Tuberculosis of the spine

Area of Science:

• Orthopedics
• Infectious Diseases
• Neurosurgery

Background:

• Spinal tuberculosis (Pott's disease) treatment traditionally involved surgery for diagnosis and debridement.
• Chemotherapy alone has shown efficacy in resolving infection and abscesses, challenging the necessity of surgery.
• Advances in imaging and surgical techniques offer new possibilities for managing complex spinal tuberculosis cases.

Purpose of the Study:

• To review the current treatment paradigms for spinal tuberculosis.
• To evaluate the evolving role of chemotherapy versus surgery.
• To identify indications for surgical intervention in spinal tuberculosis.

Main Methods:

• Review of current literature on spinal tuberculosis treatment.
• Analysis of diagnostic advancements, including modern imaging.
• Evaluation of surgical techniques and outcomes.

Main Results:

• Chemotherapy is the mainstay, with advanced biopsy techniques reducing the need for surgical diagnosis.
• Chemotherapy alone can resolve infection and most abscesses, and may improve some neurological deficits.
• Modern imaging aids precise diagnosis of neural compression and bony involvement.
• Anterior surgical techniques are safer for decompression and reconstruction in experienced hands.
• Identification of lesions prone to kyphosis is improved.
• Instrumentation use in active disease shows promise but lacks extensive data.

Conclusions:

• Chemotherapy is the cornerstone of spinal tuberculosis treatment.
• Surgery is increasingly reserved for specific indications, with improved diagnostic and surgical techniques.
• Accurate diagnosis remains paramount before initiating any treatment for spinal tuberculosis.