From the Guidelines
Tuberculosis (TB) of the spine typically does not involve disc sparing, as it characteristically involves destruction of the intervertebral discs along with adjacent vertebral bodies. The infection usually begins in the anterior part of the vertebral body near the endplate and spreads to involve the adjacent disc and neighboring vertebrae. This pattern differs from pyogenic (bacterial) spinal infections, which often start in the disc. In TB spine, the mycobacteria release enzymes that degrade the disc proteoglycans, leading to disc destruction. As the disease progresses, vertebral collapse can occur, potentially resulting in spinal deformity (kyphosis or gibbus deformity). The thoracic and thoracolumbar regions are most commonly affected.
According to the 2015 Infectious Diseases Society of America (IDSA) clinical practice guidelines for the diagnosis and treatment of native vertebral osteomyelitis in adults 1, MRI is the first diagnostic imaging of choice in patients with suspected native vertebral osteomyelitis (NVO), including TB spine. The guidelines also note that radiographic findings that should raise suspicion for Mycobacterium tuberculosis NVO infection include destruction of 2 or more contiguous vertebrae and their opposed endplates, spread along the anterior longitudinal ligament, and disc infection with or without a paraspinal mass or mixed soft tissue fluid collection.
Treatment typically involves a standard anti-tuberculosis regimen for 9-12 months, including isoniazid, rifampin, ethambutol, and pyrazinamide for the first 2 months, followed by isoniazid and rifampin for the continuation phase, as recommended by the American Thoracic Society/Centers for Disease Control and Prevention/Infectious Diseases Society of America 1. Surgical intervention may be necessary for cases with significant neurological deficits, spinal instability, or deformity.
Key points to consider in the management of TB spine include:
- Early diagnosis and treatment to prevent long-term sequelae
- Use of MRI as the first diagnostic imaging of choice
- Standard anti-tuberculosis regimen for 9-12 months
- Potential need for surgical intervention in cases with significant neurological deficits, spinal instability, or deformity
- Importance of monitoring for treatment response and potential complications, such as spinal deformity or neurological deficits.
From the Research
TB Spine Disc Involvement
- The provided studies do not directly address whether TB spine typically involves disc sparing or not 2, 3, 4, 5, 6.
- However, spinal tuberculosis often affects the vertebral bodies and discs, leading to destruction and deformation of the spine 2.
- The disease can cause abscess formation, bone destruction, and deformity, but the specific involvement of discs is not explicitly mentioned as being spared or not in the provided studies 2, 3, 4, 5, 6.
Treatment and Management
- The management of spinal tuberculosis typically involves a combination of chemotherapy and surgery, with the goal of reducing the incidence of complications such as vertebral collapse and deformity 2, 4.
- Chemotherapy regimens often include isoniazid, rifampin, and pyrazinamide, with or without ethambutol, and the duration of treatment can vary from 6 months to over a year 2, 3.
- Surgery may be necessary to stabilize the spine, prevent further deformity, and relieve neurological symptoms, but the decision to operate depends on the individual case and the presence of complications 2, 4.
Drug Concentration and Penetration
- Studies have investigated the concentration of antituberculous drugs in the focus of spinal tuberculosis, with varying results 5, 6.
- The concentration of drugs such as isoniazid, rifampin, and pyrazinamide can vary greatly in different tissues of the spine, and the presence of a sclerotic wall around the focus can affect drug penetration 5, 6.
- The results of these studies can inform the development of effective chemotherapy regimens and surgical strategies for the treatment of spinal tuberculosis 5, 6.