Case of an Immigrant Child with Back Pain Due to Tuberculosis

We present the case of an immigrant child with back pain due to spinal tuberculosis. Nearly one third of the human population is infected with tuberculosis. Of those with active disease, approximately 10% are impacted by spinal tuberculosis. Though traditionally a disease of the developing world and susceptible populations, with the rise of immigration patients may present in developed countries. The microbe responsible is the mycobacterium tuberculosis complex bacillus. The infection begins in the anterior vertebral bodies. The natural history and presentation are notable for “cold” abscesses causing mass effect, early or late neurological deficit, and kyphotic deformity of the spine due to anterior vertebral body destruction. The disease can be diagnosed with laboratory studies or characteristic imaging findings, but tissue diagnosis with cultures, histology, and a real-time polymerase chain reaction (PCR) is the gold standard. The cornerstone of medical management is multidrug chemotherapy to minimize relapse or resistance and can be curative for patients with spinal tuberculosis without associated spinal deformity. Surgical management is reserved for patients presenting with neurological deficits or severe kyphosis. The pillars of surgical management are debridement, correction of deformity, and stable fusion. Modern outcomes of the treatment of spinal tuberculosis are overall excellent.