Tuberculosis of the spine: a historical review

Almost all ancient civilizations described tuberculous bacilli in their old scripts, and these bacteria have been found in prehistoric skeletal remains. The clinical availability of specific antitubercular drugs was the most important breakthrough in managing spinal tuberculosis. Any attempt at surgical excision of the disease prior to the antitubercular era met with serious complications, dissemination of disease and high mortality (nearly 50%). Antitubercular drugs markedly improved the results of management by operative treatment. Excellent healing of disease was also observed in those patients who were treated nonoperatively. However, it took many years (1950-1970) for clinicians to appreciate the efficacy of antitubercular drugs. Operations for spinal tuberculosis are now indicated less for control of disease (5-10% of all cases) than for complications, including nonresponding neural deficit (nearly 40% of neural complications), prevention or correction of severe kyphotic deformity, and for tissue diagnosis (approximately 5% of all cases). For a classic spondylodiscitis when surgery is required for débridement and decompression, an anterior approach through an extrapleural anterolateral route or through transpleural route is recommended. Healthy posterior elements should not be jeopardized by surgery. The real control of tuberculous disease requires a serious and sustained global effort to eliminate immunocompromised states, poverty, malnutrition, and overcrowding.