Epidemiology and clinical management of spinal tuberculosis (TB) at a south-east London hospital

Background: Spinal TB presents a challenging diagnosis with potentially devastating outcomes. NICE guidelines [CG117] suggest 6 months of treatment (12 months if cord compression) but data on spinal TB in UK is limited. Aim: To review the epidemiology + clinical management of Spinal TB at Queen Elizabeth Hospital, London. Methods: A retrospective study was performed on spinal TB patients from 2008-2012. Results: 34 patients, mean age 43 years, 22(65%) male. All patients had back pain; 24 (71%) had focal neurology; 15(44%) had constitutional symptoms (fevers + weight loss). On average patients had symptoms for 8.3 months prior to diagnosis. Sites affected: 22(65%) thoracic, 16(47%) lumbar and 4(12%) cervical spine. Commonest MRI abnormalities: 28(82%) Para-vertebral abscesses, 21(62%) vertebral body collapse, 15(44%) epidural abscesses, 13(38%) cord compression. Diagnostic sampling (image guided/surgical) was performed in 29 patients. 10/29 (34%) were smear +ve and 20/29 (69%) were culture +ve; 10/17(59%) histology was +ve for Granulomas. Average treatment duration was 11.9 months. 16 (47%) required steroid therapy in addition to anti-TB medications; 6 (19%) required surgery. Average time for improvement on imaging (MRI/CT scan) was 9.7 months. 29 patients (97%) improved clinically with TB treatment, 12 (36%) had ongoing symptoms post treatment and 6 (18%) remained with disability. Conclusions: Despite diagnostic delay, good diagnostic samples can be obtained with appropriate imaging. Treatment duration (+ time to resolution on MRI scans) was longer than NICE recommends. There continues to be long-term disability and clinicians should be more alert to spinal TB presentation.