Tuberculous spondylodiscitis: epidemiology, clinical features, treatment, and outcome

Abstract BACKGROUND: Tuberculous spondylodiscitis (TS) is a rare but serious clinical condition which may lead to severe deformity and early or late neurological complications. AIM: To discuss certain aspects of the approach to TSs, focusing upon epidemiology, diagnosis, and treatment outcome. MATERIALS AND METHODS: For the purpose of this review, a literature search was performed using the Pubmed database through to 19th October 2011 to identify studies published in the last 20 years, concerned in epidemiological, clinical, diagnostic, and therapeutical aspects of TS in adults. Only studies drafted in English language and reporting case series of more than 20 patients have been included. RESULTS: TS has been reported to accounts for 1-5% of all TB cases, and for about 50% of the cases of articulo-skeletal TB infections. Despite the actual availability of more effective diagnostic tools, early recognition of TS remains difficult and a high index of suspicion is needed due to the chronic nature of the disease and its insidious and variable clinical presentation. A prompt diagnosis is required to improve long term outcome, and a microbiological confirmation is recommended to enable appropriate choice of anti-mycobacterial agents. Surgery has an important role in alleviating pain, correcting deformities and neurological impairment, and restoring function. CONCLUSIONS: Further studies are required to assess the appropriate duration of anti-microbial treatment, also in regarding of a combined surgical approach.