Guidelines and current evidence in medical therapy of spinal tuberculosis-Comprehensive review

Volume 16 | Issue 1 | January-March 2021 | Page 17-23 | Munjal Shah, Harshal Bamb, Abhay Nene

Authers: Munjal Shah [1], Harshal Bamb [2], Abhay Nene [3]

[1] Department of Spine, Aims Hospital, Ahmedabad.
[2] Department of Spine, Global Hospital, Mumbai.
[3] Department of Spine, Lilavati Hospital and Research Centre, Mumbai.

Address of Correspondence
Dr. Munjal Shah,
Plot No. 1322/A/2,
Sector 7-D, Gandhi Nagar, Gujarat.


Tuberculosis is a major health problem in developing countries, and India is considered endemic for the disease. Tuberculosis of the spine is one of the most common extrapulmonary manifestations.The management of spinal tuberculosis has come to a full circle. It has evolved drastically from an era of conservative treatment due to lack of good surgical techniques to an era of aggressive surgery with anterior reconstructions and now to conservative treatment with better availability of diagnostic methods and understanding of pharmacology of drugs. Despite the widespread availability of anti-tubercular drugs, the global incidence and prevalence of tuberculosis continues to rise. This has been attributed to different factors like MDR-TB, and difficulty in diagnosis of tuberculosis. Spinal tuberculosis is essentially a medical disease . Successful outcome of spinal tuberculosis relies upon appropriate diagnosis and proper dosage of drugs.
Keywords: Spinal tuberculosis, medical disease, diagnosis,conservative treatment.


