Spinal Tuberculosis



Most common site for skeletal TB

- usually haematogenous spread

- can be direct from lung


3 patterns


1.  Peridiscal (50%) - originating in metaphyseal region

2.  Central - high incidence of vertebral collapse

3.  Anterior - instability less common with less bony destruction




Affects multiple contiguous vertebrae

- starts anterior 1/3 vert body

- doesn't stay within body

- spreads along fascial planes

- spreads under ALL


More likely to produce kyphosis


Disc sequestered rather than destroyed


Posterior elements frequently involved unlike pyogenic




Short kyphotic deformity

- known as Gibbus Deformity




May be mistaken for neoplasia


Similar Xray appearance 

- brucellosis, hydatid disease

- fungus (aspergillosis / Cryptococcus / candidiasis)




Age influences risk of paralysis


Cervical in patient younger than 10 years

- 17% risk of cord injury


Cervical in patient older than 10 years 

- up to 81% risk of paralysis




Non operative


British Medical Research Council

- 77% settled with drug treatment alone

- no patients with neurology / paralysis

- drug treatment for 12/12

- spontaneous fusion can be expected




Indications for Surgery


1.  Deformity

- kyphosis

- >50% verterbral body destruction


2.  Neurology


3.  Biopsy


4.  Failure nonoperative treatment




Hong Kong Procedure

- debridement of infected bone

- decompression of spinal canal

- correction of kyphotic deformity using structure grafting

- instrumentation