Spinal tuberculosis is one of the oldest diseases known to mankind. It has been found in Egyptian mummies dating back to 3400 BC. The disease is popularly known as Pott’s spine. This name traces back its origin to the description of Spinal tuberculosis by Sir Percival Pott in his monograph in 1779. The exact incidence and prevalence of Spinal tuberculosis in most parts of the world are not known. In countries with a high burden of pulmonary tuberculosis, the incidence is expected to be proportionately high. One out of ten patients with extrapulmonary tuberculosis have skeletal involvement. Spine is the most common skeletal site affected, followed by the hip and knee.

Case study

A 30 year old male worker started complaining of fever for the past 3 months. The fever was low grade, more in the evenings and associated with loss of appetite and feeling of being unwell. One month prior to admisssion, he started complaining of mid-dorsal pain which was aggravated by the slightest of spinal movements and progressively worsened over time. He complained of progressive weakness of both lower limbs two weeks after onset of mid-dorsal pain with urinary symptoms in the form of hesitency and precipitancy. Examination confirmed Spastic paraparesis Grade 3/5 with a transverse sensory level involving all modalities at D8 level. An MR imaging of Dorsolumbar spine was requested.

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Plain X-rays confirmed the destruction of the involved intervertebral disc at D8-9 with focal kyphosis.

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Magnetic Resonance imaging (Sagittal T1W, T2W and Coronal T2W) demonstrates involvement of the vertebral bodies on either side of the disk, disk destruction, cold abscess, vertebral collapse, and presence of vertebral column deformity.

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He was operated by the posterior approach to correct the kyphotic deformity and drain the extradural abscess by the transpedicular approach. He was started on antitubercular drugs and Steroids. He recovered over weeks with resolution of pain and was ambulatory without support with 2 weeks.

Spinal tuberculosis is a destructive form of tuberculosis. It accounts for 50% of all cases of skeletal tuberculosis. It is more common in children and young adults. Its incidence is increasing in developed nations. Genetic susceptibility to spinal tuberculosis has recently been demonstrated. Characteristically, there is destruction of the intervertebral disc space and the adjacent vertebral bodies, collapse of the spinal elements, and anterior wedging leading to kyphosis (a form of spinal deformity)  and gibbus (acute angulation like a ‘knuckle’ at the affected site) formation. The thoracic region of vertebral column is most frequently affected. Formation of a ‘cold’ abscess around the lesion is another characteristic feature. The incidence of multi-level noncontiguous vertebral tuberculosis occurs more frequently than previously recognized with Magnetic Resonance Imaging.

Common clinical manifestations include constitutional symptoms (fever, weight loss, loss of appetite), back pain, spinal tenderness, paraplegia and spinal deformities. For the diagnosis of Spinal tuberculosis Magnetic Resonance imaging is more sensitive imaging technique than X-ray and more specific than Computed Tomography. Magnetic Resonance imaging frequently demonstrates involvement of the vertebral bodies on either side of the disk, disk destruction, cold abscess, vertebral collapse, and presence of vertebral column deformities. Neuroimaging-guided needle biopsy from the affected site in the center of the vertebral body is the gold standard technique for early histopathological diagnosis.

Antituberculous treatment remains the cornerstone of treatment. Surgery may be required in selected cases, e.g. large abscess formation, severe kyphosis, an evolving neurological deficit, or lack of response to medical treatment. With early diagnosis and early treatment, prognosis is generally good.