1. Chauhan A, BB G. Spinal Tuberculosis. Indian Academy of Clinical Medicine. 2007;8:110-4.
2. Rajasekaran S, Prasad Shetty A, Dheenadhayalan J, Shashidhar Reddy J, Naresh-Babu J, Kishen T. Morphological Changes During Growth in Healed Childhood Spinal Tuberculosis A 15-year Prospective Study of 61 Children Treated With Ambulatory Chemotherapy. Journal of Pediatric Orthopaedics. 2006;26(6):716-724.
3. Teo H, Peh W. Skeletal tuberculosis in children. Pediatr Radiol. 2004;34(11):853-860.
4. Kiran N, Vaishya S, Kale S, Sharma B, Mahapatra A. Surgical results in patients with tuberculosis of the spine and severe lower-extremity motor deficits: a retrospective study of 48 patients. Journal of Neurosurgery: Spine. 2007;6(4):320-326.
5. Jain A. Tuberculosis of the spine: A FRESH LOOK AT AN OLD DISEASE. Journal of Bone and Joint Surgery – British Volume. 2010;92-B(7):905-913.
6. Jain A, Dhammi I. Tuberculosis of the Spine. Clinical Orthopaedics and Related Research. 2007;460:39-4
7. Boachie-Adjei O J, Squillante R. Tuberculosis of the spine. Orthop Clin North Am. 1996;27(1):95-103.
8. Pun W, Chow S, Luk K, Cheng C, Hsu L, Leong J. . Tuberculosis of the lumbosacral junction.Long-term follow-up of 26 cases. J Bone Joint Surg Br. 1990;72(4):675–8.
9. Nussbaum E, Rockswold G, Bergman T, Erickson D, Seljeskog E. Spinal tuberculosis: a diagnostic and management challenge. Journal of Neurosurgery. 1995;83(2):243-247.
10. Tuli S. Tuberculosis of the skeletal system New Delhi: Jaypee Brothers Medical Publishers. 2010;4.
11. Jain AK. Tuberculosis of the spine: A fresh look at an old disease. J Bone Joint Surg Br 2010;92:905-13.
12. Le Page L, Feydy A, Rillardon al. Spinal tuberculosis: a longitudinal study with clinical,laboratory, and imaging outcomes. Semin arthritis Rheum 2006;36(2): 124-129
13. Azzam NI, Tammawy M. Tuberculous spondylitis in adults: diagnosis and treatment. Br J Neurosurg 1988;2(1):85-91
14. Thelander U, Larsson S.Quantitation of C-reactive protein and Erythrocyte sedimentation rate after spinal surgery. Spine 1992;17(4):400-404
15. Chew FS, Kline MJ. Diagnostic yield of CT-guided percutaneous aspiration procedures in suspected spontaneous infectious diskitis. Radiology 2001;218:211-4.
16. Fouquet B, Goupille P, Gobert F, Cotty P, Roulot B, Valat JP. Infectious discitis diagnostic contribution of laboratory tests and percutaneous discovertebral biopsy. Rev Rhum Engl Ed 1996;63:24-9.
17. Staatz G, Adam GB, Keulers P, Vorwerk D, Gunther RW. Spondylodiskitic abscesses: CT-guided percutaneous catheter drainage. Radiology 1998;208:363-7.
18, An HS, Seldomridge J. Spinal Infections. Clin Orthop Relat Res 2006;444:27-33.
19. Cottle L, Riordan T. Infectious spondylodiscitis. J Infect 2008;56:401-12.
20. Yadav RN, Singh BK, Sharma SK, Sharma R, Soneja M, Sreenivas V, et al. Comparative evaluation of GenoType MTBDRplus line probe assay with solid culture method in early diagnosis of multidrug-resistant tuberculosis (MDR-TB) at a tertiary care centre in India. PLoS One 2013;8:e72036.
21. Kim SJ. Drug-susceptibility testing in tuberculosis: Methods and reliability of results. Eur Respir J 2005;25:564-9.
22. Caminero JA; World Health Organization; American Thoracic Society; British Thoracic Society. Treatment of multidrug-resistant tuberculosis: Evidence and controversies. Int J Tuberc Lung Dis 2006;10:829-37.
23. Tuli SM. Tuberculosis of Spine: a historical review. Clin Orthop Relat Res 2007:460:29-38
24. Patil SS, Mohite S,Varma R Bhojraj SY, Nene AM. Non-surgical management of cord compression in tuberculosis, a series of surprises. Asian Spine J 2014;8(3):315-321
25. Bhojraj S, Nene A. Lumbar and lumbosacral tuberculous spondylodiscitis in adults. Redefining the indications for surgery. J Bone Joint Surg Br 2002;84:530-4
26. Rajasekeran s. Kyphotic deformity in spinal tuberculosis and its management. Int Orthop 2012;36(2):359-365
27. World Health organization. Treatment of tuberculosis: Guidelines for National Programmes. 4th ed. 2009
28. Jain AK, Srivastava A, et al. Efficacy of extended DOTS category 1 chgemotherapy in spinal tuberculosis based on MRI-based healed status. Indian J Orthop 2012;46(6)633-639
29. Singh R, Magu NK, Rohilla RK. Clinicoradiologic profile of involvement and healing in tuberculosis of the spine.Ann Med Health Sci Res 2016;6(5):311-327
30. Antonio RG, Silvana SE, Carme TO,et al. Imaging findings of Pott’s disease. Eur Spine J 2013;22(Suppl 4):567-578
31. Moon MS. Tuberculosis of the spine. Controversies and a new challenge. Spine 1997;22(15):1791-1797
32. Nene AM, Patil S, Kathare AP, Nagad P, Nene A, Kapadia F. Six vs Twelve Months of Anti-tubercular Therapy in Patients with biopsy proven Spinal Tuberculosis. A single Centre, open labelled, Prospective randomized clinical trial- A pilot study. Spine (Phila Pa 1976). 2018
33. Mohan K, Rawall S, Pawar UM, Sadani M, Nagad P, Nene AA, Nene AM. Drug resistance patterns in 111 cases of drug-resistant tuberculosis spine. Eur Spine J 2013;22(Suppl 4):647-652
34. Pawar UM, Kundnani V, Agashe V, Nene A, Nene A. Multidrug-Resistant Tuberculosis of the Spine—Is it the Beginning of the End? A Study of Twenty-Five Culture Proven Multidrug-Resistant Tuberculosis Spine Patients. Spine 2009;34:E806-10.

How to Cite this article: Shah M, Bamb H, Nene A. Guidelines and current evidence in medical therapy of spinal tuberculosis-Comprehensive review. Journal of Trauma and Orthopaedic Surgery January-March 2021;16(1): 17-23.

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