The dismal outcome of
tuberculosis of the spine in the pre-
antibiotic era has improved significantly because of the use of potent
antitubercular drugs, modern diagnostic
aids and advances in surgical management. MRI allows the diagnosis of a tuberculous lesion, with a sensitivity of 100% and specificity of 88%, well before
deformity develops. Neurological deficit and
deformity are the worst complications of
spinal tuberculosis. Patients treated conservatively show an increase in
deformity of about 15 degrees . In children, a
kyphosis continues to increase with growth even after the lesion has healed.
Tuberculosis of the spine is a medical disease which is not primarily treated surgically, but operation is required to prevent and treat the complications. Panvertebral lesions, therapeutically refractory disease, severe
kyphosis, a developing neurological deficit, lack of improvement or deterioration are indications for surgery. Patients who present with a
kyphosis of 60 degrees or more, or one which is likely to progress, require anterior
decompression, posterior shortening, posterior instrumented stabilisation and anterior and posterior
bone grafting in the active stage of the disease. Late-onset
paraplegia is best prevented rather than treated. The awareness and suspicion of an atypical presentation of
spinal tuberculosis should be high in order to obtain a good outcome. Therapeutically refractory cases of
tuberculosis of the spine are increasing in association with the presence of HIV and
multidrug-resistant tuberculosis.