What are the symptoms of cervical tuberculosis (TB) spondylitis?

Symptoms of Cervical Tuberculosis Spondylitis

Cervical TB spondylitis presents most commonly with progressive neck pain and stiffness as the dominant symptoms, often accompanied by constitutional symptoms such as fever and weight loss, with a high risk (42.5%) of developing neurological deficits including cord compression and paralysis if left untreated. 1, 2, 3

Primary Clinical Presentation

Cardinal Symptoms

• Neck pain is the most consistent and dominant presenting symptom, typically progressive over weeks to months with an insidious onset 1, 4, 5, 2, 3
• Neck stiffness and reduced range of motion are important early findings that accompany the pain 4, 2, 3
• The onset is characteristically insidious with slow development, which frequently causes diagnostic delays 5

Constitutional "Red Flag" Symptoms

• Fever and night sweats may be present as systemic manifestations of tuberculosis infection 6
• Unexplained weight loss is a critical constitutional symptom that should raise suspicion for TB spondylitis 6
• These constitutional symptoms, when combined with neck pain, represent critical "red flags" requiring immediate imaging evaluation 6

Neurological Manifestations

Spinal Cord Compression

• Cord compression occurs in 42.5% of cases overall, with a much higher incidence (81% or 13 of 16 patients) in the "adult type" disease pattern affecting patients over 10 years old 3
• Progressive weakness or tetraparesis can develop, as demonstrated in cases where patients progress from normal function to severe motor deficits (2/5 strength) over weeks 1
• Paralysis (Pott's paraplegia) is a devastating complication that occurs when epidural abscesses or vertebral collapse compress the spinal cord 2, 3

Radicular Symptoms

• Nerve root compression may produce radiating pain, numbness, or weakness in the upper extremities depending on the level of involvement 1, 5

Age-Related Presentation Patterns

Pediatric Pattern (Under 10 Years)

• Kyphotic deformity is a prominent presenting feature in all children with cervical TB spondylitis 2
• Disease is typically extensive and diffuse with large prevertebral abscess formation 2
• Multiple vertebral levels are commonly involved 5

Adult Pattern (Over 10 Years)

• Disease is more localized to one or two motion segments 2
• Much higher incidence of cord compression (81%) compared to children 3
• Less pus formation but more focal destructive vertebral lesions 2

Physical Examination Findings

Structural Deformities

• Visible or palpable kyphotic deformity of the cervical spine, particularly in children 2
• Vertebral body tenderness on palpation is a red flag for infection or malignancy 6, 7

Neurological Deficits

• Motor weakness in upper and/or lower extremities, ranging from subtle weakness to complete paralysis 1, 3
• Sensory changes in dermatomal distributions 1
• Gait disturbance if lower extremity involvement is present 7

Associated Findings

Respiratory Symptoms

• Compressive respiratory symptoms can occur due to large prevertebral abscesses in the cervical region 3

Laboratory Abnormalities

• Elevated inflammatory markers including ESR, CRP, and WBC count are common red flags requiring urgent evaluation 6

Critical Diagnostic Pitfalls

Delayed Diagnosis

• The insidious onset with nonspecific symptoms and slow development of radiographic abnormalities frequently causes diagnostic delays 5
• Cervical TB spondylitis must be included in the differential diagnosis of any patient with persistent neck pain, especially with constitutional symptoms or risk factors (immunosuppression, IV drug use, endemic exposure) 6, 5

High-Risk Populations

• Immunocompromised patients and those with history of IV drug use are at increased risk and require heightened suspicion 6
• Patients from TB-endemic regions or with known pulmonary TB should be evaluated for extrapulmonary spread 4

Imaging Urgency

MRI is the main imaging modality and must be obtained immediately when cervical TB spondylitis is suspected, as it demonstrates osteitis, intraosseous abscesses, paravertebral and epidural soft tissue extensions, discitis, multilevel involvement, and spinal cord or nerve root compression 6, 5. Early diagnosis through MRI and prompt initiation of antituberculous chemotherapy enables satisfactory outcomes and prevents irreversible neurological damage 1, 5, 3.