Leowattana W, Leowattana P, Leowattana T. Tuberculosis of the spine. World J Orthop 2023; 14(5): 275-293 [PMID: 37304201 DOI: 10.5312/wjo.v14.i5.275]
Corresponding Author of This Article
Wattana Leowattana, BMed, MD, MSc, PhD, Full Professor, Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, 420/6 Rajavithi Road, Tungphayathai, Rachatawee 10400, Bangkok, Thailand. wattana.leo@mahidol.ac.th
Research Domain of This Article
Infectious Diseases
Article-Type of This Article
Review
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This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Wattana Leowattana, Pathomthep Leowattana, Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, Rachatawee 10400, Bangkok, Thailand
Tawithep Leowattana, Department of Medicine, Faculty of Medicine, Srinakarinwirot University, Wattana 10110, Bangkok, Thailand
Author contributions: Leowattana W wrote the paper; Leowattana T and Leowattana P collected the data. Leowattana W, Leowattana T and Leowattana P contributed equally to this work; Leowattana W wrote the paper; Leowattana T and Leowattana P collected the data.
Conflict-of-interest statement: The authors declare no conflicts of interest related to this article.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Wattana Leowattana, BMed, MD, MSc, PhD, Full Professor, Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, 420/6 Rajavithi Road, Tungphayathai, Rachatawee 10400, Bangkok, Thailand. wattana.leo@mahidol.ac.th
Received: December 29, 2022 Peer-review started: December 29, 2022 First decision: February 20, 2023 Revised: February 24, 2023 Accepted: April 12, 2023 Article in press: April 12, 2023 Published online: May 18, 2023 Processing time: 140 Days and 10.3 Hours
Abstract
Pott's spine, commonly known as spinal tuberculosis (TB), is an extrapulmonary form of TB caused by Mycobacterium TB. Pott's paraplegia occurs when the spine is involved. Spinal TB is usually caused by the hematogenous spread of infection from a central focus, which can be in the lungs or another location. Spinal TB is distinguished by intervertebral disc involvement caused by the same segmental arterial supply, which can result in severe morbidity even after years of approved therapy. Neurological impairments and spine deformities are caused by progressive damage to the anterior vertebral body. The clinical, radiographic, microbiological, and histological data are used to make the diagnosis of spinal TB. In Pott's spine, combination multidrug antitubercular therapy is the basis of treatment. The recent appearance of multidrug-resistant/extremely drug-resistant TB and the growth of human immunodeficiency virus infection have presented significant challenges in the battle against TB infection. Patients who come with significant kyphosis or neurological impairments are the only ones who require surgical care. Debridement, fusion stabilization, and correction of spinal deformity are the cornerstones of surgical treatment. Clinical results for the treatment of spinal TB are generally quite good with adequate and prompt care.
Core Tip: Pott's spine is a type of spinal tuberculosis (TB) characterized by hematogenous dissemination of mycobacterium from a primary lesion. It accounts for roughly half of all skeletal TB patients. The most frequent type of spinal TB is para-discal TB. Untreated infections can result in consequences such as a cold abscess, paraplegia, and deformity, all of which may necessitate surgical intervention. Rapid molecular approaches have aided in the detection of spinal TB and drug resistance, but it remains difficult due to sample collection issues and the paucibacillary nature of spinal TB. The presence of human immunodeficiency virus, which is endemic in some areas, increases the burden and complexity of care. Moreover, the emergence of multidrug-resistant TB and extremely drug-resistant TB has posed a big challenge in the management.
