Inês Esteves Cruz1*, Pedro Ferreira2, Sara Brandão Machado1, João Mourato Torres1, Cláudia Miranda1 and Isabel Antunes1
1Hospital de Egas Moniz, Centro Hospitalar de Lisboa Ocidental, Portugal 2Hospital de Santa Maria, Centro Hospitalar Lisboa Norte, PortugalFulltext PDF
Spinal tuberculosis, a presentation of extrapulmonary tuberculosis, usually presents with chronic back pain or deformity. The diagnosis is often delayed due to the insidious and nonspecific nature of the initial symptoms. The thoracic spine is more commonly affected, but it can affect other segments or be multisegmental. The site and extent of the lesion will determine the resulting neurological deficits which can lead to significant morbidity and functional impairment. Combination chemotherapy for 6 months is recommended, but some experts may recommend therapy for 9 to 12 months depending on the circumstances. Adjunct corticotherapy and surgery are also options in specific cases. Further studies will be needed in order to better understand the role of these therapies in severe tuberculosis, and in particular spinal tuberculosis. Learning Points • Neurologic abnormalities appear in 10% to 27% of cases and can be associated with significant morbidity and functional impairment. • Expert opinion supports the extension of combined chemotherapy for 9 to 12 months in selected cases. • Extended combined chemotherapy and adjunct corticotherapy might be considered in spinal tuberculosis with evidence of cord compression and severe neurological compromise. • Patients with severe neurological impairment due to tuberculous spondylitis may have a good prognosis.
Tuberculosis; Spinal tuberculosis; Spinal cord compression; Paraplegia; Corticosteroid therapy; Mycobacterium tuberculosis
Cruz IE, Ferreira P, Machado SB, Torres JM, Miranda C, Antunes I. Spinal Tuberculosis - Treatment Options Beyond Guidelines. Ann Clin Case Rep. 2019; 4: 1776..