Spinal tuberculosis: a report of five cases and a review

Spinal tuberculosis (TB) is an uncommon occurrence in developed countries. We present five cases of spinal TB illustrating some of the problems that can be encountered in clinical practice. Delay in diagnosis due to physicians unawareness of TB as a diagnostic possibility in patients with persistent back pain was observed in two patients. A high clinical index of suspicion is, therefore, needed for diagnosis. Tuberculin skin testing was positive in four patients. Computed tomography (CT) has become the examination of choice. It allows precise location of lesions and their extension to paraspinal soft tissue. Furthermore, abscess aspiration and biopsy specimens can be obtained under CT guidance. Magnetic resonance imaging in patients with neurological involvement may provide better information than CT. Definitive diagnosis depending on histological examination, smear and culture of biopsy material, however, may be difficult to obtain. In three patients, diagnosis was based on clinical presentation and response to therapy. Antituberculosis chemotherapy was highly effective in curing all patients. Management of patients should be ensured by experts in antituberculosis chemotherapy, usually chest physicians.