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Tuberculosis of the Spine: Experience in an Inner City Hospital

Schlesinger, Naomi MD*; Lardizabal, Alfred MD; Rao, Jayanti MD; Rao, Jyoti MD§; McDonald, Reynard MD

JCR: Journal of Clinical Rheumatology: February 2005 - Volume 11 - Issue 1 - p 17-20
doi: 10.1097/01.rhu.0000152144.91206.0c
Original Article

Background: It is estimated that 10 to 15 million people are infected with Mycobacterium tuberculosis in the United States. Spinal involvement is said to occur in less than 1%.

Methods: A review of the clinic records of all patients having a diagnosis of spinal tuberculosis at the New Jersey Medical School National Tuberculosis Center from January 1994 to January 1999 was done.

Results: Twelve patients with spinal TB were identified (2.2%). Spinal tuberculosis is characteristically chronic and slowly progressive. Presenting symptoms are usually back and neck pain or pain at the site of involvement. Pain was noted in a majority (83%) of our patients. Despite proven diagnoses by culture or histology, only 41% were purified protein derivative-positive. Unlike pulmonary tuberculosis, which may present with a constellation of symptoms, including cough, weight loss, fever, and night sweats, if tuberculosis only involves bone, pain may be the only symptom. Most patients were successfully treated with surgery and anti-TB medications. Tuberculosis remains a major public health problem.

Conclusions: Before the disease can be treated, it must be recognized. Tuberculosis should be considered a diagnostic possibility when spinal osteomyelitis is seen, even in the absence of pulmonary disease or HIV infection. Back pain in a patient with tuberculosis should be evaluated. Early initiation of an appropriate treatment regimen may reduce the need for surgical intervention, but most patients require surgery.

Spinal tuberculosis in 12 patients in New Jersey mainly presented with back pain. Fever was rare. Only 50% had pulmonary tuberculosis.

From the *Department of Medicine, Rheumatology Division, University of Medicine and Dentistry of New Jersey/Robert Wood Johnson University Hospital, New Brunswick, New Jersey; the †New Jersey Medical School National Tuberculosis Center, Department of Medicine, University of Medicine and Dentistry of New Jersey, Newark, New Jersey; the ‡Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts; and the §Department of Medicine, New York University, New York, New York.

Supported by grants from the CDC Tuberculosis Model Center (00-57-TB-S-2: Alfred Lardizabal, MD, and Reynard McDonald, MD) and NJDHSS 00-35-TB-S-2 (Reynard McDonald, MD).

Reprints: Naomi Schlesinger, MD, Department of Medicine, UMDNJ-Robert Wood Johnson Medical School, One Robert Wood Johnson Pl., P.O. Box 19, New Brunswick, NJ 08903-0019. E-mail:

© 2005 Lippincott Williams & Wilkins, Inc.