Angular kyphosis as an indicator of the prevalence of Pott's disease in Transkei

To understand better the prevalence, distribution and major causes of sagittal spinal deformity in a rural homeland, the authors conducted a study of angular kyphosis in the spines of 2,329 Transkei patients. Thirty-one (1.33%) had angular kyphosis. Lateral chest radiographs were obtained from 22 of these patients. Radiographic kyphotic angles ranged from 28 degrees to 130 degrees (mean: 70.3 +/- 7.6). The vast majority (81%) demonstrated classical clinical and/or radiographic findings of tuberculous aetiology. Less frequent aetiologies included fractures (2), osteoporosis (1), congenital malformation (1) and kyphosis of unknown origin (2). Eleven of the kyphotic patients were seeking care for unrelated problems and were asymptomatic in respect of their kyphoses. As a subset, the asymptomatic individuals demonstrated a similar aetiological distribution, with 73% strongly suggestive of tuberculous aetiology. The prevalence of asymptomatic angular kyphosis in this unselected Transkei patient population was 0.47% +/- 0.14%. In this hospital-based study, angular kyphosis proved a valuable marker for spinal tuberculosis. Because tuberculous spondylitis is more successfully treated when detected early, spinal palpation should be included in the routine physical examination of patients or populations at risk for tuberculosis.