Spinal tuberculosis : 12 years experience at a Tunisian center

Résumé

Background: We aimed to describe clinical, laboratory, diagnostic and therapeutic features of spinal tuberculosis and to identify factors associated with unfavorable evolution.

Methods: Diagnosis was based on microbiological evidence, and/or histopathological evidence of tuberculosis infection, or clinical and paraclinical data.

Results: A total of 49 patients (26 females) were enrolled. The mean age of the sample was 51.84 years, and the mean duration from initial symptoms to the time of diagnosis was 6.65 months. A predisposing factor to infection was noted in 38.7% of patients. Lumbar vertebrae (67.3%) were the most commonly involved site of infection. Spinal tuberculosis was associated with 3 cases of peripheral arthritis and 13 cases of visceral involvement (seven pulmonary tuberculosis). Diagnosis was based on histopathological evidence in 9 cases. Computed tomography-guided percutaneous biopsy was performed in 36 patients, and was consistent with tuberculosis in 6/36 cases. Medical treatment alone was implemented in all patients, while 8 patients underwent interventional treatment. The mean duration of medical treatment was 13.59 months. The outcome was favorable in 84.2% of cases, without neurological sequelae. Presence of abscess, vertebral fracture on magnetic resonance imaging, initial blood cells counts ≥11.500/mm³ and spinal deformity were the predictors of unfavorable outcome.

Conclusion: Spinal tuberculosis results in significant morbidity due to its insidious course and delayed diagnosis because of diagnostic and therapeutic challenges. Early establishment of definitive etiologic diagnosis and appropriate treatment is of paramount importance to prevent development of sequelae.