Treatise on Tuberculous Spondylitis

Abstract

This is a retrospective study of 32 patients suffering from tuberculous spondylitis (Pott's disease of the spine) admitted to Jos University Teaching Hospital from September 1995 to August 2000, there were 21 males and 11 females giving a male:'female ratio of l.9:l. The ages ranged from 9 years to 62 years with a mean age of 35.2 years. There was a preponderance of young adults. Back pain, paraparesis and evening pyrexh were the most frequently occurring clinical features. Twenty four (75.)%) patients had positive radiological findings. Of these, l8 (75.0%) had wedge collapse, (16.7%) had paraspinal shadows while 8 (33.3%) had loss of joint space. Lumbar region was predominantly affected in 12 patients, while the upper and lower thoracic regions were affected in three and seven patients respectively. Two cases of cervical affectation were encountered. Mantoux test was either negative or equivocal in 60.0% of result and positive in 40.0%. Erythrocyte sedimentation rate (ESR) varied widely with 81.0% being equal or above 20mm/hour. Differential lymphocyte count of 40% and above was found in sixty-five percent of 20 patients. All patients had treatment with standard antituberculous combination of drugs with addition of second generation antibtuberculous drugs in eight patients. Additional treatment with vitamin B-Complex, analgesics, nutritional support and physiotherapy was offered to all patients. Spinal jacked was used for stabilization in eight patients while one patient had sequestrectomy through a posterior approach. Complete recovery was recorded in 56.3% of patients. Two patients relapsed after initial cure, while five mortalities (15.6%) were recorded. Tuberculous spondylitis is found to be a major surgical problem. In the absence of invasive test in our centre, no single ancillary test could be wholly relied upon for diagnosis. A high index of suspicion and integration of both clinical and radiological features in addition to laboratory findings and occasionally therapeutic trial may be required.