kyphosis rarely are seen today, particularly in urban centers that have an effective medical system. For these same reasons, patients with
spinal tuberculosis who present with
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.